OJOG  Vol.5 No.11 , September 2015
Endometrial Polyps: Which Patients Should Be Selected for Hysteroscopic Surgery?
—A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery
ABSTRACT
Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were <52 years old (p < 0.001). Among those women with dysplasia, 12/41 (29%) were <52 years old (p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The <52-year-old cancer patient had treatment-resistant bleeding. Increasing weight was a risk factor associated with tissue alterations in endometrial polyps (p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.

Cite this paper
Zacharias, S. and Löfgren, M. (2015) Endometrial Polyps: Which Patients Should Be Selected for Hysteroscopic Surgery?
—A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery. Open Journal of Obstetrics and Gynecology, 5, 592-599. doi: 10.4236/ojog.2015.511084.
References
[1]   (2013) Swedish National Quality Register of Gynecological Surgery.
http://www.gynop.org/english/about/about.htm

[2]   Dreisler, E., Stampe Sorensen, S., Ibsen, P.H. and Lose, G. (2009) Prevalence of Endometrial Polyps and Abnormal Uterine Bleeding in a Danish Population Aged 20 - 74 Years. Ultrasound in Obstetrics and Gynecology, 33, 102-108.
http://dx.doi.org/10.1002/uog.6259

[3]   Kasraeian, M., Asadi, N., Ghaffarpasand, F. and Karimi, A.A. (2011) Value of Transvaginal Ultrasonography in Endometrial Evaluation of Non-Bleeding Postmenopausal Women. Climacteric, 14, 126-131.
http://dx.doi.org/10.3109/13697137.2010.514079

[4]   Soguktas, S., Cogendez, E., Kayatas, S., Asoglu, M., et al. (2012) Comparison of Saline Infusion Sonohysterography and Hysteroscopy in Diagnosis of Premenopausal Women with Abnorm Uterine Bleedning. European Journal of Obstertrics & Gynecology and Reproductive Biology, 161, 66-70. http://dx.doi.org/10.1016/j.ejogrb.2011.11.022

[5]   Costa-Paiva, L., Godoy Jr., C.E., Antunes Jr., A., et al. (2011) Risk of Malignancy in Endometrial Polyps in Premenopausal and Postmenopausal Women According to Clinicopathologic Characteristics. The Journal of the North American Menopause Society, 18, 1278-1282.

[6]   Epstein, E. (2004) Management of Postmenopausal Bleeding in Sweden: A Need for Increased Use of Hydrosonography and Hysteroscopy. Acta Obstetricia et Gynecologica Scandinavica, 83, 89-95.
http://dx.doi.org/10.1111/j.1600-0412.2004.00357.x

[7]   Petterson, B., Adami, H.O., Lindgren, A. and Hesselius, I. (1985) Endometrial Polyps and Hyperplasia as Risk Factors for Endometrial Carcinoma. A Case-Control Study of Curettage Specimens. Acta Obstetricia et Gynecologica Scandinavica, 64, 653-659. http://dx.doi.org/10.3109/00016348509158208

[8]   Savelli, L., De Iaco, P., Santini, D., Rosati, F., Ghi, T., Pignotti, E. and Bovicelli, L. (2003) Histopatologic Features and Risk Factors for Benignity, Hyperplasia and Cancer in Endometrial Polyps. American Journal of Obstetrics & Gynecology, 188, 927-931. http://dx.doi.org/10.1067/mob.2003.247

[9]   Antunes, A., Costa-Paiva, L., Arthuso, M., Costa, J.V. and Pinto-Neto, A.M. (2007) Endometrial Polyps in Pre- and Postmenopausal Women: Factors Associated with Malignancy. Maturitas, 57, 415-421.
http://dx.doi.org/10.1016/j.maturitas.2007.04.010

[10]   Timmermans, A., Gerritse, M.B.E., Opmeer, B.C., Jansen, F.W., Mol, B.W.J. and Veersema, S. (2008) Diagnostic Accuracy of Endometrial Thickness to Exclude Polyps in Women with Postmenopausal Bleeding. Journal of Clinical Ultrasound, 36, 286-290. http://dx.doi.org/10.1002/jcu.20415

[11]   Grimbizis, G.F. Tsolakidis, D., Themistoklis, M., Anagnostou, E., Asimakopoulos, E., Stamatopoulos, P. and Tarlatzis, B.C. (2010) A Prospective Comparison of Ultrasound, Saline Infusion Sonohysterography and Diagnostic Hysteroscopy in the Evaluation of Endometrial Pathology. Fertility and Sterility, 94, 2720-2725.
http://dx.doi.org/10.1016/j.fertnstert.2010.03.047

[12]   Van Dijk, L., Breijer, M., Veersema, S., Mol, B. and Timmermans, A. (2012) Current Practice in the Removal of Benign Endometrial Polyps: A Dutch Survey. Gynecological Surgery, 9, 163-168.
http://dx.doi.org/10.1007/s10397-011-0707-3

[13]   Clark, J.T., Khan, K.S. and Gupta, J.K. (2002) Current Practice for the Treatment of Benign Intrauterine Polyps: A National Questionnaire Survey of Consultant Gynaecologists in UK. European Journal of Obstetrics & Gynecology and Reproductive Biology, 103, 65-67. http://dx.doi.org/10.1016/S0301-2115(02)00011-8

[14]   Epstein, E., Skoog, L. and Valentin, L. (2001) Comparison of Endorette and Dilatation and Curettage for Sampling of the Endometrium in Women with Postmenpausal Bleeding. Acta Obstetricia et Gynecologica Scandinavica, 80, 959-964.

[15]   Svirsky, R., Smorgick, N., Rozowski, U., Sagiv, R., Feingold, M., Halperin, R. and Pansky, M. (2008) Can We Rely on Blind Endometrial Biopsy for Detection of Focal Intrauterine Pathology? American Journal of Obstetrics and Gynecology, 199, 115.e1-115.e3. http://dx.doi.org/10.1016/j.ajog.2008.02.015

[16]   Epstein, E., Ramirez, A., Skoog, L. and Valentin, L. (2001) Dilatation and Curettage Fails to Detect Most Foca Lesions in the Uterine Cavity in Women with Postmenopausal Bleeding. Acta Obstetricia et Gynecologica Scandinavica, 80, 1131-1136. http://dx.doi.org/10.1034/j.1600-0412.2001.801210.x

[17]   Scrimin, F., Wiesenfeld, U., Candiotto, A., Inglese, S. and Guaschino, S. (2008) Resectoscopic Treatment of Atypical Endometrial Polyps in Fertile Women. American Journal of Obstetrics and Gynecology, 199, 365.e1-365.e3.
http://dx.doi.org/10.1016/j.ajog.2008.03.041

[18]   Bixo, M. and Landgren, B.M. (2010) Studentliteratur: Gynekologi, Kap. 7 Klimakteriet p85. Lund.

[19]   Hysteroskopi Report from Swedish Society of Obstetrics and Gynecology, Nr 66, 2010. ( In Swedish)

[20]   Ferazzi, E., Zupi, E., Leone, F.P., Savelli, L., Omodei, U., Moscarini, M., et al. (2009) How Often Are Endometrial Polyps Malignant in Asymptomatic Postmenopausal Women? A Multicenter Study. American Journal of Obstetrics and Gynecology, 200, 235.e1-235.e6. http://dx.doi.org/10.1016/j.ajog.2008.09.876

[21]   Domingues, A.P., Lopes, H., Dias, I. and De Oliviera, C.F. (2009) Endometrial Polyps in Postmenopausal Women. Acta Obstetricia et Gynecologica Scandinavica, 88, 618-620.
http://dx.doi.org/10.1080/00016340902818188

 
 
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