The malignant potential of endometrial polyps

Ben-Arie, Alon; Goldchmit, Chen; Laviv, Yosef; Levy, Rivka; Caspi, B.; Huszar, Monica; Dgani, R.; Hagay, Zion

doi:10.1016/j.ejogrb.2004.02.002

Cited by 160 publications

(121 citation statements)

References 19 publications

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“…Sabri Cavkaytar 1 , Mahmut Kuntay Kokanali 1 *, Ufuk Ceran 1 , Hasan Onur Topcu 1 , Levent Sirvan 2 , Melike Doganay 1 endometrial polyps increases with age, particularly in the postmenopausal period (Ben-Arie et al, 2004;Ferrazzi et al, 2009;Costa-Paiva et al, 2011;Uglietti et al, 2014). And also, endometrial carcinoma is one of the most curable cancers as detected in early stages (Binesh et al, 2014).…”

Section: Roles Of Sonography and Hysteroscopy In The Detection Of Prementioning

confidence: 99%

Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

Cavkaytar

Kokanali²,

Ceran³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: To assess the role of sonographic endometrial thickness and hysteroscopic polyp size in predicting premalignant and malignant polyps in postmenopausal women. Materials and Methods: A total of 328 postmenopausal women with abnormal uterine bleeding and thickened endometrium underwent operative hysteroscopy due to detection of endometrial polyps were included in this retrospective study. Preoperative endometrial thickness measured by transvaginal ultrasonography and polyp size on hysteroscopy were noted. Hysteroscopic resection with histology was performed for endometrial polyps. Endometrial thickness and polyp size were evaluated on the basis of final diagnosis established by histologic examination. Receiver operator characteristic curves were calculated to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of endometrial thickness and polyp size for detecting pemalignant and malignant polyps. Results: Premalignant and malignant polyps were identified in 26 (7.9%) of cases. Sonographic measurement showed a greater endometrial thickness in cases of premalignant and malignant polyps when compared to benign polyps. On surgical hysteroscopy, premalignant and malignant polyps were also larger. Endometrial thickness demonstrated a sensitivity of 53.8%, specificity of 85.8%, PPV of 24.6% and NPV of 95.6% at a cut-off limit of 11.5 mm with diagnostic accuracy of 83.2%. Polyp size has a diagnostic accuracy of 94.8% with a sensitivity of 92.3%, specificity of 95.0%, PPV of 61.5% and NPV of 99.3% at a cut-off point of 19.5mm. Conclusions: Endometrial thickness measured by transvaginal ultrasonography is not sufficient in predicting premalignant and malignant endometrial polyps in postmenopausal women with abnormal uterine bleeding and thickened endometrium. Polyp size on hysteroscopy is a more accurate parameter, because of better sensitivity and specificity. However, while polyp size ≥19.5mm seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.

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Section: Roles Of Sonography and Hysteroscopy In The Detection Of Prementioning

confidence: 99%

Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

Cavkaytar

Kokanali²,

Ceran³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Some studies found malignancy arising from a polyp only in symptomatic menopausal women [8], whereas others found malignancy in premenopausal women and in asymptomatic postmenopausal women [9]. The polyps may be an incidental asymptomatic finding diagnosed during routine vaginal sonography or infertility investigations.…”

Section: Introductionmentioning

confidence: 98%

“…The presence of abnormal bleeding, during the perimenopause, was not found to be a risk factor for premalignancy or malignancy [8]. However, late menopause, obesity, arterial hypertension, and the use of tamoxifen therapy in women with breast cancer have been identified as risk factors [11].…”

Section: Introductionmentioning

confidence: 98%

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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Objective This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy. Methods One hundred and fifty women aged 29-52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome. Results Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p \ 0.001; OR 4.61; CI 1.9-27), polyp volume [10 ml (p \ 0.001; OR 5.83; CI 4.31-9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09-3.76). Notably, the odds ratio of polyp volume [10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women. Conclusion Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant 123 transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume B10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.

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“…Few studies have evaluated the relationship between the size of the polyp and the risk of malignancy [15][16][17]24,25 . In this study, a size of 30 mm showed the best sensitivity (47.8%) and specificity (66.1%) in predicting malignancy in endometrial polyps.…”

Section: Discussionmentioning

confidence: 99%

“…In a meta-analysis performed by Lee et al 9 , it was determined that malignant endometrial polyps were present in 0.8 to 8% of the patients, depending on the population studied and the methods used for diagnosis and resection [10][11][12][13][14][15][16][17] . In postmenopausal women, there is a direct relationship between the size of endometrial polyps and the existence of atypical hyperplasia and endometrial carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

Godoy¹,

Antunes²,

Morais³

et al. 2013

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy. ResumoOBJETIVO: Avaliar a acurácia da espessura endometrial ecográfica e características histeroscópicas em predizer malignidade em mulheres na pós-menopausa submetidas à ressecção cirúrgica de pólipos endometriais. MÉTODOS: Quinhentos e vinte e uma (521) mulheres na pós-menopausa submetidas à ressecção histeroscópica de pólipo endometrial entre janeiro de 1998 e dezembro de 2008 foram incluídas no estudo. Para cada valor de espessura endometrial ecográfica e tamanho dos pólipos na histeroscopia, a sensibilidade, a especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados em relação ao diagnóstico histológico de malignidade. Os melhores valores de sensibilidade e especificidade para o diagnóstico de malignidade foram determinados pela curva Receiver Operating Characteristic (ROC). RESULTADOS: O diagnóstico histológico identificou a presença de pré-malignidade ou malignidade em 4,1% dos casos. A espessura endometrial medida por ultrassonografia em casos de pólipos malignos foi maior quando comparado com pólipos benignos e pré-malignos. Na histeroscopia os pólipos malignos também foram maiores. A espessura endometrial de 13 mm mostrou uma sensibilidade de 69,6%, especificidade de 68,5%, VPP de 9,3% e VP...

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The malignant potential of endometrial polyps

Cited by 160 publications

References 19 publications

Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

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