RMG Tibosch

Atypical endometrial polyps and the incidence of endometrial cancer: a retrospective cohort study

ObjectiveThe aim of this study was to evaluate the incidence of endometrial carcinoma, proven after hysterectomy, in patients diagnosed with atypical endometrial hyperplasia confined to a polyp. A secondary aim was to establish factors associated with (pre‐)malignant alterations in a polyp.DesignA retrospective cohort study.SettingMaastricht University Medical Centre (MUMC+) and Máxima Medical Centre in Eindhoven/Veldhoven (Máxima MC).PopulationWomen who underwent a hysteroscopic polyp resection between 2008 and 2016.MethodsPatient characteristics and histopathology results of the polyp and, in the case of a hysterectomy, uterus were collected from patients’ charts.ResultsA total of 1445 complete hysteroscopic polyp resections were included. Of those, 1390 polyps showed benign histopathology results, 39 polyps contained atypical hyperplasia and 16 polyps contained endometrial carcinoma. A hysterectomy was performed in 35 women who were diagnosed with atypical hyperplasia confined to a polyp after hysteroscopic polyp resection. Histopathological assessment showed no additional (pre‐)malignant changes of the endometrium in 12 women (30.8%), atypical hyperplasia in 11 women (28.2%) and endometrial carcinoma in 12 women (30.8%). None of the prognostic factors under consideration were significantly associated with (pre‐)malignant changes in a polyp.ConclusionThe incidence of endometrial carcinoma in the surrounding endometrium after complete resection of a polyp with atypical hyperplasia is 30.8% in this study. This supports the current advice to perform a hysterectomy and bilateral salpingo‐oophorectomy. No prognostic factor for (pre‐)malignant changes in a polyp was established.Tweetable abstractThe incidence of endometrial carcinoma after complete resection of a polyp with atypical hyperplasia is high.