Decade-Stratified Malignancy Risk in Hysteroscopic Polypectomy: A Multicenter Registry Analysis of 9269 Procedures.
- 1Department of Gynecology, Assuta Medical Centers, Tel Aviv 6971028, Israel.
- 2Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel.
Abstract
Background
Malignancy risk in hysteroscopic polypectomy specimens rises with age and postmenopausal status, but decade-stratified absolute rates from large, unselected cohorts remain scarce, limiting the quantitative basis for pre-procedural risk counseling.Objective
To estimate decade-specific absolute malignancy rates and to determine how the documented procedural indication modifies that risk.Methods
Retrospective multicenter cohort study with SNOMED-coded histology. All hysteroscopic polypectomies at five Assuta Medical Center sites from January 2019 to April 2026 with a linked histology result constituted the analytic cohort (n = 9269; 75.1% of a base cohort of 12,339). The primary outcome was histologically confirmed endometrial malignancy, defined by SNOMED morphology and topography coding. Multivariable logistic regression adjusted for weight category, hospital site, and calendar year.Results
The overall malignancy rate was 1.63% (151/9269), increasing monotonically: 0.45% (under 50 years), 1.25% (50-59), 3.79% (60-69), and 4.58% (70 or older). Adjusted odds ratios versus the reference group were 2.02 (95% CI, 1.13-3.60), 5.77 (95% CI, 3.39-9.83), and 8.03 (95% CI, 4.51-14.30). Across all age groups, procedures with a documented postmenopausal bleeding (PMB) indication carried an overall malignancy rate of 6.32% (29/459; adjusted OR, 3.04; 95% CI, 1.96-4.72 versus incidental polyp finding); among women aged 70 or older with a documented PMB indication, the rate was 8/61 (13.1%; 95% CI, 6.8-23.8%). Procedures coded with a non-PMB uterine bleeding indication were not associated with excess malignancy risk (0.36%). Weight over 80 kg was an independent predictor of endometrial malignancy (adjusted OR, 3.05; 95% CI, 1.92-4.84). Age group and the documented PMB indication were entered as independent covariates in a single multivariable model; no significant age-by-PMB interaction was detected (likelihood ratio test p = 0.667).Conclusions
Malignancy risk rises more than tenfold from the youngest to the oldest age group. Procedures with a documented PMB indication were associated with substantially higher risk than other indications, while non-PMB bleeding was not associated with excess risk in this cohort. Age and documented procedural indication may be the most clinically useful predictors for stratifying histological examination decisions.
Related
- Hysteroscopic polypectomy with vs. without levonorgestrel-releasing intrauterine system in women with endometrial polyps and dysmenorrhea
- Uterine-cavity Lactobacillus relative abundance and endometrial polyp recurrence after hysteroscopic polypectomy: a retrospective cohort study.
- Fine-tuned Medical Vision-Language Model (MedGemma 1.5 4B) with and without Structured Radiologist Descriptors versus EU-TIRADS for Malignancy Risk Stratification of Thyroid Nodules at Ultrasound: A Tunisian Multicenter Diagnostic Accuracy Study
- The Resection Ability of Low‐power Pure‐cut Hot Snare Polypectomy for Nonpedunculated Colorectal Polyps Smaller Than 10 mm: A Single‐center Prospective Study
- Robot-assisted aspiration improves survival over conservative treatment in critical primary brainstem hemorrhage: a multicenter, volume-stratified cohort study
BibTeX
@article{yaniv2026decadestratified,
title = {{Decade-Stratified Malignancy Risk in Hysteroscopic Polypectomy: A Multicenter Registry Analysis of 9269 Procedures.}},
author = {Rina Tamir Yaniv and Tamar Tzur and Hila Goldstein and Gadi Ben-Shitrit and Gabi Haran},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193206},
url = {https://europepmc.org/article/MED/42882900},
note = {CC BY},
}
RIS
TY - JOUR
TI - Decade-Stratified Malignancy Risk in Hysteroscopic Polypectomy: A Multicenter Registry Analysis of 9269 Procedures.
AU - Rina Tamir Yaniv
AU - Tamar Tzur
AU - Hila Goldstein
AU - Gadi Ben-Shitrit
AU - Gabi Haran
PY - 2026
DA - 2026/10/04
JO - Cancers
DO - 10.3390/cancers18193206
UR - https://europepmc.org/article/MED/42882900
AB - Background Malignancy risk in hysteroscopic polypectomy specimens rises with age and postmenopausal status, but decade-stratified absolute rates from large, unselected cohorts remain scarce, limiting the quantitative basis for pre-procedural risk counseling.Objective To estimate decade-specific absolute malignancy rates and to determine how the documented procedural indication modifies that risk.Methods Retrospective multicenter cohort study with SNOMED-coded histology. All hysteroscopic polypectomies at five Assuta Medical Center sites from January 2019 to April 2026 with a linked histology result constituted the analytic cohort (n = 9269; 75.1% of a base cohort of 12,339). The primary outcome was histologically confirmed endometrial malignancy, defined by SNOMED morphology and topography coding. Multivariable logistic regression adjusted for weight category, hospital site, and calendar year.Results The overall malignancy rate was 1.63% (151/9269), increasing monotonically: 0.45% (under 50 years), 1.25% (50-59), 3.79% (60-69), and 4.58% (70 or older). Adjusted odds ratios versus the reference group were 2.02 (95% CI, 1.13-3.60), 5.77 (95% CI, 3.39-9.83), and 8.03 (95% CI, 4.51-14.30). Across all age groups, procedures with a documented postmenopausal bleeding (PMB) indication carried an overall malignancy rate of 6.32% (29/459; adjusted OR, 3.04; 95% CI, 1.96-4.72 versus incidental polyp finding); among women aged 70 or older with a documented PMB indication, the rate was 8/61 (13.1%; 95% CI, 6.8-23.8%). Procedures coded with a non-PMB uterine bleeding indication were not associated with excess malignancy risk (0.36%). Weight over 80 kg was an independent predictor of endometrial malignancy (adjusted OR, 3.05; 95% CI, 1.92-4.84). Age group and the documented PMB indication were entered as independent covariates in a single multivariable model; no significant age-by-PMB interaction was detected (likelihood ratio test p = 0.667).Conclusions Malignancy risk rises more than tenfold from the youngest to the oldest age group. Procedures with a documented PMB indication were associated with substantially higher risk than other indications, while non-PMB bleeding was not associated with excess risk in this cohort. Age and documented procedural indication may be the most clinically useful predictors for stratifying histological examination decisions.
SN - 2072-6694
ER -