{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:21:57Z","timestamp":1788337317644,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Endometrial polyps are a prevalent pathological condition within the uterine cavity. While the majority of lesions are classified as benign, histopathological examinations indicate a potential for malignant transformation occurring in 0.5\u20135% of cases. The present study aimed to evaluate the prevalence of endometrial carcinoma and pre-malignant histopathological findings (glandular hyperplasia without atypia and atypical glandular hyperplasia) associated with endometrial polyps and to identify pertinent risk factors among Polish women undergoing hysteroscopic polypectomy under local anesthesia. Methods: A retrospective cohort study was conducted at the Outpatient Hysteroscopy Center of the Heliodor Swiecicki University Hospital of Gynecology and Obstetrics, affiliated with Poznan University of Medical Sciences. The study included patients treated using the GUBBINI mini-resectoscope under local anesthesia with the Hystero-Block system (Tontarra Medizintechnik GmbH, Wurmlingen, Germany) between December 2022 and July 2026. Statistical analysis of risk factors was performed using the Kruskal\u2013Wallis H test and Fisher\u2019s exact test. Odds ratios for potential risk factors were also calculated. Results: The study comprised 2588 patients. Endometrial carcinoma associated with endometrial polyps was identified in 16 women (0.62%). Additional histopathological findings included glandular hyperplasia in 360 patients (13.91%) and atypical hyperplasia in 35 patients (1.35%), with the remaining patients diagnosed with benign uterine polyps (84.12%). Patients with malignant and pre-malignant lesions were significantly older than those with benign polyps (p &lt; 0.001). Regarding polyp size, patients diagnosed with glandular hyperplasia without atypia had significantly larger polyps than those with benign lesions (p &lt; 0.001). Estimated postmenopausal status was associated with significantly higher odds of endometrial carcinoma (Odds Ratio [OR] = 6.56, 95% Confidence Interval [CI]: 2.12\u201320.30, p = 0.001) and atypical glandular hyperplasia (OR = 3.13, 95% CI: 1.41\u20136.96, p = 0.005) compared to benign polyps. Similarly, obesity increased the odds of glandular hyperplasia without atypia (OR = 1.32, 95% CI: 1.01\u20131.74, p = 0.045) and atypical glandular hyperplasia (OR = 3.33, 95% CI: 1.67\u20136.65, p &lt; 0.001). Furthermore, hypertension was associated with higher odds of glandular hyperplasia without atypia compared to benign polyps (OR = 1.41, 95% CI: 1.02\u20131.97, p = 0.040). Other evaluated risk factors, including type II diabetes mellitus, infertility, abnormal uterine bleeding, breast cancer history, hypothyroidism and polyendocrine metabolic ovarian syndrome (PMOS), did not reach statistical significance (p &gt; 0.05). This large cohort provides important data regarding the prevalence and risk factors of carcinoma associated with endometrial polyps and pre-malignant uterine lesions in Polish women. Conclusions: Endometrial carcinoma associated with endometrial polyps is a rare entity among Polish women undergoing outpatient hysteroscopy (0.62%). Nevertheless, the primary diagnostic value of this large-scale study lies in demonstrating that despite the low prevalence of malignancy in standard \u201csee-and-treat\u201d outpatient settings, systematic histopathological evaluation remains an absolute diagnostic mandate, as relying solely on visual or clinical parameters is insufficient to exclude malignancy. Furthermore, identified risk factors, such as age, polyp size, estimated postmenopausal status, obesity and hypertension, serve as critical diagnostic red flags, associated with increased odds of concurrent premalignant lesions or carcinoma.<\/jats:p>","DOI":"10.3390\/diagnostics16172821","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T07:53:11Z","timestamp":1788335591000},"page":"2821","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Risk Factors of Endometrial Carcinoma Associated with Endometrial Polyps: A Retrospective Study of 2588 Polish Patients"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2398-3252","authenticated-orcid":false,"given":"Zofia Maria","family":"Kiestrzyn","sequence":"first","affiliation":[{"name":"Medical Faculty, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"},{"name":"Student Scientific Society of Obstetrics and Gynecology, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Wilczak","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Gynecological Surgery, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-8353","authenticated-orcid":false,"given":"Karolina","family":"Chmaj-Wierzchowska","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Minimally Invasive Gynecological Surgery, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland"},{"name":"Laboratory of Modern Interventional Therapies in Gynecology and Urogynecology, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"ref_1","unstructured":"WHO Classification of Tumours Editorial Board (2020). Female Genital Tumours, International Agency for Research on Cancer. [5th ed.]. WHO Classification of Tumours Series."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"232","DOI":"10.31083\/j.ceog4910232","article-title":"Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment","volume":"49","author":"Vieira","year":"2022","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.ygyno.2014.01.004","article-title":"Hyperinsulinemia is associated with endometrial hyperplasia and disordered proliferative endometrium: A prospective cross-sectional study","volume":"132","author":"Shan","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1080\/13645706.2021.1948867","article-title":"Endometrial polyps: Diagnosis and treatment options\u2014A review of literature","volume":"30","author":"Raz","year":"2021","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_5","unstructured":"Mansour, T., and Chowdhury, Y.S. (2026, March 19). Endometrial Polyp, StatPearls [Internet], Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557824\/."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"American Association of Gynecologic Laparoscopists (2012). AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps. J. Minim. Invasive Gynecol., 19, 3\u201310.","DOI":"10.1016\/j.jmig.2011.09.003"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ejogrb.2019.04.009","article-title":"The risk of malignancy in uterine polyps: A systematic review and meta-analysis","volume":"237","author":"Uglietti","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.jmig.2018.02.004","article-title":"Factors Associated with Malignancy in Hysteroscopically Resected Endometrial Polyps: A Systematic Review and Meta-Analysis","volume":"25","author":"Sasaki","year":"2018","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4103\/gmit.GMIT-D-24-00056","article-title":"Risks of Malignancy among 11,204 Patients with Endometrial Polyp: A Systematic Review and Meta-analysis","volume":"14","author":"Mohamed","year":"2025","journal-title":"Gynecol. Minim. Invasive Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"75","DOI":"10.5603\/njo.99065","article-title":"Cancer incidence and mortality in Poland in 2023","volume":"74","author":"Didkowska","year":"2024","journal-title":"Nowotw. J. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102402","DOI":"10.1016\/j.jogc.2024.102402","article-title":"Guideline No. 447: Diagnosis and Management of Endometrial Polyps","volume":"46","author":"Bougie","year":"2024","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"482","DOI":"10.5603\/GP.2019.0083","article-title":"Polish Society of Gynecologists and Obstetricians Guidelines for the application of hysteroscopy in gynecology","volume":"90","author":"Zimmer","year":"2019","journal-title":"Ginekol. Pol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.jmig.2021.10.004","article-title":"International Consensus Statement for Recommended Terminology Describing Hysteroscopic Procedures","volume":"29","author":"Carugno","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ejogrb.2024.01.033","article-title":"The risk factors for premalignant and malignant endometrial polyps in premenopausal and postmenopausal women and trends over the past decade: A retrospective study in a single center, South Korea","volume":"295","author":"Jang","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Nowak, A., Chmaj-Wierzchowska, K., Lach, A., Malinger, A., and Wilczak, M. (2024). Evaluation of Pain During Hysteroscopy Under Local Anesthesia, Including the Stages of the Procedure. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237030"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.ijgo.2006.07.007","article-title":"Hysteroscopic evaluation of endometrial polyps","volume":"95","year":"2006","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ygyno.2005.09.042","article-title":"Thin endometrial echo complex on ultrasound does not reliably exclude type II endometrial cancers","volume":"101","author":"Wang","year":"2006","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cetin, F., Kayar, \u0130., Birge, \u00d6., and Goc, G. (2024). Malignancy risk factors based on endometrial polyp. BMC Womens Health, 24.","DOI":"10.1186\/s12905-024-03406-3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s004040050241","article-title":"Endometrial polyps","volume":"262","author":"Kugler","year":"1999","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"pkad001","DOI":"10.1093\/jncics\/pkad001","article-title":"Differential trends in rising endometrial cancer incidence by age, race, and ethnicity","volume":"7","author":"Liu","year":"2023","journal-title":"JNCI Cancer Spectr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Guo, F., Adekanmbi, V., Hsu, C.D., Hoang, T.N., Soliman, P.T., Baillargeon, J.G., and Berenson, A.B. (2025). Trends in Endometrial Cancer Incidence Among Premenopausal and Postmenopausal Women in the United States Between 2001 and 2021. Cancers, 17.","DOI":"10.3390\/cancers17061035"},{"key":"ref_22","first-page":"382","article-title":"Predictors of malignancy in endometrial polyps: A multi-institutional cohort study","volume":"35","author":"Litta","year":"2014","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/IGC.0000000000000609","article-title":"ESMO-ESGO-ESTRO Consensus Conference on endometrial cancer","volume":"26","author":"Colombo","year":"2016","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1007\/s00125-007-0681-5","article-title":"Diabetes mellitus and risk of endometrial cancer: A meta-analysis","volume":"50","author":"Friberg","year":"2007","journal-title":"Diabetologia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ygyno.2004.03.048","article-title":"Endometrial pathologies associated with postmenopausal tamoxifen treatment","volume":"94","author":"Cohen","year":"2004","journal-title":"Gynecol. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/ijgo.14923","article-title":"FIGO staging of endometrial cancer: 2023","volume":"162","author":"Berek","year":"2023","journal-title":"Int. J. Gynecol. Obstet."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2821\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:02:44Z","timestamp":1788336164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":26,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16172821"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16172821","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}