OC21.05: Saline contrast sonohysterography with liquid-based endometrial cytology in post-menopausal patients

Objectives: Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of preand malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ≤4 mm) in asymptomatic postmenopausal women. Methods: 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth >50% at follow-up. Demographic, sonographic and surgical data were recorded. Results: Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of followup, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). Conclusions: This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.