Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases Enzo Ricciardi a,b, *, Andrea Vecchione d , Roberto Marci e , Mauro Schimberni c , Antonio Frega c , Paolo Maniglio c , Donatella Caserta c , Massimo Moscarini c a Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy b Department of Obstetrics and Gynecology, Universita ¨tsklinikum Freiburg, Freiburg i.Br., Germany c Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy d Department of Pathology, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy e Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Ferrara, Italy Introduction Endometrial polyps represent a localized overgrowth of the endometrium, projecting above the epithelium. They show a higher rate of incidence in patients between 30 and 50 years of age [1,2]. Prevalence in the normal population is about 24% (range 13–50%) and ranges from 10 to 30% in women with abnormal uterine bleeding (AUB). Incidence at autopsy is about 10% [3,4]. Presentation includes inter-menstrual or post-menopausal bleeding, infertility, persistent bleeding following curettage, or polyps may also show as an incidental finding at routine transvaginal ultrasounds. [5–7]. The use of tamoxifen has been associated with their development [8,9]. Endometrial polyps are usually benign although some may be precancerous or cancerous. Guidelines for the management of women with endometrial polyps were introduced by the American Association of Gyneco- logic Laparoscopists (AAGL) in 2012 [10]. However, the authors of the guidelines stressed the absence of high-quality data supporting the pathology. This is particularly true for asymptomatic women. Their management may, therefore, be even more difficult for gynecologists, who may lack sufficient data to effectively deter- mine the most effective form of treatment and patient care. The objective of the present study was to determine whether clinical factors could be useful for clinicians in predicting malignant transformation in a patient with endometrial polyps. European Journal of Obstetrics & Gynecology and Reproductive Biology 183 (2014) 121–124 A R T I C L E I N F O Article history: Received 12 January 2014 Received in revised form 28 July 2014 Accepted 22 October 2014 Keywords: Endometrial polyps Endometrial cancer Clinical factors Hysteroscopy Oncologic risk A B S T R A C T Study objective: To assess the prevalence of polyps carrying a malignancy and match association between clinical factors and oncologic progression. Study design: A retrospective study (Canadian Task Force classification II-3) at a university hospital in Rome, Italy. We retrospectively analyzed data from 1027 women consecutively treated for endometrial polyps at our center in the period 2002–2011. The association of malignancy with hormonal status, tamoxifen, hypertension, symptoms, diabetes mellitus, obesity, and hormonal replacement therapy in pre- and post-menopausal women was assessed. Results: Mean age was 45.8  10.8 years. Benign polyps accounted for 95.8% of the total, pre-malignant for 2.67%, malignant for 1.54%. Our data showed that post-menopausal and older women (>60 y) with endometrial polyps have a higher risk of developing a related endometrial cancer (OR: 3.05, 95% CI [1.54, 6.19], p < 0.001 and OR: 2.8, 95% CI [1.38, 5.56], p 0.003. Also we observed that women with AUB in the post-menopausal period displayed a risk of malignancy (OR: 31.1, 95% CI [10.3,111], p value <0.001). Conclusion: Special attention should be drawn to symptomatic post-menopausal patients that appear to be at higher risk of malignancy. Symptomatic pre-menopausal women and asymptomatic post- menopausal women with polyps may be a group with intermediate-risk. These patients should undergo an individualized management plan, balancing both risks and benefits of surgical intervention after discussion with the patient. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Obstetrics, Gynecology and Urology. Sapienza University of Rome, Sant’Andrea Hospital, via di Grottarossa, 1035-1039, 00189 Roma, Italy. Tel.: +39 0633775696; fax: +39 0633776660. E-mail address: enzo.ricciardi@uniroma1.it (E. Ricciardi). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb http://dx.doi.org/10.1016/j.ejogrb.2014.10.021 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.