Frequência de pólipos endometriais neoplásicos diagnosticados por histeroscopia ambulatorial

Abstract

An endometrial polyp is a localized hyperplastic growth composed of stroma with a thin, richly vascularized wall covered by an epithelial surface. The prevalence of endometrial polyps in the population appears to be high, estimated at 25% to 30%. Detection of an endometrial polyp has been associated with a risk factor for endometrial adenocarcinoma, a lesion nine times more common in these patients than in non-carriers. Diagnostic hysteroscopy is the gold standard method for endometrial evaluation, as it allows for the detection of pathologies and histopathological analysis of lesions with degrees of suspicion. Based on these premises, the objective of this study was to investigate the frequency of endometrial polyps diagnosed by hysteroscopy in symptomatic and asymptomatic patients and their relationship with endometrial cancer. A retrospective study was conducted, collecting data from a review of 542 medical records. These data were collected at the Maternidade Escola Assis Chateaubriand, a reference service in the state of Ceará, from March 2019 to December 2023, in cases where there was an indication for hysteroscopy. The results of ultrasound examinations from this service or other institutions were used. Data were analyzed using inferential statistics, using the Shapiro-Wilk normality test and the chi-square association test. Data were expressed as means ± standard deviation, and p < 0.05 was considered significant. This work was approved by the CEP under CAAE opinion 78452124.5.0000.5050. The number of patients obtained was 533, with a mean age of 54 years (53%) with a range ± 10 years. Altered transvaginal ultrasonography was the main indication for hysteroscopy in 273 cases (50.8%). Other justifications for indicating the exam were: abnormal uterine bleeding (AUB) in 147 cases (27%); postmenopausal bleeding in 113 cases (21%), uterine prolapse in two cases (4%) and cervical polyp in one case (0.2%). The main ultrasonographic findings were: endometrial thickening (229 - 44%); polyp (190 - 36%); myoma (102 - 20%). According to location, the polyps were endometrial in 476 cases (89%), cervical in 49 (9.2%), and cervical/endometrial in nine (1.7%). In the 478 histopathological studies of polyps obtained, 460 were nonmalignant (90%) and 18 were malignant (10%). The most prevalent indication for hysteroscopy was abnormal uterine bleeding. However, the finding that showed the greatest correlation with endometrial cancer was postmenopausal bleeding. Of the biopsy results obtained, a small percentage were positive for neoplasia, with the most common histological type being endometrial adenocarcinoma. Patients with asymptomatic endometrial polyps had a low risk of endometrial carcinoma. Hysteroscopy is an effective method for evaluating the endometrium and its disorders. The endometrial polyp, the main finding in the examination, is benign in most histopathological studies, and has a more significant prognostic correlation when in postmenopausal women with symptoms, with a greater risk of malignant neoplasia.