Introduction/Background To evaluate the role of transvaginal sonographic (tvUSG) endometrial thickness to detect endometrial cancers among postmenopausal women.
Methodology Endometrial biopsy results of 1099 postmenopausal patients who have been evaluated at our hospital since 2015 are retrospectively collected. Age, symptoms (asymptomatic vs. postmenopausal bleeding-PMB), tvUSG endometrial thickness were the parameters to be collected. Patients with insufficient endometrial sampling were excluded (n = 103, 9.3%). Remaining study group (n=996) were divided into 5 groups according to their histopathological diagnosis: benign/physiological endometrium (group A), endometrial polyp (group B), endometrial hyperplasia or intraepithelial neoplasia (group C), endometrioid carcinoma (group D) and non-endometrioid carcinoma (group E). A scatter plot graph (figure 1) is prepared comparing the endometrial pathologies vs. tvUSG thickness.
Results A total of 996 endometrial biopsies were evaluated (356 patients were asymptomatic, 640 patients presented with postmenopausal bleeding). The median age of the patients was 57.3 years. The cancer detection rate among patients with bleeding was 7.6% (49/640). This rate was 4.2% in asymptomatic patients (15/356). The comparison of the two groups is presented in table 1. High-grade cancers were detected three times more in symptomatic patients (75%, 15/20 vs. 25%, 5/20).
The mean endometrial thickness increases gradually from group A to group B: 8.3 for group A; and 12.1, 11.9, 18.7 and 16.0 mm for groups B, C, D, and E; respectively. In groups D and E, there were only 4 patients with an endometrial thickness of less than 5 mm (6.2%). Three patients were symptomatic and only one patient was asymptomatic.
A threshold of 5 mm can reveal 14/15 cancers in asymptomatic patients, while this figure is 12/15 for a 10 mm threshold and 6/15 for a threshold of 20 (figure 1). A threshold for 10 mm is reasonable for asymptomatic patients, missing 3 cancer patients (1 low grade, 2 high grade). In symptomatic patients, these figures were 46/49 for 5 mm threshold (3 missed cancer), 37/49 for a 10 mm threshold (12 missed cancer) and 21/49 for a 20 mm threshold (28 missed cancer).
Conclusion Endometrial biopsy should be performed routinely in patients with postmenopausal bleeding due to high numbers of missed cancers. However, in asymptomatic patients, a biopsy can safely be ignored in patients with endometrial thickness of less than 5 mm. A biopsy may also be reserved for patients with an endometrial thickness > 10 mm (Cancer detection rate is 1.4% vs. 7.8%).
Disclosures Nothing to declare.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.