Beyond Size: The Impact of Endometrial Polyp Location on Malignancy Risk

Objectives: To evaluate whether endometrial polyp localization is associated with premalignant/malignant histopathology and to compare clinical and morphological characteristics between benign and premalignant/malignant polyps. Design: Single-center retrospective observational study. Participants/Materials: A total of 580 women who underwent hysteroscopic polypectomy with subsequent histopathological evaluation. Setting: Tertiary referral center January 2010–December 2024. Methods: Polyps were categorized according to hysteroscopic localization (fundal, anterior wall, posterior wall, cornual, lower uterine segment). Cases were grouped as benign versus premalignant/malignant based on histopathology. Demographic variables (age, menopausal status), clinical presentation (abnormal uterine bleeding), and morphological parameters (polyp size, endometrial thickness) were compared. A multivariate logistic regression model including age, menopausal status, abnormal uterine bleeding, polyp size, endometrial thickness, and polyp localization was used to identify independent predictors. Results: Most polyps were fundal (31.0%), anterior wall (24.3%), or posterior wall (21.0). Premalignant/malignant pathology was detected in 6.4% of cases and occurred more frequently in fundal and cornual localizations. Compared with the benign group, the premalignant/malignant group had a higher mean age (56.7 ± 8.1 vs. 48.9 ± 9.4 years) and a higher proportion of postmenopausal women (78.9% vs. 37.5%). Abnormal uterine bleeding was more common in premalignant/malignant cases (94.7% vs. 61.3%). Median polyp size was larger (18 mm [7–38] vs. 12 mm [4–34]) and mean endometrial thickness was greater (15.2 ± 5.1 mm vs. 10.1 ± 4.6 mm). In multivariate analysis, fundal (OR 2.18, 95% CI 1.02–4.66) and cornual localization (OR 2.87, 95% CI 1.21–6.79) remained independently associated with premalignant/malignant pathology. Limitations: Retrospective, single-center design; results depend on the completeness and accuracy of hysteroscopic records. Conclusions: Beyond established risk factors, fundal and cornual localization of endometrial polyps is independently associated with premalignant/malignant pathology. Localization may add clinical value to risk stratification during hysteroscopic assessment.