Bel Sandra, Billard Camille, Godet Julien, Viviani Victor, Akladios Cherif, Host Aline, Faller Emilie, Boisrame Thomas, Hummel Michel, Baldauf Jean-Jacques, Lecointre Lise, Garbin Olivier
CMCO Hospital, Strasbourg University, Teaching Hospital, France.
CMCO Hospital, Strasbourg University, Teaching Hospital, France.
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:138-142. doi: 10.1016/j.ejogrb.2017.07.013. Epub 2017 Jul 15.
Improved performances in gynaecological ultrasonography have enabled an increasing number of often asymptomatic endometrial polyps to be detected. Most of these polyps are removed surgically, as a precautionary measure, so as not to miss a case of endometrial cancer. Nonetheless, this management strategy is based solely on the sonographer's judgement and a number of these operations, which are probably of no benefit, could be avoided. In order to do so, risk factors for malignancy need to be identified.
Estimate the prevalence of lesions in menopausal patients with a pre-operative diagnosis of endometrial polyp. Establish risk factors for malignancy.
This is a single-centre retrospective study. Enrolment criteria were menopausal patients aged over 45 who had undergone hysteroscopic resection of a polyp. Pre-op diagnosis was made either by ultrasonography or diagnostic hysteroscopy. Malignant lesions included cancers and atypical hyperplasia. Benign lesions consisted of simple polyps, non-atypical simple hyperplasia and non-atypical complex hyperplasia. Risk factors studied were existing abnormal uterine bleeding, endometrial thickness, personal or first-degree family history of gynaecological cancer (breast, cervix, endometrium, ovary) and age on diagnosis.
631 patients were enrolled of whom 30 presented a malignant disorder (4.75%); 579 patients (91.76%) presented a simple polyp, 11 a non-atypical simple hyperplasia (1.74%) and 11 a non-atypical complex hyperplasia (1.74%). On univariate analysis age alone proved to be statistically significant (OR 1.05; 95%CI=[1.02-1.09] p<0.01), with a threshold of 59 years of age on the ROC curve. On multivariate analysis, factors predictive of a malignant lesion were age (OR=1.06; 95%CI [1.02-1.10]), existence of AUB (OR=2.4; 95% CI [1.07-5.42]) and family history (OR=2.88; 95%CI [1.08-7.67]). Neither the univariate nor multivariate model was able to demonstrate a statistically significant relationship with respect to endometrial thickness. The risk of malignancy was 12.3% in patients aged over 59 presenting AUB. For all other subgroups, the risk varied between 2.31 and 3.78%.
The risk of a malignant lesion appears to be high (12%) in menopausal patients aged over 59 presenting an endometrial polyp detected when there is pre-existing AUB. In this situation, hysteroscopic resection of endometrial polyps should therefore be routinely proposed. For other patients, the risk of a malignant lesion is low but not insignificant, standing at about 3%. Each patient record should therefore be discussed on an individual case basis, taking into consideration the patient's pre-existing conditions, after providing clear and appropriate information.
妇科超声检查性能的提高使得越来越多通常无症状的子宫内膜息肉得以被检测出来。这些息肉大多作为预防措施通过手术切除，以免漏诊子宫内膜癌病例。然而，这种管理策略完全基于超声检查医师的判断，许多可能并无益处的手术是可以避免的。为了做到这一点，需要确定恶性肿瘤的危险因素。
估计术前诊断为子宫内膜息肉的绝经患者中病变的患病率。确定恶性肿瘤的危险因素。
这是一项单中心回顾性研究。纳入标准为年龄超过45岁且接受过息肉宫腔镜切除术的绝经患者。术前诊断通过超声检查或诊断性宫腔镜检查做出。恶性病变包括癌症和非典型增生。良性病变包括单纯息肉、非非典型单纯性增生和非非典型复杂性增生。研究的危险因素包括现有的异常子宫出血、子宫内膜厚度、个人或一级家族妇科癌症（乳腺癌、宫颈癌、子宫内膜癌、卵巢癌）病史以及诊断时的年龄。
共纳入631例患者，其中30例患有恶性疾病（4.75%）；579例患者（91.76%）患有单纯息肉，11例患有非非典型单纯性增生（1.74%），11例患有非非典型复杂性增生（1.74%）。单因素分析显示，仅年龄具有统计学意义（OR=1.05；95%CI=[1.02-1.09]，p<0.01），ROC曲线的年龄阈值为59岁。多因素分析显示，预测恶性病变的因素为年龄（OR=1.06；95%CI[1.02-1.10]）、存在异常子宫出血（OR=2.4；95%CI[1.07-5.42]）和家族史（OR=2.88；95%CI[1.08-7.67]）。单因素和多因素模型均未显示与子宫内膜厚度存在统计学意义上的关系。年龄超过59岁且存在异常子宫出血的患者发生恶性肿瘤的风险为12.3%。对于所有其他亚组，风险在2.31%至3.78%之间。
年龄超过59岁且存在异常子宫出血时检测到子宫内膜息肉的绝经患者发生恶性病变的风险似乎较高（12%）。因此，在这种情况下应常规建议进行子宫内膜息肉的宫腔镜切除术。对于其他患者，发生恶性病变的风险较低但并非微不足道，约为3%。因此，在提供清晰适当的信息后，应根据每个患者的具体情况进行个体化讨论。
