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Bougie O, Randle E, Thurston J, Magee B, Warshafsky C, Rittenberg D. Directive clinique n o 447 : Diagnostic et prise en charge des polypes endométriaux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102403. [PMID: 38331092 DOI: 10.1016/j.jogc.2024.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
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Bougie O, Randle E, Thurston J, Magee B, Warshafsky C, Rittenberg D. Guideline No. 447: Diagnosis and Management of Endometrial Polyps. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102402. [PMID: 38325734 DOI: 10.1016/j.jogc.2024.102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the diagnosis and management of endometrial polyps. TARGET POPULATION All patients with symptomatic or asymptomatic endometrial polyps. OPTIONS Options for management of endometrial polyps include expectant, medical, and surgical management. These will depend on symptoms, risks for malignancy, and patient choice. OUTCOMES Outcomes include resolution of symptoms, histopathological diagnosis, and complete removal of the polyp. BENEFITS, HARMS, AND COSTS The implementation of this guideline aims to benefit patients with symptomatic or asymptomatic endometrial polyps and provide physicians with an evidence-based approach toward diagnosis and management (including expectant, medical, and surgical management) of polyps. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane: endometrial polyps, polyps, endometrial thickening, abnormal uterine bleeding, postmenopausal bleeding, endometrial hyperplasia, endometrial cancer, hormonal therapy, female infertility. All articles were included in the literature search up to 2021 and the following study types were included: randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Gynaecologists, family physicians, registered nurses, nurse practitioners, medical students, and residents and fellows. TWEETABLE ABSTRACT Uterine polyps are common and can cause abnormal bleeding, infertility, or bleeding after menopause. If patients don't experience symptoms, treatment is often not necessary. Polyps can be treated with medication but often a surgery will be necessary. SUMMARY STATEMENTS RECOMMENDATIONS.
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Liang J, Ali F, Ramaiyer M, Borahay MA. Determinants and Assessment of Menstrual Blood Flow. CURR EPIDEMIOL REP 2023; 10:210-220. [PMID: 38275001 PMCID: PMC10810143 DOI: 10.1007/s40471-023-00332-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/27/2024]
Abstract
Purpose of review a)The modifiable and non-modifiable determinants and the currently available methods of assessment of menstrual blood flow will be discussed, with the goal of helping healthcare providers, researchers, and those interested in public health. Recent findings b)Several factors can impact menstruation. The determinants include modifiable factors such as smoking, nutrition, exercise, stress, weight fluctuation, and benign gynecologic diseases, and non-modifiable factors such as age, race, and the individual's genes. The intertwined dynamic among these determinants needs more critical attention. Currently, the methods for the assessment of menstruation all have advantages and disadvantages, often with a tradeoff between practicality and accuracy. Summary c)Considered by many as the fifth vital, menstruation provides a window to an individual's general health. The discussion of its determinants and assessment can be more appropriate for individual contexts, especially from a public health perspective as it can improve the reproductive health of the population.
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Affiliation(s)
- Jinxiao Liang
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fiza Ali
- Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Malini Ramaiyer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
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Rout D, Sinha A, Palo SK, Kanungo S, Pati S. Prevalence and determinants of hysterectomy in India. Sci Rep 2023; 13:14569. [PMID: 37666936 PMCID: PMC10477345 DOI: 10.1038/s41598-023-41863-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023] Open
Abstract
Increase in the prevalence of hysterectomy among low-and middle-income countries (LMICs) such as India has become a significant concern. Reports based on either a particular group or region show an increasing trend in hysterectomy, but there is a dearth of national-level data in this domain. Hence, there seems to be an urgent need to garner evidence on the prevalence and determinants of hysterectomy, which could pave the way for future programs and policies. We aimed to estimate the prevalence of hysterectomy and assess its determinants using a nationally representative sample. An observational analysis was conducted using data from Longitudinal Aging Study in India (LASI), 2017-2018. 38,154 women aged > 18 years were included. A multivariable logistic regression, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI), was used to predict the association between various socio-demographic characteristics and hysterectomy. A separate multivariable logistic regression model was executed to determine the association between selected non-communicable diseases (NCDs) and hysterectomy. Survey weights compensated the complex study design. The overall prevalence of hysterectomy was around 11.35%. Excessive menstrual bleeding followed by fibroids emerged as the leading causes of hysterectomy. The various determinants of hysterectomy were urban residents [AOR: 1.54 (1.21-1.96)], other backward class [AOR: 2.19 (1.72-2.78], working women [AOR: 1.19(1-1.42)] and the most affluent (rich) group [AOR: 2.06 (1.62-2.63)]. Hysterectomy was associated with cancer [AOR: 4.83 (2.51-9.29)], diabetes [AOR: 1.79 (1.25-2.57)], hypertension [AOR: 1.48 (1.27-1.71)] and joint diseases [AOR: 1.43 (1.09-1.88)]. Hysterectomy is considerably prevalent in India, which cannot be overlooked. Health promotion regarding hysterectomy and its implications is needed especially among urban residents, affluent groups and those with a higher body mass index. Health programmes aimed at women should follow a life course approach by prioritizing health and overall well-being even after reproductive years.
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Affiliation(s)
- Dejalin Rout
- ICMR-Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, 751023, Odisha, India
| | - Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, 751023, Odisha, India
| | - Subrata Kumar Palo
- ICMR-Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, 751023, Odisha, India
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, 751023, Odisha, India.
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, 751023, Odisha, India.
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Mak KS, Huang YT, Su YY, Pan YB, Lin YS, Weng CH, Wu KY, Chao AS, Wang CJ. Clinical outcomes in women with endometrial polyps underwent conservative management. Taiwan J Obstet Gynecol 2023; 62:553-558. [PMID: 37407193 DOI: 10.1016/j.tjog.2022.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE To evaluate the regression rate of endometrial polyps (EPs) in a cohort of asymmetric women after conservative follow-up. MATERIALS AND METHODS In this retrospective cohort study, a total of 1006 women with asymptomatic EPs were treated with expectant management or hormonal drugs between June 1999 and May 2018. Four hundred forty-eight women (44.5%) were administered with hormonal medications and 558 women were managed expectantly (55.5%). Office hysteroscopy was performed to confirm the diagnosis and regression of EPs. Hormonal administration included oral contraceptives, progestin and cyclic estrogen/progestin regimen according to physicians' preferences. Clinical characteristics, including the patient's age, body mass index, parity, and type of conservative management were collected. RESULTS The mean observation time was 14.1 ± 18.5 months (range, 1-162 months). The overall regression rate of EPs in this cohort was 33.5%, 24.6% occurred after medication and 8.9% after expectant management. Patient age (<50 years) (p < 0.001), follow-up period (p = 0.005) and hormonal drugs used (p < 0.001) were significantly associated with EP regression. Twenty-four (7.1%) of the 337 EP regression patients later developed recurrent disease. Follow-up period (p < 0.001) and hormonal drugs used (p = 0.032) were closely related to polyp recurrence after initial regression. Nevertheless, multivariate logistic regression analysis revealed that hormonal drugs used was significantly associated with the regression (p < 0.001) and recurrence (p = 0.016) of EPs. CONCLUSION Women aged 50 or less are more suitable for conservative treatment for EPs. Hormonal drugs used could increase the incidence of EP regression.
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Affiliation(s)
- Kit-Sum Mak
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yi-Ting Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yu-Ying Su
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan
| | - Yu-Shan Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Cindy Hsuan Weng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Molnár S, Farkas Z, Jakab A, Lampé R, Török P. Effectiveness of different methods for polypectomy in the menopause: a retrospective study. Climacteric 2021; 23:325-329. [PMID: 32648828 DOI: 10.1080/13697137.2020.1732915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.
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Affiliation(s)
- S Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Z Farkas
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - P Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio Sardo A, Carugno J. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol 2021; 260:70-77. [PMID: 33756339 DOI: 10.1016/j.ejogrb.2021.03.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide an updated practice guideline for the management of patients with endometrial polyps. MATERIALS AND METHODS A committee of six expert researchers draw the recommendations according to AGREE II Reporting Guideline. An electronic search was performed querying the following databases MEDLINE (accessed through PubMed), Scopus, PROSPERO, EMBASE, CINAHL, Cochrane Library (including the Cochrane Database of Systematic Reviews), Scielo.br, Google Scholar, from inception to May 2020. A combination of text-words and Medical Subject Headings (MeSH) regarding endometrial polyps, diagnosis, management and treatment was used. Trials were assessed for methodologic rigor and graded using the United States Preventive Services Task Force classification system. RECOMMENDATIONS Transvaginal ultrasonography (TVUS) should be the imaging modality of choice for the detection of endometrial polyps in woman of fertile age (level B). Its accuracy increases when color-doppler, 3D investigation and contrast are used (level B). Dilation and Curettage (D&C) should be avoided for the diagnosis and management of polyps (level A). In office hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps (level B). Polyps might alter endometrial receptivity, and embryo implantation reducing pregnancy rates (level C). Hysteroscopic polypectomy is feasible and safe with negligeble risk of intrauterine adhesion formation (level B). Polypectomy does not compromise reproductive outcomes from subsequent IVF procedures but the removal of polyps as a routine practice in sub-fertile women is not currently supported by the evidence (level B). Cost-effectiveness analysis suggest performing office polypectomy in women desiring to conceive (level B). Saline infused sonohysterography is highly accurate in detecting polyps in asymptomatic postmenopausal women (level B). Postmenopausal women with vaginal bleeding and suspected endometrial polyp should be offered diagnostic hysteroscopy with hysteroscopic polypectomy if endometrial polyps are present (level B). In-office hysteroscopy has the highest diagnostic accuracy with high cost-benefits ratio for premalignant and malignant pathologies of the uterine cavity (level B). Due to risk of malignancy, histopathological analysis of the polyp is mandatory (level B). Blind D&C should be avoided due to inaccuracy for the diagnosis of focal endometrial pathology (level A). Expectant management is not recommended in symptomatic patients especially in postmenopausal women (level B). In case of atypical hyperplasia or carcinoma on a polyp, hysterectomy is recommended in all post-menopausal patients and in premenopausal patients without desire of future fertility (level B). Asymptomatic endometrial polyps in postmenopausal women should be removed in case of large diameter (> 2 cm) or in patients with risk factors for endometrial carcinoma (level B). Excision of polyps smaller than 2 cm in asymptomatic postmenopausal patients has no impact on cost-effectiveness or survival (level B). Removal of asymptomatic polyps in premenopausal women should be considered in patients with risk factors for endometrial cancer (level B).
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Affiliation(s)
- Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Luis Alonso
- Centro Gutenberg, Endoscopy Unit, Malaga, Spain
| | | | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, 1321 NW 14(th) Street Suite 201, Miami, FL 33136, USA.
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Drizi A, Djokovic D, Laganà AS, van Herendael B. Impaired inflammatory state of the endometrium: a multifaceted approach to endometrial inflammation. Current insights and future directions. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:90-100. [PMID: 32802019 PMCID: PMC7422289 DOI: 10.5114/pm.2020.97863] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022]
Abstract
New insights into the complex and fine-regulated inflammatory mechanisms involved in the endometrium reveal multiple facets to the problem of endometrial inflammation. However, the entity termed chronic endometritis is to date restricted to infectious etiology and managed with antibiotics. Conversely, the concept of impaired inflammatory state of the endometrium (IISE) provides a more global approach to defective endometrial inflammation, considering both infectious and non-infectious etiology. A non-systematic review was done through a search on MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database and Web of Science, research registers. Pertinent original and review articles, published in English or French until December 31, 2019, were selected. A compelling body of evidence demonstrates transient, repeated and persistent IISE to be a major factor of most problematic disorders in obstetrics/gynecology, such as endometrial polyps, unexplained infertility, miscarriage, placenta-related pathology and endometrial cancer. When scheduled accordingly, hysteroscopy can play a key role in the IISE assessment. Robust data suggests the pertinence of minimal-effective anti-inflammatory regimens for therapeutic IISE targeting. This review provides a comprehensive update on the multiple facets of inflammation in the endometrial physiology and pathology. Further research is needed to improve classification, diagnosis and treatment of IISE.
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Affiliation(s)
- Amal Drizi
- Independent consultant in Obstetrics and Gynecology, Algiers, Algeria
| | - Dusan Djokovic
- Department of Obstetrics and Gynecology, Nova Medical School – Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
- Department of Obstetrics and Gynecology, Hospital S. Francisco Xavier – Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Bruno van Herendael
- Department of Minimally Invasive Gynecologic Surgery, Stuivenberg General Hospital, Antwerp, Belgium
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Kossaï M, Penault-Llorca F. Role of Hormones in Common Benign Uterine Lesions: Endometrial Polyps, Leiomyomas, and Adenomyosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1242:37-58. [PMID: 32406027 DOI: 10.1007/978-3-030-38474-6_3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Leiomyoma, adenomyosis, and endometrial polyps are benign uterine disorders which seem to develop in the context of hormonal imbalances, due to steroid hormones, estrogen and progesterone, in association with various factors ranging from genetic factors to modifiable lifestyle factors. A growing body of evidence suggests that those hormones and their receptors are key modulators in the genesis and the growth of those pathologic entities. Further studies are required to understand their involvement in the pathogenesis of those lesions and their link to other factors such as extracellular matrix components, growth factors, chemokines, cytokines, and tissue repair mechanisms.
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Affiliation(s)
- Myriam Kossaï
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France. .,UMR INSERM 1240, Universite Clermont Auvergne, Clermont-Ferrand, France.
| | - Frédérique Penault-Llorca
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France. .,UMR INSERM 1240, Universite Clermont Auvergne, Clermont-Ferrand, France.
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Al-Madani W, Ahmed AE, Arabi H, Al Khodairy S, Al Mutairi N, Jazieh AR. Modelling risk assessment for cervical cancer in symptomatic Saudi women. Saudi Med J 2019; 40:447-451. [PMID: 31056620 PMCID: PMC6535164 DOI: 10.15537/smj.2019.5.24085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/14/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess whether the utility of cervical cancer screening could be improved by combining multiple factors in addition to the pap test. Methods: A retrospective cohort study of 300 symptomatic women who were suspected to have cervical cancer and referred for biopsy examination at King Abdulaziz Medical City, Riyadh, Saudi Arabia between February 2017 and December 2017. Results: A high risk of cervical cancer in Saudi women was associated with 4 risk factors: family history (adjusted odds ratio [aOR], 4.216; 95% confidence intervals [CI], 1.433-12.400), vaginal bleeding (aOR, 3.959; 95% CI, 1.272-12.318), hypertension (aOR, 4.554; 95% CI, 1.606-12.912), and an abnormal pap smear test (aOR, 13.985; 95% CI, 5.108-38.284). The model yields an adequate utility (area under the curve, 87.5%, 95% CI, 80.9-94.0%) with acceptable goodness-of-fit (p=0.6915). Conclusion: The pap smear test alone is inadequate to assess high risk for cervical cancer in our center. Early detection of cervical cancer may require consideration of a combination of factors including the pap test. This study has shown that using a combination of abnormal family history, vaginal bleeding, hypertension, and the pap smear test improved the effectiveness of cervical cancer screening.
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Affiliation(s)
- Wedad Al-Madani
- Department of National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Abstract
OBJECTIVE We analyzed tamoxifen use as a malignancy risk factor in women with endometrial polyps. METHODS This retrospective study included 675 women who underwent hysteroscopic polypectomy in 2010 to 2015 at the University of Campinas. Women were divided into tamoxifen use (n = 169) and no tamoxifen use (n = 506) groups. The primary outcome was endometrial cancer prevalence. Dependent variables included age, parity, years since menopause, presence of abnormal uterine bleeding, endometrial pattern on hysteroscopy, and endometrial thickness. RESULTS There were seven cases of endometrial cancer in the tamoxifen use group (4.14%) and 41 in the no tamoxifen use group (8.1%; P = 0.083). On performing multivariate analysis, tamoxifen use was not a risk factor for endometrial cancer (prevalence ratio 0.51, 95% confidence interval [CI] 0.23-1.14, P = 0.101). The no tamoxifen use group had an increased prevalence of malignancy when women presented with abnormal uterine bleeding (prevalence ratio 3.9, 95% CI 2.08-7.29, P < 0.001), age >60 years (prevalence ratio 2.1, 95% CI 1.12-3.93, P = 0.021), or nulliparous status (prevalence ratio 3.13, 95% CI 1.55-6.35, P = 0.002). The tamoxifen use group had increased prevalence of malignancy when women were >60 years (prevalence ratio 7.85, 95% CI 1.05-58.87, P = 0.006) or nulliparous (prevalence ratio 8.36, 95% CI 2.32-30.11, P < 0.001). CONCLUSION Tamoxifen use was not related with a higher prevalence of endometrial cancer in women with endometrial polyps. Abnormal uterine bleeding, age > 60 years, and nulliparous status were associated with malignancy.
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Marnach ML, Laughlin-Tommaso SK. Evaluation and Management of Abnormal Uterine Bleeding. Mayo Clin Proc 2019; 94:326-335. [PMID: 30711128 DOI: 10.1016/j.mayocp.2018.12.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022]
Abstract
Abnormal uterine bleeding (AUB) is a common condition that leads to increased health care costs and decreased quality of life. A systematic approach to AUB evaluation can simplify management and enhance women's well-being. Abnormal uterine bleeding describes any variation from normal bleeding patterns in nonpregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Ambiguous and inconsistent use of terminology and definitions to characterize AUB in the past decades necessitated a new, consensus-based approach to nomenclature and AUB evaluation. This led to the International Federation of Gynecology and Obstetrics (FIGO) System 1 in 2007, which standardized nomenclature, set parameters, and defined normal and abnormal bleeding based on the 5th to 95th percentile data from available large-scale epidemiologic studies. FIGO System 1, endorsed by several national and international societies, improved worldwide communication among educators, clinicians, and researchers. FIGO System 2, published in 2011, focused on classifications of AUB etiology into structural and nonstructural entities using the PALM-COEIN (polyp[s], adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial disorders, iatrogenic, and not yet classified) classification system. The PALM-COEIN classification is facilitated by a complete patient history combined with appropriate imaging, histopathologic analysis, or laboratory evaluation to ensure accurate diagnostic and treatment approaches to AUB. Herein we present the systematic evaluation of AUB.
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Affiliation(s)
- Mary L Marnach
- Division of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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Venturella R, Miele G, Cefalì K, Lico D, D'Alessandro P, Arduino B, Di Cello A, Zullo F, Di Carlo C. Subcutaneous Progesterone for Endometrial Polyps in Premenopausal Women: A Preliminary Retrospective Analysis. J Minim Invasive Gynecol 2019; 26:143-147. [DOI: 10.1016/j.jmig.2018.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022]
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Peres GF, Spadoto-Dias D, Bueloni-Dias FN, Leite NJ, Elias LV, Domingues MAC, Padovani CR, Dias R. Immunohistochemical expression of hormone receptors, Ki-67, endoglin (CD105), claudins 3 and 4, MMP-2 and -9 in endometrial polyps and endometrial cancer type I. Onco Targets Ther 2018; 11:3949-3958. [PMID: 30022838 PMCID: PMC6042493 DOI: 10.2147/ott.s160014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective The aim of this study was to investigate the malignant potential of endometrial polyps (EP) by assessing the immunoexpressions of both estrogen receptor (ER) and progesterone receptor (PR), Ki-67 cell proliferation index, neovascularization network (endoglin – CD105), cellular adhesion molecules (claudins 3 and 4), and extracellular matrix proteins (MMP-2 and -9) in both EP and endometrioid adenocarcinoma (type I) in comparison with the normal endometrium. Study design This is a cross-sectional comparative study. Patients were identified from the database of Botucatu Medical School, São Paulo State University (BMS-UNESP) Clinical Pathology Laboratory. Setting The study was conducted using a convenience sample of patients attending the Sectors of Gynecologic Endoscopy and Family Planning and Gynecologic Oncology of the Department of Gynecology and Obstetrics of BMS-UNESP, Brazil. Patients A total of 90 women were allocated into the following three groups: EP without atypia (EP, n=30), endometrioid endometrial cancer (EC, n=30), and normal endometrium (control, n=30). Methods Epidemiological and clinical data were obtained by reviewing medical records. Adenocarcinoma and control cases were assessed using the tissue microarray technique. The immunoexpressions of ER, PR, Ki-67, CD105, claudins 3 and 4, and MMP-2 and -9 were assessed in paraffin blocks containing sections of the largest polyploid lesion fragment and tissue microarray recipient blocks. Major results Compared to the control group, significant differences in the expression of ER (P<0.001), PR (P<0.05), Ki-67 (P<0.001), CD105 (P<0.001), and claudin 3 (P<0.001) were observed in EP and EC. No significant differences were found between EP and EC (P≥0.05). MMP-2 and -9 expression were nearly absent in all groups. Conclusion The malignant potential of EP could not be determined through the immunohistochemical parameters used in this study. No MMP-2 or -9 expression was observed in any endometrial tissue sample. Further studies are necessary for a better understanding of the biomolecular mechanisms underlying endometrial carcinogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Carlos Roberto Padovani
- Department of Biostatistics, Institute of Biosciences, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
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Abstract
OBJECTIVE The aim of the study was to evaluate clinical predictive factors for endometrial polyps in postmenopausal women compared with postmenopausal women without polyps. METHODS In this cross-sectional study, 132 Brazilian women with a histopathological diagnosis of endometrial polyps were compared with 264 women without endometrial alterations (control). The study group included women aged at least 45 years with amenorrhea for at least 12 months, who underwent hysteroscopic polypectomy. The control group consisted of women aged at least 45 years with amenorrhea for at least 12 months, without postmenopausal bleeding and endometrial thickness less than 5 mm by transvaginal ultrasonography. Clinical, anthropometric (body mass index and waist circumference), laboratory, and ultrasonographic data were collected to evaluate predictive factors for endometrial polyps. The Student's t test, χ test, and logistic regression (odds ratio [OR]) were used for statistical analysis. RESULTS A higher percentage of women with polyps were obese (72%) when compared with control (39%) (P < 0.0001). Waist circumference was greater among women with polyps (P = 0.0001). The incidence of diabetes, hypertension, and dyslipidemia was higher among women with endometrial polyps (P < 0.0001). According to the diagnostic criteria of the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III), 48.5% of the women with polyps and 33.3% of the controls were classified as having metabolic syndrome (MetS) (P = 0.004). The risk of endometrial polyps was higher in women with body mass index at least 25 kg/m (OR = 4.66; 95% CI 2.16-10.05); glucose at least 100 mg/dL (OR = 2.83; 95% CI 1.36-5.90); dyslipidemia (OR = 7.02; 95% CI 3.70-13.32); diabetes (OR = 2.58; 95% CI 1.05-6.32); and MetS (OR = 2.76; 95% CI 1.18-6.46) when compared with control, adjusted for age, and time since menopause. CONCLUSIONS In postmenopausal women, obesity, dyslipidemia, hyperglycemia, and the presence of MetS were predictive factors for endometrial polyps.
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Daniele A, Ferrero A, Maggiorotto F, Perrini G, Volpi E, Sismondi P. Suspecting Malignancy in Endometrial Polyps: Value of Hysteroscopy. TUMORI JOURNAL 2018; 99:204-9. [DOI: 10.1177/030089161309900214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background 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 and study design 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.
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Affiliation(s)
- Alberto Daniele
- Academic Division of Gynecological Oncology, Mauriziano Hospital, Turin
| | - Annamaria Ferrero
- Academic Division of Gynecological Oncology, Mauriziano Hospital, Turin
| | | | - Gaetano Perrini
- Academic Division of Gynecological Oncology, Mauriziano Hospital, Turin
| | - Eugenio Volpi
- Division of Obstetrics and Gynecology, La Spezia Hospital, La Spezia, Italy
| | - Piero Sismondi
- Academic Division of Gynecological Oncology, Mauriziano Hospital, Turin
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Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, Sleiman Z, Campo R, Gordts S. The management of polyps in female reproductive organs. Int J Surg 2017; 43:7-16. [DOI: 10.1016/j.ijsu.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Wong M, Crnobrnja B, Liberale V, Dharmarajah K, Widschwendter M, Jurkovic D. The natural history of endometrial polyps. Hum Reprod 2016; 32:340-345. [PMID: 27994000 DOI: 10.1093/humrep/dew307] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/31/2016] [Accepted: 11/05/2016] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION What is the natural history of endometrial polyps in women who are managed expectantly? SUMMARY ANSWER The growth rates of expectantly managed polyps vary considerably and cannot be accurately predicted. WHAT IS KNOWN ALREADY The majority of polyps detected on ultrasound are treated surgically, and therefore little is known about their natural history. Some polyps have been reported to regress spontaneously without the need for treatment; however, the factors predictive of regression are unknown. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study conducted at the Department of Gynaecology, University College London Hospitals. We searched our ultrasound clinic database between July 1997 and September 2015, to identify women aged 18 years or older with endometrial polyps that were managed expectantly for ≥6 months. All women attended for a minimum of two ultrasound scans. PARTICIPANTS/MATERIALS, SETTING, METHODS A single expert operator performed all ultrasound scans. Those with <6-month follow-up and those who were taking hormonal contraception, HRT or tamoxifen were excluded from the study. The mean diameter of each polyp was calculated from the measurements in three perpendicular planes. The polyp growth rate was expressed as annual percentage change in the mean diameter. Non-parametric tests and the Fisher's exact test were used to compare differences in polyp mean diameters and growth rates between women of different demographic characteristics. To correct for multiple significance testing, we used the Bonferroni method, giving the level of probability at which findings were considered significant as P < 0.0029 (as 17 tests were undertaken). MAIN RESULTS AND THE ROLE OF CHANCE We included 112 women with endometrial polyps, which were expectantly managed over a median period of 22.5 months (range, 6-136). The annual endometrial polyp growth rate varied with a median of 1.0% (interquartile range, -6.5 to 14.3). There was no association between women's demographic characteristics or polyps' morphology and their growth rates. Eleven out of 75 (15% (95% CI, 6.9%-23.1%)) women who initially did not have abnormal uterine bleeding subsequently developed abnormal bleeding during the follow-up period. Polyp growth rate was not associated with the subsequent development of abnormal uterine bleeding (P = 0.397). Seven out of 112 (6.3% (95% CI, 1.8%-10.8%)) women had complete regression of their polyps without treatment during a median follow-up period of 28 months (range, 9-56). Spontaneous regression appeared to occur more frequently in premenopausal women (P = 0.016) and in those who presented with abnormal uterine bleeding at diagnosis (P = 0.004); however, the differences did not reach statistical significance after correction for multiple comparisons. LIMITATIONS, REASONS FOR CAUTION This study was retrospective and therefore may be prone to selection and information biases. The lack of histological confirmation on all ultrasound diagnoses may also be considered as a limitation. WIDER IMPLICATIONS OF THE FINDINGS Women should be advised that the growth pattern of an individual polyp cannot be accurately predicted; however, a small proportion of polyps do regress spontaneously. There was no correlation between polyps' growth rate and the subsequent development of abnormal uterine bleeding. In view of that, routine monitoring of asymptomatic polyps by ultrasound is not helpful and encouraging women to report clinical symptoms is more useful in deciding whether treatment is required. In contrast to previous studies, we found that polyps may regress more frequently in premenopausal women and in those who presented with abnormal uterine bleeding; a larger sample size would give us greater power to detect a difference in these subgroups of women. STUDY FUNDING/COMPETING INTERESTS No study funding was received and no competing interests are present. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Wong
- Department of Gynaecology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - B Crnobrnja
- Department of Gynaecology, Univerzitetni Klinicni Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - V Liberale
- Department of Gynaecology, Umberto I Hospital, Largo Filippo Turati 62, 10128 Torino, Italy
| | - K Dharmarajah
- Department of Gynaecology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - M Widschwendter
- Department of Gynaecology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - D Jurkovic
- Department of Gynaecology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
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Spadoto-Dias D, Bueloni-Dias FN, Elias LV, Leite NJ, Modotti WP, Lasmar RB, Dias R. The value of hysteroscopic biopsy in the diagnosis of endometrial polyps. ACTA ACUST UNITED AC 2016; 12:412-9. [PMID: 27638896 DOI: 10.1177/1745505716653695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/22/2016] [Indexed: 11/15/2022]
Abstract
Several studies have demonstrated that the combination of hysteroscopy with endometrial biopsy is more accurate in differentiating endometrial polyps from endometrial hyperplasia and cancer. However, blind biopsy not always confirms hysteroscopic findings due to high rates of inadequate or insufficient material. The objective of this clinical, prospective, and comparative study was to establish a correlation between the histological results of office-based endometrial biopsies (hysteroscopically guided and blind) with the surgical polypectomy specimens. We evaluated 82 patients with hysteroscopic diagnosis of endometrial polyp, who randomly underwent hysteroscopically guided biopsy or blind biopsy, referred for surgical resection. A total of 36 women (43.9%) underwent hysteroscopically guided biopsy and 46 women (56.1%) underwent blind biopsy. The sensitivity of hysteroscopically guided biopsy for the diagnosis of endometrial polyps ranged between 35.3 and 36.8%, when carried out at the apex and base of the lesion, compared with 29.2% for blind biopsy. Specificity was 33.3, 50, and 60%, respectively, for each biopsy. The positive predictive values were 75, 77.8, and 87.5%, and negative predictive values were 8.3, 14.3, and 8.1% respectively, compared with surgical polypectomy specimens. The office-based endometrial biopsies had low diagnostic accuracy for endometrial polyps compared with surgical polypectomy specimens.
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Affiliation(s)
- Daniel Spadoto-Dias
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University-FMB/UNESP, Botucatu, Brazil
| | - Flávia Neves Bueloni-Dias
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University-FMB/UNESP, Botucatu, Brazil
| | - Leonardo Vieira Elias
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University-FMB/UNESP, Botucatu, Brazil
| | - Nilton José Leite
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University-FMB/UNESP, Botucatu, Brazil
| | | | | | - Rogério Dias
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University-FMB/UNESP, Botucatu, Brazil
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Unler GK, Gokturk HS, Toprak E, Erinanc OH, Korkmaz H. Does the Presence of Endometrial Polyp Predict Colorectal Polyp? Am J Med Sci 2016; 351:129-32. [PMID: 26897266 DOI: 10.1016/j.amjms.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/22/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Endometrial polyps (EPs) and colorectal polyps (CPs) are common disorders and the incidence of both increase rapidly with aging. CPs are focal lesions and incidence increases with age. AIM In this study, we aimed to analyze retrospectively the relationship between the EPs and CPs sharing similar clinical and genetic factors in their etiopathogenesis. MATERIALS AND METHODS This study was retrospectively performed between 2010 and 2013 and it included patients diagnosed to have eEPs. The study group and the control group consisted of patients who were diagnosed with or without EPs and who underwent colonoscopy at the same period. RESULTS The study group was formed by 57 patients with diagnosis of EP who underwent colonoscopy during the same period. The control group consisted of 71 patients without EP examined with colonoscopy. Among 128 patients assessed in this study, 24 were diagnosed with CPs, all of which were adenomatous polyps smaller than 1cm. No hyperplastic or inflammatory polyps were diagnosed. While 18 of 57 patients with EPs had CPs, 6 of 71 control subjects had CPs. Hence, the risk of having CP was 5 times greater in patients with EP compared to those without (P < 0.05). CONCLUSION The present study demonstrated that the prevalence of CPs increased significantly in postmenopausal patients with EPs. Recommending colonoscopy to these patients irrespective of age may be beneficial for detecting more CPs and preventing colorectal cancer.
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Affiliation(s)
- Gulhan Kanat Unler
- Department of Gastroenterology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Huseyin Savas Gokturk
- Department of Gastroenterology, Baskent University Faculty of Medicine, Konya, Turkey.
| | - Erzat Toprak
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Ozgur Hilal Erinanc
- Department of Pathology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Huseyin Korkmaz
- Department of Gastroenterology, Selcuk University Faculty of Medicine, Konya, Turkey
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Kınay T, Öztürk Başarır Z, Fırtına Tuncer S, Akpınar F, Kayıkçıoğlu F, Koç S. Prevalence of endometrial polyps coexisting with uterine fibroids and associated factors. Turk J Obstet Gynecol 2016; 13:31-36. [PMID: 28913086 PMCID: PMC5558353 DOI: 10.4274/tjod.36043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/19/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate the prevalence of endometrial polyps in patients with uterine fibroids and associated factors of coexistence of these two pathologies. MATERIALS AND METHODS The medical records of 772 patients who underwent hysterectomy because of uterine fibroids were retrospectively reviewed. Patients were divided into two groups according to the presence of endometrial polyps in the histopathologic examination. Demographic, clinical and histopathologic findings of the patients with and without endometrial polyps were compared. Student's t-test, Mann-Whitney U test, Pearson's Chi-square test, and logistic regression analysis were used for statistical analysis. RESULTS The prevalence of the endometrial polyps in uterine fibroid cases was found 20.1% (n=155). Age ≥45 years (odds ratio [OR] 1.61; 95% confidence interval [CI]: [1.06-2.44]; p=0.014), presence of hypertension (23.9% vs. 17.5%; p=0.047), endometrial hyperplasia (OR 4.00; 95% CI: [1.92-8.33]; p<0.001) and cervical polyps (OR 3.13; 95% CI: [1.69-5.88]; p<0.001) were significantly associated with the coexistence of endometrial polyps and uterine fibroids. Endometrial polyps were more common in patients with ≥2 fibroids (p=0.023) and largest fibroid <8 cm (p=0.009). A negative correlation was found between condom use and endometrial polyps (8.1% vs. 3.9%; p=0.044). CONCLUSIONS The prevalence of the endometrial polyps coexisting with uterine fibroids was 20.1%. Age, hypertension, endometrial hyperplasia, cervical polyps, and number of fibroids were positively correlated; condom use and size of largest fibroid were negatively correlated with the coexistence of these two pathologies.
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Affiliation(s)
- Tuğba Kınay
- Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Zehra Öztürk Başarır
- Zekai Tahir Burak Women’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Serap Fırtına Tuncer
- Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Funda Akpınar
- Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Fulya Kayıkçıoğlu
- Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Sevgi Koç
- Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review. Surg Res Pract 2015; 2015:914390. [PMID: 26301260 PMCID: PMC4537769 DOI: 10.1155/2015/914390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/26/2015] [Indexed: 11/18/2022] Open
Abstract
Endometrial polyps are benign localized lesions of the endometrium, which are commonly seen in women of reproductive age. Observational studies have suggested a detrimental effect of endometrial polyps on fertility. The natural course of endometrial polyps remains unclear. Expectant management of small and asymptomatic polyps is reasonable in many cases. However, surgical resection of endometrial polyps is recommended in infertile patients prior to treatment in order to increase natural conception or assisted reproductive pregnancy rates. There is mixed evidence regarding the resection of newly diagnosed endometrial polyps during ovarian stimulation to improve the outcomes of fresh in vitro fertilization cycles. Hysteroscopy polypectomy remains the gold standard for surgical treatment. Evidence regarding the cost and efficacy of different methods for hysteroscopic resection of endometrial polyps in the office and outpatient surgical settings has begun to emerge.
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de Godoy Borges PC, Dias R, Machado RB, Borges JBR, Dias DS. Transvaginal Ultrasonography and Hysteroscopy as Predictors of Endometrial Polyps in Postmenopause. WOMENS HEALTH 2015; 11:29-33. [DOI: 10.2217/whe.14.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The study compared ultrasound and ambulatorial hysteroscopy as diagnostic methods detecting endometrial polyps in postmenopause women. 281 women aged 41–82 years who underwent ambulatorial hysteroscopy were analyzed for presence of uterine bleeding and/or altered transvaginal ultrasound (endometrial thickness ≥5 mm). Ultrasonography detected endometrial polyps in 22.8% of patients and endometrial thickening in the other 59.8%. Hysteroscopy diagnosed endometrial polyps in 80.8%. Ultrasonography showed sensitivity of 88.7%, specificity of 25.4%, positive predictive value of 81.7%, negative predictive value of 37.5% and accuracy of 75.4% in diagnosing endometrial polyps. Hysteroscopy showed 96.4% sensitivity, 74.6% specificity, 93.4% positive predictive value, 84.6% negative predictive value and 91.8% accuracy. Hysteroscopy demonstrated more accuracy than ultrasonography, which is not sufficient for accurate diagnosis.
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Affiliation(s)
- Pítia Cárita de Godoy Borges
- Department of Gynecology & Obstetrics, Faculdade de Medicina de Jundiaí, São Paulo, Brasi
- Post Graduation Program in Gynecology, Obstetrics, & Mastology, Faculdade de Medicina de Botucatu da Universidade Estadual Paulista “Júlio de Mesquita Filho“- UN ESP- Botucatu (SP), Brasil
| | - Rogério Dias
- Department of Gynecology, Obstetrics, & Mastology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazi
| | | | | | - Daniel Spadoto Dias
- Post Graduation Program in Gynecology, Obstetrics, & Mastology, Faculdade de Medicina de Botucatu da Universidade Estadual Paulista “Júlio de Mesquita Filho“- UN ESP- Botucatu (SP), Brasil
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Serhat E, Cogendez E, Selcuk S, Asoglu MR, Arioglu PF, Eren S. Is there a relationship between endometrial polyps and obesity, diabetes mellitus, hypertension? Arch Gynecol Obstet 2014; 290:937-41. [PMID: 24858564 DOI: 10.1007/s00404-014-3279-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the relationship between endometrial polyps and obesity, diabetes mellitus (DM) and hypertension (HT). MATERIALS AND METHODS 202 patients who applied to our gynecology clinic with complaints of infertility, recurrent pregnancy loss and abnormal uterine bleeding, diagnosed to have endometrial polyps by hysteroscopy, were compared with 79 patients without polyps, retrospectively. The relationships between risk factors and presence of a polyp and polyp size were analyzed. RESULTS The mean age of cases with endometrial polyps was significantly greater than the controls. The mean body mass index (BMI) of the cases with polyps was also significantly greater than the controls. There was no significant difference between groups with respect to prevalence of DM or HT. CONCLUSION This study suggests that obesity is an independent risk factor in the development of endometrial polyps. Clinicians should be aware in terms of endometrial polyps in the assessment of patients with BMI ≥30. There was no relationship between HT or DM with presence of polyps.
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Affiliation(s)
- Esra Serhat
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Education and Research Hospital, Istanbul, Turkey
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Lenci MA, Nascimento VALD, Grandini AB, Fahmy WM, Depes DDB, Baracat FF, Lopes RGC. Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy. EINSTEIN-SAO PAULO 2014; 12:16-21. [PMID: 24728240 PMCID: PMC4898233 DOI: 10.1590/s1679-45082014ao2764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 12/04/2013] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods: The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results: Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion: Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.
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Affiliation(s)
| | | | - Ana Beatriz Grandini
- Hospital do Servidor Público Estadual ?Francisco Morato de Oliveira?, São Paulo, SP, Brazil
| | - Walid Makin Fahmy
- Hospital do Servidor Público Estadual ?Francisco Morato de Oliveira?, São Paulo, SP, Brazil
| | | | - Fausto Farah Baracat
- Hospital do Servidor Público Estadual ?Francisco Morato de Oliveira?, São Paulo, SP, Brazil
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Dias DS, Bueloni-Dias FN, Dias R, Nahás-Neto J, Petri Nahás EA, Leite NJ, Custódio Domingues MA, Bueno Angela SP, Padovani CR. Usefulness of Clinical, Ultrasonographic, Hysteroscopic, and Immunohistochemical Parameters in Differentiating Endometrial Polyps From Endometrial Cancer. J Minim Invasive Gynecol 2014; 21:296-302. [DOI: 10.1016/j.jmig.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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Lasmar BP, Lasmar RB. Endometrial polyp size and polyp hyperplasia. Int J Gynaecol Obstet 2013; 123:236-9. [DOI: 10.1016/j.ijgo.2013.06.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/07/2013] [Accepted: 08/27/2013] [Indexed: 11/30/2022]
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Endometrial polyps in women affected by levothyroxine-treated hypothyroidism--histological features, immunohistochemical findings, and possible explanation of etiopathogenic mechanism: a pilot study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:503419. [PMID: 24058909 PMCID: PMC3766560 DOI: 10.1155/2013/503419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/19/2013] [Indexed: 11/22/2022]
Abstract
The aim of the study was to investigate the possible overexpression of estrogen (ERs) and progesterone (PRs) receptors both in EPs glandular and stromal cells in postmenopausal women with levothyroxine-treated hypothyroidism in comparison to EPs detected in women with physiological thyroid hormone levels. During the study period (January-February 2013) 22 patients were eligible (12 treated, 10 controls). The two groups were homogenous for general, EPs sonographic and hysteroscopic features. None of the cases of atypia was found. Immunohistochemistry showed that the two groups were similar for ERs and PRs intensity rates in EPs glandular cells despite a trend of ERs percentage expression more than 60% in 2/3 of treated patients versus 1/3 of controls. In stromal EPs components, ERs intensity was high positive in 10 (83,3%) treated cases while it was high positive in 1 control (10%). Percentage of ERs stromal expression showed a different trend between the two groups despite a borderline statistical significance. Our hypothesis is based on a possible double action of hypothyroidism and thyroxine intake: the subclinical TSH increased levels and its possible circadian oscillation could stimulate the endometrial TSHRs (increasing type 2 DIO activity); the circulating levels of exogenous thyroxine could be locally metabolized in active form by type 2 DIO stimulating ERs.
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AlHilli MM, Nixon KE, Hopkins MR, Weaver AL, Laughlin-Tommaso SK, Famuyide AO. Long-Term Outcomes After Intrauterine Morcellation vs Hysteroscopic Resection of Endometrial Polyps. J Minim Invasive Gynecol 2013; 20:215-21. [DOI: 10.1016/j.jmig.2012.10.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/12/2012] [Accepted: 10/18/2012] [Indexed: 11/30/2022]
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Hassa H, Korkmazer E, Tokgöz VY, Öge T. Independent risk factors for endometrial polyps: diabetes, hypertension, and obesity. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps. J Minim Invasive Gynecol 2012; 19:3-10. [DOI: 10.1016/j.jmig.2011.09.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/03/2011] [Indexed: 01/02/2023]
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Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature. J Minim Invasive Gynecol 2011; 18:569-81. [DOI: 10.1016/j.jmig.2011.05.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/18/2011] [Accepted: 05/26/2011] [Indexed: 01/02/2023]
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Indraccolo U, Barbieri F. Relationship between adenomyosis and uterine polyps. Eur J Obstet Gynecol Reprod Biol 2011; 157:185-9. [PMID: 21470766 DOI: 10.1016/j.ejogrb.2011.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/09/2011] [Accepted: 02/27/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether adenomyosis is associated with uterine polyps. STUDY DESIGN To perform an ethical human study, we planned a large retrospective observational study covering the entire patient population of the ULSS 17-Veneto district who underwent resectoscopy in 2007 and 2008 (959 patients). We enrolled all the patients underwent resectoscopy with resection of uterine polyps, with resection of myomas, with endometrial ablations by slicing, and with endometrial biopsies in both the presence and absence of hysteroscopically visible lesions. The diagnosis of adenomyosis was made by pathological examination of tissue specimens obtained using a resectoscope loop. Multivariate logistic regression was performed to determine if adenomyosis was one of the various risk factors for the presence and number of uterine polyps. Statistical Package for the Social Sciences (SPSS 16.0) was employed, and p≤0.05 was the minimum for significance. RESULTS Age (p=0.005), adenomyosis (p=0.013), high fasting glucose levels (p=0.004), and hypertension (p=0.045) were significantly associated with endometrial polyps. The presence of multiple endometrial polyps seemed to be associated with the presence of adenomyosis (p=0.016). The presence of cervical polyps was significantly associated only with presence of adenomyosis (p=0.002). The presence of multiple cervical polyps did not seem to be influenced by any of the variables considered. CONCLUSIONS The results clearly demonstrate an association between adenomyosis and uterine polyps. The pathogenetic role of adenomyosis in the development of polyps should therefore be investigated further.
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Affiliation(s)
- Ugo Indraccolo
- Department of Surgical Sciences, University of Foggia, Italy.
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Gregoriou O, Konidaris S, Vrachnis N, Bakalianou K, Salakos N, Papadias K, Kondi-Pafiti A, Creatsas G. Clinical parameters linked with malignancy in endometrial polyps. Climacteric 2009; 12:454-8. [PMID: 19591006 DOI: 10.1080/13697130902912605] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gentile G, Indraccolo U. An independent prognostic factor for the development of endometrial polyps in infertile patients. Fertil Steril 2009; 91:e7; author reply e8. [DOI: 10.1016/j.fertnstert.2009.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 03/04/2009] [Indexed: 11/17/2022]
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