Endometrial Polyps - When Should Hysteroscopic Resection Be Performed? - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(7):315-316
The prevalence of endometrial polyps in postmenopausal women can be as high as 35%, and it has been steadily increasing with the wide dissemination of ultrasound in the routine gynecological practice. Endometrial polyps are important because they can cause symptoms, and might be associated with endometrial cancer. The percentage of malignant lesions found in association with the polyps, or even within them, is ∼ 2.5 to 3%, and can be higher in some populations. Risk factors for malignancy include advanced age, menopausal status, size of the lesion, hypertension, obesity and the presence of postmenopausal bleeding. Selective modulators of estrogenic receptors, such as tamoxifen, also play a role in the increased risk of endometrial cancer.
Hysteroscopic biopsy is the gold standard for evaluation and diagnosis, since blind dilation and curettage have very low accuracy for detection of focal lesions, and the treatment is also performed hysteroscopically. However, even though hysteroscopy is a safe procedure, it is considered invasive, with risk of complications. In this way, when considering asymptomatic polyps with low risk of associated cancer, we must question whether resection is mandatory.
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The prevalence of endometrial polyps in postmenopausal women can be as high as 35%, and it has been steadily increasing with the wide dissemination of ultrasound in the routine gynecological practice. Endometrial polyps are important because they can cause symptoms, and might be associated with endometrial cancer. The percentage of malignant lesions found in association with the polyps, or even within them, is ∼ 2.5 to 3%, and can be higher in some populations. Risk factors for malignancy include advanced age, menopausal status, size of the lesion, hypertension, obesity and the presence of postmenopausal bleeding. Selective modulators of estrogenic receptors, such as tamoxifen, also play a role in the increased risk of endometrial cancer.
Hysteroscopic biopsy is the gold standard for evaluation and diagnosis, since blind dilation and curettage have very low accuracy for detection of focal lesions, and the treatment is also performed hysteroscopically. However, even though hysteroscopy is a safe procedure, it is considered invasive, with risk of complications. In this way, when considering asymptomatic polyps with low risk of associated cancer, we must question whether resection is mandatory.
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