A study presented at RCOG 2024 supports the non-removal of incidentally identified cervical polyps, given the low incidence of malignancy and the cost-effectiveness of such approach.

Researchers from Epsom and St Helier University Hospitals (ESTH) National Health Service (NHS) Trust, Obstetrics and Gynaecology, Carshalton, Surrey, UK, conducted a retrospective case notes review of all cervical polyps removed and examined histologically over a period of 8 years at ESTH. Their objectives were todetermine the incidence of malignancy in symptomatic and asymptomatic cervical polyps removed at an NHS District General Hospital and to evaluate the cost-effectiveness of cervical polyp removal in secondary care. [RCOG 2024, abstract MTeP-31]

A review of electronic patient records showed 1,067 cases of cervical polyp removal during the study period. The age of the participants at presentation ranged between 25.7 and 93.3 years (median 52.4 years). It was not feasible to review the records of 73 cases. Seven cases were excluded after being confirmed to be endometrial rather than cervical polyps.

About 90 percent (n=886) of participants had available clinical information. Of these, 43.7 percent were premenopausal, 38.1 percent perimenopausal, and 7.3 percent postmenopausal.

The mean total number of cervical polyps removed and evaluated was 138.6 per year (80.4 asymptomatic, 58.2 symptomatic).

Low malignancy rate on histological analysis

Cervical polyps are mostly asymptomatic and usually present as an incidental finding after routine cervical cancer screening or gynaecological examination. Symptomatic polyps are usually characterized by post-coital, intermenstrual, or post-menopausal bleeding, the researchers noted.

“There remains a widely held view in both primary and secondary care that all cervical polyps should be removed, regardless of symptomatology. This is largely due to the uncertainty regarding an underlying malignancy,” the researchers pointed out.

However, a retrospective analysis showed that none of the cervical polyps evaluated in the study had malignant features. [BJOG 2009;116:1127-1129] In another observational study, 100 percent of the asymptomatic cervical polyps removed were benign, while only 0.2 percent of symptomatic cases showed high-grade cervical intraepithelial neoplasia. [Eur J Obstet Gynecol Reprod Biol 2010;150:190-194]

In the current study, 994 participants (93.2 percent) had histological findings available. Of these, 576 (58 percent) had asymptomatic or incidental cervical polyps, none of which were malignant. In the subgroup of participants who had symptomatic polyps (n=418 [42 percent]), three cases were determined to be malignant (one cervical and two endometrial).

Financial impact

In the UK, a first appointment in a gynaecology outpatient department would cost about ￡174 and standard histological analysis is estimated at ￡150. [https://www.england.nhs.uk/publication/2023-25-nhs-payment-scheme, Annex A; http://thepathlab.co.uk/Price-List-2021.pdf, accessed November 26, 2024]

“[These represent] an annual cost of ￡13,990 to primary care for the initial appointment alone and ￡12,060 for histological analysis for all asymptomatic polyps referred and removed, totalling ￡26,050 per annum,” the investigators explained.

“[Hence,] adjusting clinical policy to reflect this so that only patients with symptomatic polyps are referred will result in significant improvement in cost-saving, waiting list times, and efficiency in the gynaecology outpatient setting,” they said.