Role of hysteroscopy in detection and extraction of endometrial polyps: Results of a prospective study

OBJECTIVE: The aim of this study was to determine whether hysteroscopy impr oves the detection and extraction of endometrial polyps in postmenopausal w omen. This method was compared with curettage complemented by Randall polyp forceps. STUDY DESIGN: In a prospective study hysteroscopy was performed before and after curettage in postmenopausal women. In addition to curettage, the Rand all polyp forceps was used to extract endometrial polyps. Curettage and pol yp extraction by Randall forceps were performed by a second surgical team t hat did not know the results of hysteroscopy. RESULTS: A total of 83 patients were included in the study because of eithe r postmenopausal bleeding (n = 40) or ultrasonographic abnormal endometrium (n = 37), or both (n = 6). Thirty-two patients received either hormone rep lacement therapy or tamoxifen. Hysteroscopy revealed endometrial polyps in 51 patients. Polyps were diagnosed by curettage alone in 22 (43%) cases. In 18 of these 22 cases remnants of polyps were extracted by Randall forceps, and in another 23 cases polyps were only found by use of the Randall force ps. Thus in 45 (88%) of 51 patients the detection of endometrial polyps by curettage and Randall forceps was possible. A second hysteroscopy procedure revealed remnants of polyps or polyps in 31 cases. These patients with inc omplete curettage predominantly had a preoperative endometrial thickness of greater than or equal to 10mm. CONCLUSIONS: Curettage alone in postmenopausal patients is not sufficient f or detection and extraction of endometrial polyps. Additional use of Randal l forceps improves detection of polyps considerably. However, with both pro cedures complete extraction of polyps was not achieved in a considerable nu mber of patients. Hysteroscopy-controlled extraction was superior, especial ly in those patients with an endometrial thickness of >10mm.