Can malignant potential of endometrial polyps be determined by incorporating the endometrial intraepithelial neoplasia (EIN) classification?

Naaman, Yael; Diment, Judith; Perlman, Sharon; Oustinov, Natalia; Vaisbuch, Edi; Ben-Arie, Alon

doi:10.1016/j.ygyno.2014.12.014

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…This finding has been corroborated by other studies. 7,8,22 This situation was less frequent than that reported in the GOG 167, in which the prevalence of endometrial cancer after hysterectomy with atypical hyperplasia was 42.6%. 23 Notably, a systematic review confirmed that when the atypical hyperplasia is restricted to polyps, < 10% of the final specimen would be expected to have cancer.…”

Section: Discussionmentioning

confidence: 63%

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps

Simonsen

Mantoan

Faloppa

et al. 2021

Rev Bras Ginecol Obstet

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Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. Results In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

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Section: Discussionmentioning

confidence: 63%

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps

Simonsen

Mantoan

Faloppa

et al. 2021

Rev Bras Ginecol Obstet

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“…It is possible that performing routine endometrial sampling following hysteroscopic polypectomy might reveal cases with multiple sources of EIN or endometrial cancer. In a study by Naaman et al, the rate of concurrent EIN/endometrial cancer in women who had hysteroscopic polypectomy followed by endometrial curettage was 48% 28. As such, the advantage of subjecting these women to a secondary diagnostic procedure is questionable.…”

Section: Discussionmentioning

confidence: 99%

Incidence of endometrial carcinoma in patients with endometrial intraepithelial neoplasia versus atypical endometrial polyp

Cohen

Tsur

Tako

et al. 2022

Int J Gynecol Cancer

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ObjectiveOur study’s primary aim was to compare the incidence of endometrial carcinoma in patients with a presurgical diagnosis of endometrial intraepithelial neoplasia confined to the endometrium (EIN-E) versus endometrial intraepithelial neoplasia confined to a polyp (EIN-P). Our secondary aim was to examine the difference in pathological features, prognostic risk groups and sentinel lymph node involvement between the two groups.MethodsWe conducted a retrospective cohort study between January 2014 and December 2020 in a tertiary university-affiliated medical center. The study considered the characteristics of women who underwent hysterectomy with sentinel lymph node dissection for endometrial intraepithelial neoplasia (EIN). We compared EIN-E diagnosed by endometrial sampling via dilatation curettage or hysteroscopic curettage vs EIN-P. A multivariate logistic regression analysis was used to assess risk factors for endometrial cancer.ResultsEighty-eight women were included in the study, of those, 50 were women with EIN-P (EIN-P group) and 38 were women with EIN following an endometrial biopsy (EIN-E group).The median age was 57.5 years (range; 52–68) in the EIN-P group as compared with 63 years (range; 53–71) in the EIN-E group (p=0.47). Eighty-nine percent of the women in the EIN-E group presented with abnormal uterine bleeding whereas 46% of the women in the EIN-P group were asymptomatic (p=0.001). Pathology results following hysterectomy revealed concurrent endometrial carcinoma in 26% of women in the EIN-P group compared with 47% of women in the EIN-E group (p=0.038). Multivariate analysis showed that endometrial cancer was significantly less common in the EIN-P group (overall response (OR)=0.3 95% confidence interval (CI)=0.1–0.9, p=0.03). Eighty-four percent of cancers were grade one in the EIN-P group compared with 50% in the EIN-E group (p=0.048).ConclusionsConcurrent endometrial cancer is less frequent with EIN-P than with EIN-E. The high incidence of endometrial carcinoma in both groups supports the current advice to perform hysterectomy for post-menopausal women. Our data does not support performing sentinel lymph node dissection for EIN-P that was completely resected. The benefit of sentinel lymph node dissection for women with pre-operative EIN-E is yet to be determined.

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“…Há relatos de que o tamoxifeno está associado a aumento da incidência de lesões endometriais, como pólipos, hiperplasia e cerca de duas a quatro vezes de risco aumentado de câncer do endométrio em pacientes na pós-menopausa. 24 A literatura relata que a lesão maligna mais frequente localizada em pólipo, é o adenocarcinoma, 25 que tem como lesão precursora a hiperplasia atípica, nos seus diversos graus de intensidade 26,27,28,29,30 . Os dados da literatura nos mostram que os multíplos fatores de riscos, tais como hipertensão arterial sistêmica, diabetes mellitus tipo II, obesidade e longo tempo de menopausa, estão associados,significativamente, com a pré malignidade e malignidade do pólipo endometrial 31,32,33,34 .…”

Section: Hg Mercúriounclassified

Estudo pela imunoexpressão da proteína p53 e do PTEN nos pólipos endometriais

Abrão

2023

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Can malignant potential of endometrial polyps be determined by incorporating the endometrial intraepithelial neoplasia (EIN) classification?

Cited by 7 publications

References 25 publications

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps

Incidence of endometrial carcinoma in patients with endometrial intraepithelial neoplasia versus atypical endometrial polyp

Estudo pela imunoexpressão da proteína p53 e do PTEN nos pólipos endometriais

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