Pietro Gambadauro MD PhD 1,2,3,*, Maria Ángeles Martínez-Maestre MD PhD 4, José Schneider MD PhD 5, Rafael Torrejón MD PhD 2
1 Karolinska Institutet, Stockholm, Sweden; 2 Obstetrics and Gynaecology, University of Cádiz, Cádiz, Spain; 3 Res Medica Sweden, Uppsala, Sweden; 4 Gynecology Division, Virgen del Rocío University Hospital, Seville, Spain; 5 Department of Gynaecology, University of Cantabria, Santander, Spain
Climacteric. 2015;18(3):399-404. DOI:10.3109/13697137.2014.967673
Objectives To identify factors associated with endometrial neoplasia in women diagnosed with endometrial polyp at transvaginal ultrasound.
Methods Within a population of 1390 consecutive patients undergoing hysteroscopy following an ultra- sonographic diagnosis of polyps, we compared the cases with a final diagnosis of endometrial neoplasia with controls with benign endometrial polyps. The controls were selected randomly in a ratio of 4 : 1 (controls : cases). Bivariate statistical analysis and multiple logistic regression were used to measure the association between various variables and endometrial neoplasia.
Results Sixteen cases of endometrial neoplasia were compared to 64 controls with confirmed benign endome- trial polyps. All cases of neoplasia were among symptomatic women, while 40.62% of women with benign polyps had been referred to hysteroscopy after a routine ultrasound and were asymptomatic. Women with endometrial neoplasia were significantly older (mean age 64.19±9.382 vs. 52.03±9.846 years; p < 0.001) and had a significantly greater body mass index (median 27.66 vs. 24.59 kg/m2; p < 0.001). Other factors statistically associated with endometrial neoplasia were postmenopausal status and bleeding as a main symptom. At multivariate analysis with logistic regression, the only factors showing a statistically significant association with endometrial neoplasia were older age (odds ratio 1.102; 95% confidence interval 1.015–1.198) and bleeding (odds ratio 13.7; 95% confidence interval 1.486–126.278).
Conclusion When polyps are diagnosed at ultrasound, bleeding and an older age are independently associ- ated with endometrial neoplasia. A significant proportion of asymptomatic women is referred to hysteroscopy because of a polyp seen at routine ultrasound, although malignancy is highly unlikely in these cases.
Keywords: Endometrial polyps, endometrial neoplasia, hysteroscopy, ultrasound, abnormal uterine bleeding, menopause