| Objective:Through the retrospective analysis of the relationship between the general information,clinical symptoms,ultrasonic image characteristics and postoperative pathological diagnosis of postmenopausal endometrial polyps,to explore the clinical characteristics of postmenopausal endometrial polyps and the risk factors of malignant transformation and precancerous lesions,and to seek the appropriate diagnosis and treatment plan.Method:The clinical data of 387 cases of postmenopausal endometrial polyps treated by hysteroscopy in Tianjin Medical University General Hospital from January 2012to October 2019 were analyzed retrospectively.According to the postoperative pathological diagnosis,it can be divided into:In the group of malignant and precancerous lesions,19 cases(group A),including malignant transformation of polyps(local malignant transformation of polyps with normal peripheral intima)and malignant transformation of normal peripheral intima;Precancerous lesions include atypical hyperplasia of polyp gland,atypical hyperplasia of normal surrounding intima and atypical adenomyomatous polyp;368 cases of benign polyps(group B),including atrophic endometrial polyps,endometrial polyps with hyperplasia of glands and adenomyomatous polyps.The BMI(kg/m~2),age,menarche age,menopause age,menopause years,regular menstruation before perimenopause,pregnancy and childbirth times,hypertension,diabetes,family history of malignant tumors,personal history of malignant tumors,serum estradiol level,postmenopausal bleeding,endometrial thickness under transvaginal color Doppler ultrasound,intrauterine mass size,echo characteristics were compared between the two groups The high risk factors of malignant transformation and precancerous lesions in postmenopausal endometrial polyps were analyzed.SPSS 22.0 software package was used for statistical analysis.The measurement data between the two groups were analyzed by independent t-test or nonparametric test;Chi square test or Fisher’s exact test were used for counting data;The variables with statistical significance in single factoranalysis were included in multi factor Logistic regression analysis.P<0.05,the difference was statistically significant.Result:1.In this study,the pathological results of 387 postmenopausal patients with endometrial polyps after hysteroscopy were malignant and precancerous lesions in4.91%(19 cases),of which only 1.03%(4 cases)were malignant polyps;The proportion of benign lesions was 95.05%(368 cases).2.BMI of group A(28.43±4.812kg/m2)was significantly higher than that of group B(25.84±4.037kg/m2),the difference was statistically significant(P=0.009);The proportion of obese patients in group A was 57.9%(10 cases),which was significantly higher than that in group B(26.9%)(P=0.015);The percentage of irregular menstruation in group A was 31.6%(6 cases),which was significantly higher than that in group B(5.7%)(21 cases),the difference was statistically significant(P<0.001);There was no significant difference in age,menarche age,menopause age,menopause years,pregnancy and childbirth times,hypertension history,diabetes history,family history of malignant tumor,personal history of malignant tumor,E2 and other factors between group A and B.3.The proportion of postmenopausal bleeding in group A was 78.9%(15 cases),which was significantly higher than that in group B(51.6%)(190 cases),the difference was statistically significant(P=0.020).47.4%(9 cases)of patients with bleeding times≥2 in group A were significantly higher than that in group B(18.8%)(69 cases),the difference was statistically significant(P=0.006).There was no significant difference in the amount of bleeding between the two groups(P=0.073).The incidence of postmenopausal bleeding was 68.1%(62 cases)in patients with endometrial polyps and adenomyomatous polyps,which was significantly higher than45.9%(105 cases)in patients with atrophic endometrial polyps and 47.9%(23 cases)in patients with adenomyomatous polyps.The difference was statistically significant(P<0.001 and P=0.020).4.The average diameter of polyps in group A was 20.76±7.99mm,which was significantly larger than that in group B(16.6±8.75mm,P=0.046).The average diameter of polyps was further classified,In group A,5.3%(1 case),47.4%(9 cases),47.4%(9 cases),22.6%(83 cases),52.2%(192 cases)and 25.3%(93 cases)were≤10 mm,10-20 mm,10-20 mm,10-20 mm,10-20 mm,respectively.The difference was statistically significant(P=0.042).The average diameter of polyps in group A was more than 20 mm in 47.4%(9 cases),which was significantly higher than that in group B in 25.3%(93 cases).There was no significant difference in echo,blood flow and the relationship between the two groups.5.Single factor Logistic regression analysis,Irregular perimenopause(or 0.131,95%CI 0.045-0.380,P<0.001),obesity(or 3.503,95%CI 1.343-9.134,P=0.010),postmenopausal bleeding(or 3.513,95%CI 1.144-10.786,P=0.028),bleeding times≥2(or 3.900,95%CI 1.527-9.962,P=0.004),average polyp diameter>20 mm(or2.661,95%CI 1.527-9.962,P=0.004)1.049-6.750,P=0.039)is the risk factor of malignant transformation or precancerous lesions of endometrial polyps after menopause.The multivariate logistic regression analysis showed that obesity(BMI≥28KG/m2)(or 3.080,95%CI 1.147-8.273,P=0.026)and irregular premenopausal menstruation(or 7.574,95%CI 2.510-22.852,P<0.001)were independent risk factors for malignant transformation or precancerous lesions of postmenopausal endometrial polyps.Conclusion:1.1.03%of postmenopausal endometrial polyps were malignant.2.Obesity and premenopausal irregular menstruation are independent risk factors for precancerous lesions and malignant changes in postmenopausal endometrial polyps.3.Postmenopausal bleeding is a risk factor for adenosis,precancerous lesions and malignant changes in postmenopausal endometrial polyps.Once found,further hysteroscopy is needed.4.The mean diameter of polyp>20 mm is a risk factor for malignant or precancerous changes in postmenopausal endometrial polyps.Postmenopausal endometrial polyps with no symptoms,no high risk factors and polyp diameter≤10 mm have a very low possibility of malignant transformation. |
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