The risk of malignancy in uterine polyps: A systematic review and meta-analysis

Uglietti, Anna; Buggio, Laura; Farella, Marilena; Chiaffarino, Francesça; Dridi, Dhouha; Vercellini, Paolo; Parazzini, Fabio

doi:10.1016/j.ejogrb.2019.04.009

Cited by 58 publications

(46 citation statements)

References 55 publications

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“…Most polyps are known to be benign, especially in premenopausal women. Estimates of endometrial cancer occurrence within polyps vary across study populations as 1.1-4.9% [3]. While endometrial polyps are usually asymptomatic, they may lead to intermenstrual bleeding, menorrhagia, postmenopausal…”

Section: Introductionmentioning

confidence: 99%

Endometrial polyps: Is the prediction of spontaneous regression possible?

Yüksel¹,

Tuna²,

Çelik

et al. 2021

Obstet Gynecol Sci

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Objective Endometrial polyps have been considered as a hyperplastic growth of endometrial stromal and glandular tissues. Even asymptomatic polyps in premenopausal women are usually removed as soon as they are diagnosed, although it is still unknown how often endometrial polyps disappear spontaneously. The aim of this study was to investigate the regression rate of endometrial polyps and the possible factors related to their spontaneous regression. Methods A total of 197 women with endometrial polyps were treated with operative hysteroscopy between January 2017 and April 2019 at our tertiary center. Of these, 123 patients who preferred conservative follow-up were enrolled in the study. Clinical and pathological data were obtained from electronic medical records. Results Patients with endometrial polyps were followed up for a median period of 62 days (range 30–360 days). Most women with endometrial polyps (84%) were reported to have gynecologic symptoms. Spontaneous polyp regression was observed in 28 (23%) patients who underwent surgery reevaluation. Patient age (<45 years), premenopausal period, and polyp size (<2 cm) were found to be associated with spontaneous endometrial polyp regression ( P <0.05). We also observed more polyp regression in women with abnormal uterine bleeding ( P =0.05). Second-look hysteroscopy showed that all postmenopausal women had persistent endometrial polyps. Conclusion Patient age (<45 years), premenopausal period, polyp size (<2 cm), and abnormal uterine bleeding may be associated with spontaneous endometrial polyp regression.

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Section: Introductionmentioning

confidence: 99%

Endometrial polyps: Is the prediction of spontaneous regression possible?

Yüksel¹,

Tuna²,

Çelik

et al. 2021

Obstet Gynecol Sci

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show abstract

“…On the other hand, among asymptomatic patients, conservative management is more appropriate, since malignancy risk is low and small polyps can regress spontaneously [ 28 ]. According to a large meta-analysis, EC risk is higher in patients with bleeding (5.14%) compared to the asymptomatic (1.89%), and EC risk is greater with postmenopausal (4.93%) women compared to premenopausal women (1.12%) [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Tumor Characteristic Variations between Symptomatic and Asymptomatic Endometrial Cancer

et al. 2021

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Endometrial cancer is the most common gynecologic malignancy in Europe and usually diagnosed in its initial stage owing to early symptoms of abnormal bleeding. There is no population screening for this disease, although it can sometimes be accidentally diagnosed in asymptomatic patients. Our study aims to determine differences in clinical and tumor characteristics between an asymptomatic and symptomatic group of patients. This unicentric prospective observational study took place in University Hospital Brno between January 2016 and December 2019. A total of 264 patients met inclusion criteria (26% asymptomatic, 74% with reported symptoms). We did not find a statistically significant difference in clinical characteristics (menopausal status, parity, age, BMI, and serum level of CA 125) between groups. According to ultrasound examination, bleeding tumors were larger (19.5 vs. 12.7 mm, p ≤ 0.001). Definitive histology results indicated more frequent lymphovascular space invasion (p < 0.001), along with deep myometrial (p = 0.001) and cervical (p = 0.002) invasion. There was no difference in advanced stages of the tumor. We did not substantiate statistically significant difference in immunohistochemical profile (estrogen and progesterone receptors, L1 cell adhesion molecule, tumor protein p53), which is relevant for tumor recurrence risk and survival capacity. Our conclusions affirmed that bleeding occurs more often among patients with local tumor invasion into the myometrium and cervical stroma. Final International Federation of Gynecology and Obstetrics (FIGO) stage, histology, and immunohistochemical characteristics do not significantly affect symptom appearance.

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“…It is important to point out that in the stromal component of endometrial polyps there is a lower number of hormone receptors. Therefore, the glands and stroma of polyps do not respond to progesterone stimulation, which may be the cause of abnormal secretion of progesterone in the endometrium [27,28,29]. A study that measured TNF-α concentration in uterine flushings of 12 patients before and after hysteroscopic polypectomy showed an increase in TNF-α concentrations after polyp removal with TNF-α values reaching the peak in the midluteal menstrual cycle phase [25].…”

Section: Discussionmentioning

confidence: 99%

The effect of hysteroscopic polypectomy on the concentrations of tumour necrosis factor-α in uterine flushings and serum in infertile women

et al. 2020

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Introduction/Objective The aim of this paper is to present changes of tumor necrosis factor-α (TNF-α) levels in uterine flushings and serum of infertile female patients before and after hysteroscopic polypectomy. Methods A total of 82 infertile female patients were included in the study. The patients were divided into two groups. The first group was the experimental group and comprised 56 infertile women with endometrial polyps, whereas the second group was the control group of 26 infertile women who were not diagnosed with endometrial polyps. Results The results of this research primarily suggest that TNF-α concentrations obtained from uterine flushings and serum of infertile patients diagnosed with endometrial polyps differed before and after a surgical procedure. In the control group of patients, there was no significant difference observed regarding TNF-α concentrations in serum and uterine flushings of women without endometrial polyps. A comparison between these two groups revealed differences in TNF-α concentrations in both venous blood and uterine flushings. These differences were considered statistically significant. Conclusion Endometrial polyps are one of the causes of higher TNF-α levels in both uterine flushings and serum.

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The risk of malignancy in uterine polyps: A systematic review and meta-analysis

Cited by 58 publications

References 55 publications

Endometrial polyps: Is the prediction of spontaneous regression possible?

Endometrial polyps: Is the prediction of spontaneous regression possible?

Tumor Characteristic Variations between Symptomatic and Asymptomatic Endometrial Cancer

The effect of hysteroscopic polypectomy on the concentrations of tumour necrosis factor-α in uterine flushings and serum in infertile women

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