Objectives To study the correlation between endometrial thickness (ET) and histopathological hyperplasia to come up with an algorithm to guide the management of patients with postmenopausal bleeding when endometrial sampling is not possible for any reason such as patient refusal, or unavailability of the test.
Methods In this retrospective cohort, we identified 121 patients with histopathological confirmation of endometrial hyperplasia (EH) then we reviewed their ET on ultrasound scans (USS) at the time of obtaining their endometrial samplings using different cutoffs.
Results The sensitivity of the ultrasound, using the cutoff for the ET as 8 mm was 84.3%. The positive predictive value (PPV) of the USS was found to be 61.4% with a prevalence of 56.3%. When we used 7mm as cutoff, the sensitivity of the ultrasound to identify the patients with EH was 90.9%. The PPV was found to be 58.8%. When we used 6mm as cutoff, the sensitivity of the ultrasound to identify the patients with EH was 96.7%. The PPV of the US was found to be 57.9%.
Conclusions In postmenopausal women, endometrial thickness correlates significantly with histopathological EH. In the absence of endometrial sampling, the presence of thickened endometrium is an independent predictor for EH specifically if there is one or more of the risk factors for endometrial cancer such as Obesity, DM or HTN. An algorithm using ET and risk factors can be of great help in guiding the management of these patients where endometrial sampling is not possible.
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