Clinical Significance of Polyp Findings in Endometrial Biopsies

Abstract

Objectives:

To evaluate the prevalence of polyp findings in office endometrial biopsies, estimate the incidence of endometrial polyps on diagnostic evaluation, and to describe demographic and clinical characteristics associated with these findings.

Materials and Methods:

We conducted a retrospective chart review of 7073 patients undergoing an endometrial biopsy between January 1, 2015 and December 31, 2019. We collected demographic data, clinical characteristics, and findings at diagnostic workup. Bivariate analysis was performed to compare demographic and clinical characteristics between patients with and without a clinically identifiable polyp and stratified analysis was performed according to menopausal status. Patients with hyperplasia, premalignancy, or malignancy were described.

Results:

Among endometrial biopsies performed during the study period, 10.2% (n = 719/7073) were reported to have polyp findings. Further diagnostic evaluation was pursued in 33.4% (n = 240/719) with hysteroscopy or hysterectomy. Among those with diagnostic procedures performed, 70.4% (n = 169/240) had a clinically identifiable polyp at the time of the procedure or on pathological specimen report. Patients with clinically identifiable polyps were more often postmenopausal (71.6% vs. 21.1%, p < 0.001), age 55 or older (63.3% vs. 18.3%, p < 0.001), had a history of hypertension (42.0% vs. 28.2%, p = 0.04), or current or prior tamoxifen use (11.2% vs. 2.8%, p = 0.04) compared with patients without clinically identifiable polyps. Patients with clinically identified polyps more often had initial endometrial biopsy pathology reports stating “endometrial polyp” (p < 0.001) and had undergone endometrial biopsy for postmenopausal bleeding (p = 0.04). Stratified analysis in postmenopausal patients demonstrated confirmed polyp in 88.9% (n = 121/136) of cases, with 8.8% (n = 12/136) of patients demonstrating hyperplasia and premalignant or malignant findings.

Conclusions:

Approximately 1 in 10 endometrial biopsies report polyp findings. Further diagnostic evaluation should be considered when an endometrial biopsy indicates polyp, particularly in postmenopausal patients, given the high probability of a clinically identifiable polyp, hyperplasia, and premalignant or malignant findings.