Ultrasound finding of endometrial polyp and factors increasing risk of malignancy
Authors:
M. Koblížková 1
; P. Bretová 1; Michal Felsinger 1
; Luboš Minář 1
; Markéta Bednaříková 2
; Vít Weinberger 1
Authors place of work:
Gynekologicko-porodnická klinika LF MU a FN Brno
1; Interní hematologická a onkologická klinika LF MU a FN Brno
2
Published in the journal:
Ceska Gynekol 2024; 89(1): 44-51
Category:
Přehledová práce
doi:
https://doi.org/10.48095/cccg202444
Summary
This article presents a comprehensive review of factors that increase the risk of malignancy in ultrasound findings of an endometrial polyp. We collected original studies, reviews, and meta-analyses that dealt with the topic of endometrial polyps and the risk of developing endometrial cancer. Each presumed risk factor was analysed individually. According to searched studies, abnormal uterine bleeding, old age, and body mass index are valid risk factors for developing endometrial cancer in endometrial polyps. Lynch syndrome patients are also in a high-risk group for endometrial cancer. On the other hand, the number of polyps, their size, diabetes mellitus, hypertension, and positive family history are factors with inconclusive results. There are either not enough data or different results among several studies.
Keywords:
Endometrial carcinoma – risk factors – abnormal uterine bleeding – tamoxifen – endometrial polyp – polyp size
Zdroje
1. Wethington SL, Herzog TJ, Burke WM et al. Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol 2011; 18 (13): 3819–3823. doi: 10.1245/s10434-011-1815-z.
2. Heremans R, Van den Bosch T, Valentin L et al. Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3). Ultrasound Obstet Gynecol 2022; 60 (2): 243–255. doi: 10.1002/uog.24910.
3. American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol 2011; 19 (1): 3–10. doi: 10.1016/j.jmig.2011.09.003.
4. Vitale SG, Haimovich S, Lagana AS et al. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol 2021; 260: 70–77. doi: 10.1016/j.ejogrb.2021.03.017.
5. Colombo N, Creutzberg C, Amant F et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27 (1): 16–41. doi: 10.1093/annonc/mdv484.
6. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. 2023 [online]. Dostupné z: https: //svod.cz/report.php?diag=C54,C55.
7. Clark TJ, Stevenson H. Endometrial polyps and Abnormal Uterine Bleeding (AUB-P): what is the relationship, how are they diagnosed and how are they treated. Best Pract Res Clin Obstet Gynaecol 2017; 40: 89–104. doi: 10.1016/ j.bpobgyn.2016.09.005.
8. Uglietti A, Mazzei C, Deminico N et al. Endometrial polyps detected at ultrasound and rate of malignancy. Arch Gynecol Obstet 2014; 289 (4): 839–843. doi: 10.1007/s00404-013-3037-z.
9. Wong CL, So PL. Prevalence and risk factors for malignancy in hysteroscopy-resected endometrial polyps. Int J Gynecol Obstet 2021; 155 (3): 433–441. doi: 10.1002/ijgo.13656.
10. Patrizi L, Ticconi C, Borelli B et al. Clinical significance of endometrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery. BMC Womens Health 2022; 22 (1): 106. doi: 10.1186/s12905-022-01682-5.
11. Wong M, Thanatsis N, Nardelli F et al. Risk of pre-malignancy or malignancy in postmenopausal endometrial polyps: a CHAID decision tree analysis. Diagnostics (Basel) 2021; 11 (6): 1094. doi: 10.3390/diagnostics11061094.
12. Leone FP, Timmerman D, Bourne T et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 2010; 35 (1): 103–112. doi: 10.1002/uog.7487.
13. Van Den Bosch T, Verbakel JY, Velantin L et al. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol 2021; 57 (1): 164–172. doi: 10.1002/uog.22109.
14. Bel S, Bilard C, Godet J et al. Risk of malignancy on suspicion of polyps in menopausal women. Eur J Obstet Gynecol Reprod Biol 2017; 216: 138–142. doi: 10.1016/j.ejogrb.2017.07.013.
15. Vinklerová P, Felsinger M, Frydová S et al. Je nález hyperplazie či polypu děložní dutiny automatickou indikací k biopsii? Ceska Gynekol 2020; 85 (2): 84–93.
16. Fernández-Parra J, Rodríguez OA, López CS et al. Hysteroscopic evaluation of endometrial polyps. Int J Gynaecol Obstet 2016; 95 (2): 144–148. doi: 10.1016/j.ijgo.2006.07.007.
17. Garuti G, Luerti M, Leone FP et al. Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial. Facts Views Vis Obgyn 2019; 11 (2): 127–134.
18. Ferrazzi E, Zupi E, Leone FP et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol 2009; 200 (3): 235.e1–235.e6. doi: 10.1016/j.ajog.2008.09.876.
19. Xu J, Rao X, Lu W et al. Noninvasive predictor for premalignant and cancerous lesions in endometrial polyps diagnosed by ultrasound. Front Oncol 2022; 11: 812033. doi: 10.3389/fonc.2021.812033.
20. Mansour T, Chowdhury YS. Endometrial Polyp. StatPearls Publishing. 2022 [online]. Available from: http: //www.ncbi.nlm.nih.gov/books/NBK557824/.
21. Uglietti A, Buggio L, Farella M et al. The risk of malignancy in uterine polyps: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 237: 48–56. doi: 10.1016/j.ejogrb.2019.04.009.
22. Kolhe S. Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy. Int J Womens Health 2018; 10: 127–136. doi: 10.2147/IJWH.S98579.
23. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 2004; 24 (5): 558–565. doi: 10.1002/uog.1704.
24. Ricciardi E, Vecchione A, Matci R et al. Clinical factors and malignancy in endometrial polyps. Analysis of 1,027 cases. Eur J Obstet Gynecol Reprod Biol 2014; 183: 121–124. doi: 10.1016/j.ejogrb.2014.10.021.
25. Lee SC, Kaunitz AM, Sanchez-Ramos L et al. The oncogenic potential of endometrial polyps: a systematic review and meta-analysis. Obstet Gynecol 2010; 116 (5): 1197–1205. doi: 10.1097/AOG.0b013e3181f74864.
26. Win AK, Reece JC, Ryan S. Family history and risk of endometrial cancer: a systematic review and meta-analysis. Obstet Gynecol 2015; 125 (1): 89–98. doi: 10.1097/AOG.0000000000000563.
27. Yokoyama T, Takehara K, Sugimoto N et al. Lynch syndrome-associated endometrial carcinoma with MLH1 germline mutation and MLH1 promoter hypermethylation: a case report and literature review. BMC Cancer 2018; 18 (1): 576. doi: 10.1186/s12885-018-4489-0.
28. Zhao S, Chen L, Zang Y et al. Endometrial cancer in Lynch syndrome. Int J Cancer 2022; 150 (1): 7–17. doi: 10.1002/ijc.33763.
29. Tafe LJ, Riggs ER, Tsongalis GJ. Lynch syndrome presenting as endometrial cancer. Clin Chem 2014; 60 (1): 111–121. doi: 10.1373/ clinchem.2013.206888.
30. Manchanda R, Saridogan E, Abdelraheim A et al. Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch syndrome (LS). Arch Gynecol Obstet 2012; 286 (6): 1555–1562. doi: 10.1007/s00404-012-2492-2.
31. Concin N, Matias-Guiu X, Vergote I et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021; 31 (1): 12–39. doi: 10.1136/ijgc-2020-002230.
32. Češka R et al. Diabetes mellitus. In: Češka R et al (eds). Interna. 3. vydání. Praha: Triton 2020: 238–267.
33. Giordano G, Gnetti L, Merisio C et al. Postmenopausal status, hypertension and obesity as risk factors for malignant transformation in endometrial polyps. Maturitas 2007; 56 (2): 190–197. doi: 10.1016/j.maturitas.2006.08.002.
34. Ghoubara A, Sundar S, Ewies A. Predictors of malignancy in endometrial polyps: study of 421 women with postmenopausal bleeding. Climacteric 2018; 21 (1): 82–87. doi: 10.1080/13697137.2017.1410783.
35. Elfayomy AK, Soliman BS. Risk factors associated with the malignant changes of symptomatic and asymptomatic endometrial polyps in premenopausal women. J Obstet Gynaecol India 2015; 65 (3): 186–192. doi: 10.1007/s13224-014-0576-6.
36. Lee M, Piao J, Jeon MJ. Risk factors associated with endometrial pathology in premenopausal breast cancer patients treated with tamoxifen. Yonsei Med J 2020; 61 (4): 317–322. doi: 10.3349/ymj.2020.61.4.317.
37. Jeon J, Kim SE, Lee DY et al. Factors associated with endometrial pathology during tamoxifen therapy in women with breast cancer: a retrospective analysis of 821 biopsies. Breast Cancer Res Treat 2020; 179 (1): 125–130. doi: 10.1007/s10549-019-05448-w.
38. Mbatsogo BA, Bouëdec BL, Michy T et al. Endometrial cancers arising in polyps associated with tamoxifen use. Gynecol Obstet Fertil 2005; 33 (12): 975–979. doi: 10.1016/j.gyobfe.2005.10.021.
39. Yela DA, Ikejiri TA, Machado CR et al. Tamoxifen use as a malignancy risk factor in postmenopausal women with endometrial polyps. Menopause 2019; 26 (8): 863–866. doi: 10.1097/GME.0000000000001340.
Štítky
Dětská gynekologie Gynekologie a porodnictví Reprodukční medicínaČlánek vyšel v časopise
Česká gynekologie
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