[1193] Cervical Polyps: Is Histologic Evaluation Necessary?

Rebecca A Levy, Charles Quick. UAMS, Little Rock, AR

Background: Multiple clinical studies have shown that cervical polyps are essentially benign, with a prevalence of malignancy of 0.1%; for this reason, several studies have recommended that polypectomy is not indicated in all cases. However, histologically examined cervical polyps may contain unexpected cervical intraepithelial neoplasia (CIN), endometriosis, metaplasia and primary malignancies. The purpose of this study was to examine a consecutive series of clinically identified polyps, determine the incidence of clinically significant pathologic findings, and correlate them with atypical pap test results if available.
Design: 369 consecutive endocervical polyps (identified by clinical terminology of “cervical polyp” in pathology reports) from the past 12 years were reviewed. A histologic evaluation of the polyps was performed, followed by a chart review to identify clinical presentation and the immediately prior or concurrent pap test results.
Results: Our dysplastic/malignant findings and benign/reactive findings are listed in tables below. The incidence of each finding is the number of involved cases compared to all of the polyps evaluated (369 cases), except for the pap test percentages, which are compared to the patients with pap tests (228 cases).

Dysplastic \ Malignant FindingsIncidence
ASCUS29 (12.7%)
AGC13 (5.7%)
CIN 16 (1.6%)
CIN 2/32 (0.5%)
Adenosarcoma2 (0.5%)
Atypical Polyp / Possible Adenosarcoma2 (0.5%)
Endometrioid Adenocarcinoma1 (0.3%)
Adenocarcinoma in-situ1 (0.3%)

Benign \ Reactive FindingsIncidence
Inflammation356 (96.5%)
Thick walled vessels361 (97.8%)
Reactive epithelium336 (91.1%)
Squamous metaplasia145 (39.3%)
Tubal\endometrioid metaplasia79 (21.4%)
Microglandular hyperplasia67 (18.2%)
Endometriosis18 (4.9%)
Atypical Stromal cells29 (7.9%)
Stromal Mitoses5 (1.3%)
Granulation\Ulceration53 (14.1%)

Conclusions: We demonstrate a higher rate of clinically significant findings in cervical polyps (14 of 369 cases, 3.8 %) than previously reported in clinical studies. In addition, College of American Pathologist guidelines state that ThinPrep testing has a mean expected reporting rate of 4.9% for ASCUS and 0.2% for AGC. The increased incidence of ASCUS (12.7%) and AGC (5.7%) in the pap test of our study patients is most likely related to the associated reactive and inflammatory changes present in the polyps, as none of the patients with abnormal paps had squamous intraepithelial lesions on biopsy. In contrast to recent clinical literature, our results suggest that removal of all cervical polyps and subsequent histologic review is warranted.
Category: Gynecologic & Obstetrics

Wednesday, March 6, 2013 1:00 PM

Poster Session VI # 184, Wednesday Afternoon


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