Hysteroscopic Resection Of Endometrial Polyps Research Articles

Improved Hysteroscopic Resection of Endometrial Polyps Using 6-Fr Micro-Scissors and Forceps.

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. Numerous resection methods are available, with the most used and cost-effective options being cold resection employing micro-scissors or hot resection using an electric loop. However, both methods involve sharp resection, posing a challenge in achieving complete polyp removal while avoiding damage to the uterine endometrium. To address this issue, this study proposes an innovative approach: the combined use of the 6 Fr micro-scissors and forceps under hysteroscopy. The method entails utilizing 6 Fr micro-scissors to initially remove large polyps, followed by using 6 Fr micro-forceps to extract the remaining polyp tissue expeditiously and bluntly near the basal layer of the endometrium. This approach not only prevents surgical damage to the basal layer of the endometrium but also mitigates the risk of residual polyps resulting from incomplete resection. This method is particularly suitable for women with fertility requirements, offering additional considerations for the selection of treatment options for endometrial polyp resection.

Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study.

Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. Cross-sectional analytical study in a tertiary-level academic hospital. 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

Hysteroscopic Endometrial Polypectomy: Comparative Retrospective Study of the Morcellator System versus Electrosurgical Resection

A single-center observational retrospective comparative study was performed, including 190 patients who underwent hysteroscopic resection of endometrial polyps from January 2017 to December 2017. The hysteroscopic techniques were TRUCLEAR 5.5® to morcellation and Karl Storz® monopolar resection.

HISTOPATHOLOGIC FINDINGS IN WOMEN UNDERGOING HYSTEROSCOPIC RESECTION OF ENDOMETRIAL POLYPS AND UTERINE MYOMAS.

SUMMARYThe aim of our study was to determine the prevalence of endometrial premalignant and malignant lesions in women undergoing hysteroscopy and to identify anthropologic factors related to the presence of malignancy. Data on 3470 women with submucosal myomas or endometrial polyps suspected on ultrasound were retrospectively analyzed. Hysteroscopy was performed in all these women in order to make a more precise diagnosis. Histologic analysis of endometrial samples obtained during hysteroscopy was used to confirm the diagnosis. Statistical analysis was performed using the SPSS 20.0.0 software. The mean age of study women was 49.1±13.3 years. The number of procedures performed due to the referral diagnosis of endometrial or submucosal myoma significantly increased over the 16-year study period. A significantly higher number of women had a benign histopathologic diagnosis. Histologic analysis revealed malignancy in 67 women. The youngest woman and oldest woman with malignant findings was aged 32 and 75, respectively. A significantly higher number of women with atypical hyperplasia and malignancy were in menopause. A comparable number of women with different histologic findings lived in urban and rural areas. There were a significantly larger proportion of widows among women with the histologic diagnosis of atypical hyperplasia or malignancy. The prevalence rate of malignancy in women having undergone hysteroscopy for polyps and myoma found by ultrasound was 1.93%. Postmenopausal status and older age were associated with an increased risk of malignancies, but premalignant changes and malignancies were also found in young and premenopausal women. Therefore, diagnostic hysteroscopy can be recommended in women of all age groups.

Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review

Endometrial polyps are frequently encountered in the uterine cavity of infertile women. There is much debate regarding the treatment of endometrial polyps in patients who are undergoing assisted reproductive technology (ART). A systematic review was performed by searching PubMed, Embase, and the Cochrane Library for retrospective or prospective studies that compared the effect of hysteroscopic resection of polyps with no treatment on pregnancy outcomes of patients who underwent ART. The primary outcomes were clinical pregnancy, live birth, miscarriage, and implantation rates after ART. Eight studies with a total of 2267 patients were included. The results showed that hysteroscopic resection of endometrial polyps (mean size <2 cm) was associated with an increased rate of clinical pregnancy in patients who underwent intrauterine insemination. No clear benefit was observed for clinical pregnancy, live birth, miscarriage, or implantation rates in patients who underwent in vitro fertilization/intracytoplasmic sperm injection cycles. In conclusion, the effect of hysteroscopic polypectomy on pregnancy outcomes of patients who have undergone ART remains unclear. More prospective, randomized controlled trials are warranted to determine appropriate treatment.

Intraoperative and Postoperative Clinical Evaluation of the Hysteroscopic Morcellator System for Endometrial Polypectomy: A Prospective, Randomized, Single-blind, Parallel Group Comparison Study.

Objective:To evaluate the TRUCLEAR™ system (Smith and Nephew Inc., London, UK), a hysteroscopic system that morcellates and aspirates masses, in terms of the operating time, surgeon's convenience, and effect on patients compared with conventional electrosurgical resection.Methods:Patients undergoing hysteroscopic resection of endometrial polyps were randomly allocated to undergo hysteroscopic morcellation or electrosurgical resection (UMIN-CTR identifier: UMIN000019649). The primary outcome was the operating time. Secondary outcomes were the removal success, fluid deficit, convenience with the technique, insertion time, number of insertions during the operation, visibility of the operative field, recurrence of the patient's chief complaint, and adverse events.Results:Sixty-seven women were randomly allocated to the morcellation arm (n = 34) or electrosurgical resection arm (n = 33) from November 2015 to November 2016. The polyps were completely removed, and no adverse events were observed in all 67 patients. The average operating time (8.3 min vs. 12.0 min, P = 0.014), insertion time (5.0 min vs. 9.0 min, P < 0.001), and number of insertions (1.0 vs. 8.2, P < 0.001) were significantly lower in the morcellation arm than in the electrosurgical resection arm. Surgeons' subjective evaluation measured on a 10-cm visual analog scale was higher in the morcellation arm than in the electrosurgical resection arm in terms of easiness of removal (8.4 vs. 6.5, P < 0.001) and visibility of the operative field (7.8 vs. 6.4, P < 0.001).Conclusion:Surgeons gave the hysteroscopic morcellator system a better evaluation compared than electrosurgical resection, and the system shortened the operating time.

Risk Factors of Intrauterine Adhesion after Hysteroscopic Resection of Endometrial Polyps.

Objective To analyze the risk factors of intrauterine adhesion (IUA) after hysteroscopic resection of endometrial polyps. Methods Totally 359 patients undergoing hysteroscopic resection of endometrial polyps from January 2013 to December 2016 were enrolled in this study. The clinical data of IUA group and non-IUA group were compared. Univariate analysis was performed to identify the risk factors of IUA,and multivariate Logistic regression analysis was further performed to get the independent risk factors. Results Of these 359 patients,IUA occured after operation in 56 patients (15.60%). Univariate analysis showed underlying diseases (χ2=7.381,P=0.004),multiple polyps (χ2=3.376,P=0.040),uterus with uterine fibroids or endometrial hyperplasia (χ2=6.495,P=0.009),history of curettage(χ2=31.576,P=0.000),pelvic infection (χ2=8.582,P=0.001),intrauterine device (χ2=7.161,P=0.006),history of cesarean section (χ2=5.493,P=0.014),and multigravida were (χ2=16.886,P=0.000) the risk factors of IUA. Logistic regression analysis showed other diseases of uterus(χ2=19.542,P=0.026),history of curettage (χ2=29.614,P=0.000),pelvic infection (χ2=5.627,P=0.002),intrauterine device (χ2=11.342,P=0.08),history of cesarean section(χ2=8.549,P=0.035),and multigravida (χ2=15.493,P=0.000) were the independent risk factors of IUA after hysteroscopic resection of endometrial polyps. Conclusion Other diseases of uterus,history of curettage,pelvic infection,intrauterine device,history of cesarean section,and/or multigravida can increase the risk of IUA after hysteroscopic resection of endometrial polyps.

120 - A Prospective Study of 162 Consecutive Patients Undergoing Hysteroscopic Resection of Endometrial Polyps Using MyoSure Lite in a “See and Treat” Office Based Postmenopausal Bleeding Clinic

Study Objective: To evaluate treatment of endometrial polyps using MyoSure Lite hysteroscopic resection in a “see and treat” office based clinic for women complaining of postmenopausal bleeding.

Risk of malignancy on suspicion of polyps in menopausal women

Improved performances in gynaecological ultrasonography have enabled an increasing number of often asymptomatic endometrial polyps to be detected. Most of these polyps are removed surgically, as a precautionary measure, so as not to miss a case of endometrial cancer. Nonetheless, this management strategy is based solely on the sonographer’s judgement and a number of these operations, which are probably of no benefit, could be avoided. In order to do so, risk factors for malignancy need to be identified. ObjectiveEstimate the prevalence of lesions in menopausal patients with a pre-operative diagnosis of endometrial polyp. Establish risk factors for malignancy. Study designThis is a single-centre retrospective study. Enrolment criteria were menopausal patients aged over 45 who had undergone hysteroscopic resection of a polyp. Pre-op diagnosis was made either by ultrasonography or diagnostic hysteroscopy. Malignant lesions included cancers and atypical hyperplasia. Benign lesions consisted of simple polyps, non-atypical simple hyperplasia and non-atypical complex hyperplasia. Risk factors studied were existing abnormal uterine bleeding, endometrial thickness, personal or first-degree family history of gynaecological cancer (breast, cervix, endometrium, ovary) and age on diagnosis. Results631 patients were enrolled of whom 30 presented a malignant disorder (4.75%); 579 patients (91.76%) presented a simple polyp, 11 a non-atypical simple hyperplasia (1.74%) and 11 a non-atypical complex hyperplasia (1.74%).On univariate analysis age alone proved to be statistically significant (OR 1.05; 95%CI=[1.02–1.09] p<0.01), with a threshold of 59 years of age on the ROC curve. On multivariate analysis, factors predictive of a malignant lesion were age (OR=1.06; 95%CI [1.02–1.10]), existence of AUB (OR=2.4; 95% CI [1.07–5.42]) and family history (OR=2.88; 95%CI [1.08–7.67]). Neither the univariate nor multivariate model was able to demonstrate a statistically significant relationship with respect to endometrial thickness.The risk of malignancy was 12.3% in patients aged over 59 presenting AUB. For all other subgroups, the risk varied between 2.31 and 3.78%. ConclusionThe risk of a malignant lesion appears to be high (12%) in menopausal patients aged over 59 presenting an endometrial polyp detected when there is pre-existing AUB. In this situation, hysteroscopic resection of endometrial polyps should therefore be routinely proposed.For other patients, the risk of a malignant lesion is low but not insignificant, standing at about 3%. Each patient record should therefore be discussed on an individual case basis, taking into consideration the patient’s pre-existing conditions, after providing clear and appropriate information.

Reproductive outcomes following hysteroscopic resection of endometrial polyps of different location, number and size in patients with infertility

We aimed to assess the pregnancy rates after hysteroscopic polypectomy in infertility patients with endometrial polyps and to compare pregnancy rates among subgroups with polyps of different location, size and number. All patients who underwent hysteroscopic evaluation which revealed endometrial polyps were included. Patients with any intrauterine pathology other than polyp and those undergoing frozen embryo transfer (ET) cycles were excluded. Patients were evaluated according to polyp location, size and number. Rates of β-hCG positivity and clinical pregnancy were compared. Clinical pregnancy rates after polypectomy was 41.7% for multiple polyps, 30.8% for isthmus zone polyps, 28.6% for anterior wall polyps, 27.3% for cornual zone, 22.2% for posterior uterine wall polyps and 11.8% for fundal polyps (p = 0.532). There appears no difference regarding reproductive outcomes after hysteroscopic resection of polyps situated in different intrauterine locations. Similarly, chance of conceiving seems not to change after hysteroscopic treatment of polyps of different size and number.

Endometrial polyps: when to resect?

To determine the prevalence of malignant and premalignant endometrial polyps and to investigate the association of malignancy with specific factors. This is a retrospective study of women submitted to hysteroscopic resection of endometrial polyps between January 2005 and July 2013 at a university hospital in southern Brazil. Data regarding clinical characteristics and pathology findings were collected from patient charts. Of 359 patients, 87.2% had benign polyps and 9.9% had hyperplasia without atypia. Atypical hyperplasia was found in 2.6% of the sample. Endometrial adenocarcinoma was found in one woman (0.3%). A correlation was observed between malignant/premalignant polyps and patient age, menopausal status, and uterine bleeding. All patients with malignancies/premalignancies had abnormal uterine bleeding. Higher frequency of malignant polyps was observed in tamoxifen users, however, without statistical significance (p = 0.059%). Malignancy was not correlated with arterial hypertension, diabetes mellitus, obesity, hormone therapy, endometrial thickness, and polyp diameter. Malignant/premalignant findings had low prevalence and were absent in asymptomatic patients. From the data of this retrospective study, it is unclear whether routine polypectomy should be performed in asymptomatic patients. Further prospective studies including larger numbers of patients are required to guide treatment recommendations.

Morcellement hystéroscopique versus résection à l’anse bipolaire pour les polypes endométriaux

ObjectiveThe treatment of endometrial polyps is based on hysteroscopic resection. The aim of the current study was to compare the results associated with hysteroscopic morcellation and those observed with bipolar loop resection. Patients and methodsA single-center observational retrospective comparative study was performed, including 25 patients who underwent hysteroscopic resection of endometrial polyps from January 2012 to December 2013. The mean size of polyp was 9.2mm in the group compared to 12.5mm in the resection group loop (P=0.06). ResultsTwelve patients underwent resection of the polyp morcellation with MyoSure® and 13 with bipolar resection loop Versapoint® 24F. The mean operative time was 16minutes in morcellation group and 17minutes in the bipolar resection group (P=0.76). Complete removal was achieved in 100% of cases in morcellation group and in bipolar loop resection. Regarding intraoperative and postoperative complications, no complication was observed in the two groups. Discussion and ConclusionResults associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable.

Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review.

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.

Can malignant potential of endometrial polyps be determined by incorporating the endometrial intraepithelial neoplasia (EIN) classification?

ObjectiveThe reported frequency of malignant or premalignant changes confined to endometrial polyps (EP) is 0.5–6%. The management of atypical endometrial hyperplasia (AEH) confined to EP is not yet established. Recently, an alternative pathological nomenclature has emerged using the term endometrial intraepithelial neoplasia (EIN) instead of atypia. The objective of this study was to evaluate the safety of conservative hysteroscopic resection of endometrial polyps with AEH or EIN. MethodsRetrospective cohort study of all cases of hysteroscopic resections of EP was performed at a single center between the years 2000–2011. All patients with a pathologic diagnosis of AEH in EP were included. A post-hoc revision of the pathologic specimens was made according to the EIN classification. ResultsOf the 32 patients with AEH in EP, 25 had normal endometrial curetting. Even with AEH confined to EP, 12 cases (48%) showed AEH (11 cases) or carcinoma (1 case) in the hysterectomy specimens. EIN in EP (14 cases) was correlated with 57% of diagnosis of EIN or carcinoma in the uterus; whereas in the absence of EIN in EP only 1 of 9 cases showed EIN in the final pathologic specimen (p=0.002), and none with carcinoma, which yields a PPV of 14% and a NPV of 100%. ConclusionThe diagnosis of EIN in EP may be a better predictor than AEH for endometrial involvement with malignant or pre-malignant neoplasms. The safety of conservative hysteroscopic resection of EP with AEH/EIN is questioned.

The malignant potential of endometrial polyps can be determined by incorporating the Endometrial Intraepithelial Neoplasia (EIN) classification

Objectives: The reported frequency of malignant or pre malignant changes confined to endometrial polyp is 0.5–6%. The management of Atypical Endometrial Hyperplasia (AEH) confined to endometrial polyp (EP) is not yet established. Recently, an alternative pathological nomenclature has emerged, using the term Endometrial Intraepithelial Neoplasia (EIN) instead of term the atypia. The objective of this study was to evaluate the safety of conservative hysteroscopic resection of endometrial polyps with AEH or EIN.

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.

Long-Term Outcomes After Intrauterine Morcellation vs Hysteroscopic Resection of Endometrial Polyps

Study ObjectiveTo compare the long-term outcomes of intrauterine morcellation (IUM) of endometrial polyps vs a traditional operative polypectomy technique, hysteroscopic resection (HSR), and to identify factors predictive of recurrent abnormal uterine bleeding (AUB) after operative polypectomy. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingMinimally invasive gynecologic surgery practice in a tertiary care center. PatientsWomen who underwent operative hysteroscopic polypectomy between January 1, 2004 and December 31, 2009. InterventionsIntrauterine morcellation or HSR with evaluation and/or treatment of recurrent AUB after operative polypectomy. Measurements and Main ResultsOf 311 patients (IUM group, 139; HSR group, 172), 167 (53.7%) had at least 1 gynecologic follow-up visit and 57 (18.4%) had recurrent AUB. Subsequent gynecologic clinic visit rates were similar between the 2 groups (HSR, 58.1%, vs IUM, 48.2%; p = .08). Recurrence of AUB within the first 4 years of follow-up was similar between the IUM and HSR groups (hazard ratio for HSR vs IUM, 1.12; 95% confidence interval, 0.64–1.98; p = .59). However, recurrence of endometrial polyps approached statistical significance (hazard ratio, 3.3; 95% confidence interval, 0.94–11.49; p = .06). Premenopausal status, history of hormone replacement therapy, multiparity, and polycystic ovarian syndrome were independently associated with AUB recurrence. There were no reports of inability to establish a histopathologic diagnosis among all pathology specimens evaluated. ConclusionCompared with HSR, intrauterine morcellation may be associated with lower recurrence of endometrial polyps. However, the incidence of recurrent AUB is independent of polypectomy method.

Preoperative dienogest administration facilitates accurate hysteroscopic resection of endometrial polyps by altering the endometrium.

Preoperative dienogest administration facilitates accurate hysteroscopic resection of endometrial polyps by altering the endometrium.

Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics

The aim of this study was to evaluate the prevalence of endometrial premalignant and malignant polyps in premenopausal and postmenopausal women, as well as the clinical, ultrasound, and hysteroscopic factors associated with malignancy. All women undergoing hysteroscopic resection of endometrial polyps from January 1998 to December 2008 were selected using a computerized database from the operating theater of the Prof. Dr. José Aristodemo Pinotti Women's Hospital, Women's Health Care Center/University of Campinas. Eight hundred seventy women with ages ranging from 25 to 85 years were included. Polyps were classified into benign (endometrial polyps and polyps with nonatypical simple hyperplasia and nonatypical complex hyperplasia), premalignant (polyps with atypical simple hyperplasia or atypical complex hyperplasia), and malignant. Statistical analysis was performed by measurement of the frequencies, means, and SD. The risk factors for malignancy were assessed by bivariate and multiple regression analyses, using the Epi-Info 2000 program and SAS (Statistical Analysis Software), version 9.2. The mean (SD) age of the women was 57.5 (10.6) years. Of these women, 76.4% were postmenopausal. Women were diagnosed with benign lesions in 95.8% of cases. Premalignant polyps accounted for 1.6% of the total number of cases. Malignant polyps represented 2.5% of the total sample. Postmenopausal bleeding and age greater than 60 years were the only factors that remained associated with a higher risk of malignancy with a prevalence ratio of 3.67 (95% CI, 1.69-7.97) and 1.5 (95% CI, 1.01-1.09), respectively. The prevalence rate of malignancy in endometrial polyps was higher in women with postmenopausal bleeding and advanced age.

Follow-up and hysteroscopic evaluation of the uterine cavity after hysteroscopic polypectomy

Objective: to assess the results of hysteroscopic resection of the endometrial polyp by means of diagnostic hysteroscopy. Material(s) and Method(s): This study is a prospective long-term follow-up study in a tertiary teaching hospital. Total 102 patients were included in this study. Eighty-three of them agreed with and completed the follow-ups. Result(s): Eighty three patients (81.3 %) completed follow-ups and underwent diagnostic hysteroscopic evaluation. Recurence rate was 2,4 % (2/83). Pregnancy rate after hysteroscopic polypectomy was 60.8% (14/23). Further treatment was needed in three patients in premenopausal group. Conclusion(s): Hysteroscopic resection of endometrial polyps can be regarded as safe, effective and worth to be encouraged. Infertility results was promising. Levonorgestrel-releasing intrauterine device can be considered in cases with recurrence or persistence menstrual abnormalities during the follow-ups.