Question:

Asymptomatic endocervical polyps seen on routine cervical smear test-do they need to be removed and sent for histology?

15 July 2007 note: This question is over 2 years old and may differ to any new research.

The only guidance on this topic has been produced by NHS Scotland as part of their ‘Gynaecology Patient Pathway’.  This includes a section ‘Management of Cervical Polyps’ [1], which states:

“Cervical polyps are common coincidental findings in women undergoing cervical screening.  In the asymptomatic woman they are almost always benign.  They consist of an overgrowth of the endocervical columnar epithelium and are usually solitary although a small number may coexist.  More rarely a submucosal uterine fibroid on a long pedicle may be extruded through the cervical canal.

Removal of a cervical polyp up to 2cm long by 1cm wide is a simple painless procedure requiring little skill and is not associated with significant bleeding and can be easily done in the primary care setting.  Assuming this is a coincidental finding a vaginal speculum will already be in place.

 - If the intention was to take a cervical smear this should now be performed.
 - The vaginal speculum may be replaced with a self-retaining one thus freeing up the examiner.
 - The polyp should be grasped with a polypectomy or sponge-holding forceps and twisted several times. The polyp can now be pulled upon and avulsed. The vaginal speculum should be removed.
 - The polyp should be placed in a specimen pot with fixative and sent to a pathology department with a completed request form for histological examination.
 - The patient should be reassured and advised how and when she will learn of the pathology findings.
 - Patient should be warned to expect some vaginal bleeding for up to 24 h.
 - In the unlikely event that the patient experiences significant discomfort or there is difficulty,  the procedure should be abandoned and the patient referred to a gynaecologist.” 

For further information you may be interested in the American eMedicine article on Benign Cervical Lesions [2]

References

1) http://www.pathways.scot.nhs.uk/polyps.htm
2) http://www.emedicine.com/med/topic3297.htm

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