Oncological significance of endometrial polyps

Abstract

The association of endometrial polyps and endometrial neoplasia is still controversial. Our main objectives were to study the frequency, the characteristics and possible associated factors of endometrial neoplasia in a population of 1390 consecutive patients referred for hysteroscopy following ultrasonographic diagnosis of endometrial polyps. Sixteen cases of endometrial neoplasia were diagnosed (1.15%). All the patients had symptoms and fifteen of them were post-menopausal (93.8%). The neoplasia was not confined to the polyp in most of the cases. Patients with a higher risk disease were significantly younger. In a nested case-control study, 64 controls with benign endometrial polyps were compared to the 16 cases of endometrial neoplasia. The cases were significantly older (p<.001) and had a greater BMI (p<.001). Other factors significantly associated with endometrial neoplasia were postmenopausal status and bleeding. At multivariate analysis with logistic regression, the only factors independently associated with endometrial neoplasia were older age (OR 1.102; 95%CI 1.015-1.198) and bleeding (OR 13.7; 95%Cl 1.486-126.278). In conclusion, the prevalence of endometrial neoplasia in patients with an ultrasonographic diagnosis of endometrial polyp is low, and the malignancy is commonly not confined to the polyp. Bleeding and older age are independently associated with neoplasia, and no case of cancer was found in asymptomatic women.

La asociación entre pólipos endometriales y cáncer es controvertida. Nuestros objetivos principales eran estudiar la prevalencia y las características de neoplasia endometrial, y potenciales factores asociados, en una población de 1390 pacientes consecutivas remitidas a histeroscopia tras el diagnostico ecografico de pólipo endometrial. Se identificaron 16 casos de neoplasia (1.15%). Todas estas pacientes tenían síntomas y 15 de ellas eran postmenopausicas (93.8%). La neoplasia no estaba circunscrita al pólipo en la mayoría de los casos. La pacientes con cáncer de alto riesgo eran significativamente mas jóvenes. En un estudio de caso-control nested, 64 controles con pólipos endometriales benignos se compararon con los 16 casos de neoplasia endometrial. Los casos resultaron ser de mayor edad (p<.001), y de mayor IMC (p<.001). Otros factores significativos asociados a la neoplasia fueron el estado postmenopausico, y el sangrado. Al realizar un análisis multivariante con regresión logística se confirmó la asociación estadísticamente significativa entre neoplasia de endometrio y mayor edad (OR 1.102; 95%CI 1.015-1.198), y sangrado (OR 13.7; 95%CI 1.486-126.278). En conclusión, la prevalencia de neoplasia endometrial en mujeres con diagnostico ecografico de pólipo endometrial es baja, y el cáncer no suele estar circunscrito al pólipo. Sangrado y mayor edad son significativamente asociados a la neoplasia, y no encontramos ningún caso de cáncer en mujeres asintomáticas.