Decade-Stratified Malignancy Risk in Hysteroscopic Polypectomy: A Multicenter Registry Analysis of 9269 Procedures
Year: 2026
Type: article
Study design: Observational Study
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. Objective. To estimate decade-specific absolute malignancy rates and to determine how postmenopausal bleeding and other procedural indications modify that risk. Methods. Retrospective multicenter cohort with SNOMED-coded histology. All hysteroscopic polypectomies at five Assuta Medical Center sites from January 2019 to April 2026 with a linked histology result (n = 9,269; 75.1% of a base cohort of 12,339). Primary outcome: histologically confirmed endometrial malignancy. Multivariable logistic regression adjusted for weight category, hospital site, and calendar year. Results. The overall malignancy rate was 1.63% (151/9,269), increasing monotonically with age: 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). Postmenopausal bleeding carried a malignancy rate of 6.32%; among women aged 70 or older presenting with postmenopausal bleeding, the rate reached 13.1%. Non-postmenopausal abnormal uterine bleeding was not associated with excess risk (0.36%). Weight over 80 kg was an independent predictor (adjusted OR, 3.05; 95% CI, 1.92–4.84). Conclusions. Malignancy risk rises more than tenfold across age groups. Postmenopausal bleeding carries substantially higher risk than other uterine bleeding indications, while non-postmenopausal bleeding carries none. Age and postmenopausal bleeding status, considered jointly, are the most clinically useful predictors for stratifying histological examination decisions.
Source: Cancers
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7204031252