Incidental endometrial polyps rarely cancerous

Daily POEMs

May 2009

Clinical question
How likely are endometrial polyps to be cancerous when found on imaging of postmenopausal women?

Bottom line
When imaging studies incidentally identify endometrial polyps in asymptomatic postmenopausal women with otherwise atrophic endometrium, the risk of cancer is less than 1% unless the diameter of the polyp is 18 mm or greater. (LOE = 2b)

Reference
Ferrazzi E, Zupi E, Leone FP, et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol 2009; 200(3):235.e1-235.e6.

Study design: Cohort (retrospective)

Setting: Outpatient (specialty)

Synopsis
This is a retrospective review of records of a 30-month period from 13 Italian sites of postmenopausal women who underwent sonohysterography or hysteroscopy for evaluation of endometrial polyps. Included were 1152 asymptomatic postmenopausal women and 770 women with postmenopausal bleeding. The mean diameter of the polyp was measured by ultrasound and recorded. All polyps were removed for histological examination. Among asymptomatic women there were 14 (1.2%) atypical hyperplastic polyps, and 4 cancers (0.4%). Among symptomatic women there were 17 atypical hyperplastic polyps (2.2%), and 29 cancers (3.7%). In multivariate logistic regression only a polyp diameter of 18 mm or larger was significantly associated with abnormal histology. Among asymptomatic women with polyps smaller than 18 mm there were 6 (0.5%) atypical hyperplastic polyps and no cancers.

Copyright© 2009 John Wiley & Sons, Inc.