Hysteroscopic management of endometrial polyps

Objectives: To review the surgical, histologic, intraoperative findings and bleeding patterns of patients treated by operative hysteroscopic polypectomy and compare the accuracy of preoperative assessment tools: transvaginal ultrasound (TVUS), saline infusion sonography (SIS), diagnostic hysteroscopy (HYST), and endometrial biopsy with the final pathology. Methods: A retrospective study was conducted of 201 polypectomy patients (mean age, 55.3 years; 23–88 years) who underwent operative hysteroscopy between 1992 and 1998. Results: Main indications were abnormal uterine bleeding in 172 patients (85.6%) Operative findings included benign endometrial polyps in 91.5%. Histologic abnormalities of the endometrial polyps were detected in 19 cases (9.5%); of these, complex hyperplasia was detected in 13 and atypical hyperplasia in 6. Patients with histologic abnormalities were older and had more medical problems. Sensitivity of the preoperative assessment tools for polyps were: TVUS (16.7%), SIS (83%), HYST (89.5%), and pipelle (10.8%). There were no false-negative results with SIS or hysteroscopy. There were four complications as a result of cervical dilation. After a mean follow-up of 30 months, 88% of patients had excellent clinical response with resumption of normal menstrual pattern or amenorrhea. Conclusions: Endometrial polyps frequently contribute to abnormal uterine bleeding. Benign histology is usual. Preoperative assessment with SIS or HYST are better predictors of intracavitary abnormalities than TVUS or endometrial biopsy. Resolution of menstrual dysfunction occurs in most patients.