title: Suspecting malignancy in endometrial polyps: value of hysteroscopy.
abstract: OBJECTIVE
  Hysteroscopic polypectomy is the gold standard to treat endometrial polyps and obtain specimens for histological evaluation. There is continuing debate as to when to offer hysteroscopic polypectomy, especially in asymptomatic women with incidental lesions. The aims of this study were to assess the accuracy of hysteroscopy and Vabra sampling in diagnosing atypical hyperplasia and cancer growing on the surface of endometrial polyps and to investigate the association between atypical endometrial polyps and some potential clinical risk factors.
  
  
  METHODS
  This was a retrospective study. We assessed 1039 hysteroscopies and we identified 345 women with endometrial polyps. All patients with endometrial polyps underwent hysteroscopic polypectomy. Data about age, menopausal status, abnormal uterine bleeding (AUB), hormone replacement therapy and tamoxifen use were collected. Hysteroscopic, histological and clinical data were analyzed.
  
  
  RESULTS
  The incidence of endometrial hyperplasia or cancer growing on the surface of endometrial polyps was significantly low (1.7%). Hysteroscopy correctly excluded (negative predictive value: 100%) and accurately predicted (positive predictive value: 85.7%) preneoplastic or neoplastic lesions growing within the epithelial layer of endometrial polyps. Vabra sampling was inadequate for the histological diagnosis in 38.5% of cases. Age over 60 years and postmenopausal AUB were associated with an 8.3-fold ( P = 0.022) and 8.8-fold (P = 0.020) increased risk, respectively, of preneoplastic and neoplastic lesions growing on the surface of endometrial polyps.
  
  
  CONCLUSIONS
  Diagnostic hysteroscopy is a good tool to predict malignancy of the epithelial layer of endometrial polyps. Age over 60 years and AUB are associated with an increased risk of malignant polyps. Few suspicious endometrial polyps should undergo surgical resection.
authors.affiliation: Academic Division of Gynecological Oncology, Mauriziano Hospital, Turin, Italy. albertodaniele@hotmail.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Daniele
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ferrero
authors.forename: Furio
authors.initials: F
authors.lastname: Maggiorotto
authors.forename: Gaetano
authors.initials: G
authors.lastname: Perrini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Volpi
authors.forename: Piero
authors.initials: P
authors.lastname: Sismondi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D003937:Diagnosis, Differential; D004714:Endometrial Hyperplasia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000175:diagnosis