Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: management strategies

Abstract

Study objective: To estimate the prevalence of benign, premalignant, and malignant endometrial polyps and the associated clinical risk factors for premalignant and malignant endometrial polyps.

Design: Retrospective study (Canadian Classification II-3).

Setting: Teaching hospital.

Patients: Seven hundred sixty-six patients with endometrial polyps.

Interventions: Hysteroscopic removal of endometrial polyps.

Measurements and main results: Patient clinical data were identified and analyzed. Frequency of premalignant and malignant histopathologic features in endometrial polyps was calculated. Clinical risk factors for premalignant and malignant endometrial polyps were analyzed. Endometrial polyps were histologically benign in most patients (96.21%). Hyperplasia with atypia in a polyp (premalignant polyp) was found in 3.26% of patients, and endometrial carcinoma in a polyp (malignant polyp) was detected in only 0.52% of patients. Independent variables that were significantly related to premalignant and malignant polyps (all p<.05) in a binary logistic regression analysis included polyp diameter (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.191-7.20), menopause status (OR, 4.85; 95% CI, 2.09-11.27), and abnormal uterine bleeding (OR, 3.97; 95% CI, 1.71-9.18).

Conclusion: Polyp diameter larger than 1.0cm, menopause status, and abnormal uterine bleeding may increase the risk of premalignant and malignant endometrial polyps.