Gynaecology Department, Maastricht University Medical Centre, Maastricht, the Netherlands.
Emergency Medicine, Elkerliek Medical Centre, Helmond, the Netherlands.
BJOG. 2020 Jul;127(8):994-999. doi: 10.1111/1471-0528.16194. Epub 2020 Apr 9.
The aim of this study was to evaluate the incidence of endometrial carcinoma, proven after hysterectomy, in patients diagnosed with atypical endometrial hyperplasia confined to a polyp. A secondary aim was to establish factors associated with (pre-)malignant alterations in a polyp.
A retrospective cohort study.
Maastricht University Medical Centre (MUMC+) and Máxima Medical Centre in Eindhoven/Veldhoven (Máxima MC).
Women who underwent a hysteroscopic polyp resection between 2008 and 2016.
Patient characteristics and histopathology results of the polyp and, in the case of a hysterectomy, uterus were collected from patients' charts.
A total of 1445 complete hysteroscopic polyp resections were included. Of those, 1390 polyps showed benign histopathology results, 39 polyps contained atypical hyperplasia and 16 polyps contained endometrial carcinoma. A hysterectomy was performed in 35 women who were diagnosed with atypical hyperplasia confined to a polyp after hysteroscopic polyp resection. Histopathological assessment showed no additional (pre-)malignant changes of the endometrium in 12 women (30.8%), atypical hyperplasia in 11 women (28.2%) and endometrial carcinoma in 12 women (30.8%). None of the prognostic factors under consideration were significantly associated with (pre-)malignant changes in a polyp.
The incidence of endometrial carcinoma in the surrounding endometrium after complete resection of a polyp with atypical hyperplasia is 30.8% in this study. This supports the current advice to perform a hysterectomy and bilateral salpingo-oophorectomy. No prognostic factor for (pre-)malignant changes in a polyp was established.
The incidence of endometrial carcinoma after complete resection of a polyp with atypical hyperplasia is high.
本研究旨在评估经子宫切除术证实的局限于息肉的不典型子宫内膜增生患者中子宫内膜癌的发生率。次要目的是确定与息肉中（前）恶性改变相关的因素。
回顾性队列研究。
马斯特里赫特大学医学中心（MUMC+）和埃因霍温/芬洛的马克西玛医疗中心（Máxima MC）。
2008 年至 2016 年间接受宫腔镜息肉切除术的女性。
从患者病历中收集患者特征和息肉的组织病理学结果，以及子宫切除术时子宫的组织病理学结果。
共纳入 1445 例完整的宫腔镜息肉切除术。其中，1390 个息肉显示良性组织病理学结果，39 个息肉含有不典型增生，16 个息肉含有子宫内膜癌。在经宫腔镜息肉切除诊断为局限于息肉的不典型增生的 35 名妇女中进行了子宫切除术。组织病理学评估显示，12 名妇女（30.8%）子宫内膜无额外（前）恶性改变，11 名妇女（28.2%）存在不典型增生，12 名妇女（30.8%）存在子宫内膜癌。所考虑的预后因素均与息肉中的（前）恶性变化无显著相关性。
在本研究中，完全切除伴不典型增生的息肉后，子宫内膜癌在周围子宫内膜中的发生率为 30.8%。这支持目前关于行子宫切除术和双侧输卵管卵巢切除术的建议。未确定息肉中（前）恶性变化的预后因素。
完全切除伴不典型增生的息肉后子宫内膜癌的发生率较高。
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