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Evaluation of endometrial polyps

      Abstract

      Objective: Endometrial polyps are relatively common in all groups of women. More polyps are being diagnosed with the widespread use of transvaginal ultrasound scanning and sonohysterography. The reported incidence of malignancy is low. The potential benefit of a noninvasive technique to distinguish benign from malignant polyps is obvious. This study was undertaken to evaluate endometrial polyps by color flow Doppler ultrasound scanning and histopathologic examination. Study design: This was an observational study of patients with an endometrial polyp on sonohysterography who underwent interrogation of their polyp with color Doppler ultrasound scanning and subsequently polypectomy. Polyp volume, resistive index, pulsatility index, indication for scan (bleeding vs incidental), and patient age were correlated with histopathologic type of the polyp (nonfunctional, proliferative, secretory, hyperplastic, or malignant). Results: Of 61 patients studied, 42 patients (68.9%) were scanned for abnormal bleeding, and 19 patients (31.1%) had their polyps discovered incidentally. There were no statistically significant differences between histologic categories and the resistive index, pulsatility index, or size of the polyp. The age of patients with nonfunctional polyps was significantly greater than any other group (P < .001). Ninety-four percent of the functional polyps were discovered because of abnormal bleeding; 38% of the nonfunctional polyps were discovered incidentally (P < .001). Conclusion: The data suggest that the objective assessment of blood flow impedance (resistive index, pulsatility index) in endometrial polyps and the size of these polyps cannot replace surgical removal and pathologic evaluation to predict histologic type. Patients with nonfunctional polyps were older and less likely to have vaginal bleeding. (Am J Obstet Gynecol 2002;186:669-74.)

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      References

        • Scott RB
        The elusive endometrial polyp.
        Obstet Gynecol. 1953; 1: 212-218
        • Goldstein SR
        • Nachtigall M
        • Snyder JR
        • Nachtigall L
        Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding.
        Am J Obstet Gynecol. 1990; 163: 119-123
        • Granberg S
        • Wikland M
        • Karlsson B
        • et al.
        Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality.
        Am J Obstet Gynecol. 1991; 164: 47-52
        • Parsons AK
        • Lonse JJ
        Sonohysterography for endometrial abnormalities: preliminary results.
        J Clin Ultrasound. 1993; 21: 87-95
        • Schwartz LB
        • Snyder J
        • Horan C
        • Porgess RF
        • Nachtigall LE
        • Goldstein SR
        The use of transvaginal ultrasound and saline infusion sonohysterography for the evaluation of asymptomatic postmenopausal breast cancer patients on tamoxifen.
        Ultrasound Obstet Gynecol. 1997; 10: 1-6
        • Berliere M
        • Charles A
        • Galant C
        • Donnez J
        Uterine side-effects of tamoxifen: a need for systematic pretreatment screening.
        Obstet Gynecol. 1998; 91: 40-44
        • Goldstein SR
        • Zeltser I
        • Horan CK
        • Snyder JR
        • Schwartz LB
        Ultrasonography-based triage for perimenopausal patients with uterine bleeding.
        Am J Obstet Gynecol. 1997; 177: 102-108
        • Wolfe SA
        • Mackles A
        Malignant lesions arising from benign endometrial polyps.
        Obstet Gynecol. 1962; 20: 542-551
        • Anastasiadis PG
        • Koutlaki NG
        • Skaphida PG
        • Galazios GC
        • Tsikouras PN
        • Liberis VA
        Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding.
        Eur J Gynaecol Oncol. 2000; 21: 180-183
        • Kurjak A
        • Zalud I
        • Alfirevic Z
        Evaluation of adnexal masses with transvaginal color ultrasound.
        J Ultrasound Med. 1991; 10: 295-297
        • Goldstein SR
        • Timor-Tritsch IE
        Sonography.
        in: Ultrasound in gynecology. : Churchill Livingston, New York1995: 204-205
        • Folkman J
        • Watson K
        • Ingber D
        • Hanahan D
        Induction of angiogenesis during the transition from hyperplasia to neoplasia.
        Nature. 1989; 339: 58-61
        • Fleischer AC
        • Rodgers WH
        • Rao BK
        • et al.
        Assessment of ovarian tumor vascularity with transvaginal color Doppler sonography.
        J Ultrasound Med. 1991; 10: 563-565
        • Bourne T
        • Campbell S
        • Steer C
        • Whitehead MI
        • Collins WP
        Transvaginal colour flow imaging: possible new screening technique for ovarian cancer.
        BMJ. 1989; 299: 1367-1370
        • Briley M
        • Lindesell DR
        The role of transvaginal ultrasound in the investigation of women with post-menopausal bleeding.
        Clin Radiol. 1998; 53: 502-505
        • Schindler AE
        • Schmidt G
        Post-menopausal bleeding: a study of more than 1000 cases.
        Maturitas. 1980; 2: 269-274
        • Karlsson B
        • Granberg S
        • Wikland M
        • et al.
        Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: a Nordic multicenter study.
        Am J Obstet Gynecol. 1995; 172: 1488-1494
        • Burke T
        • Morris M
        Adenocarcinoma of the endometrium.
        in: Textbook of gynecology. : Saunders, Philadelphia1993: 1014-1031
        • Stovall TG
        • Photopulos GJ
        • Poston WM
        • Ling FW
        • Sandles LG
        Pipelle endometrial sampling in patients with known endometrial carcinoma.
        Obstet Gynecol. 1991; 77: 954-956
        • Guido RS
        • Kanbour-Shakir A
        • Rulin MC
        • Christopherson WA
        Pipelle endometrial sampling: sensitivity in the detection of endometrial cancer.
        J Reprod Med. 1995; 40: 553-555
        • Langer RD
        • Pierce JJ
        • O'Hanlan KA
        • et al.
        Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease: postmenopausal estrogen/progestin interventions trial.
        N Engl J Med. 1997; 337: 1792-1798
        • Berliere M
        • Roadikov G
        • Galant C
        • Piette P
        • Marbaix E
        • Donnez J
        Identification of women at high risk of developing endometrial cancer on tamoxifen.
        Eur J Cancer. 2000; 36: S35-S36