THICK ENDOMETRIUM IN SYMPTOMATIC AND ASYMPTOMATIC POSTMENOPAUSAL WOMEN: SONOGRAPHIC AND HISTOPATHOLOGICAL CORRELATION 

Shano A. Muhammad a, Srwa J. Murad b, and Ariana K. Jawad c



a KBMS Trainee, Sulaimani Maternity Hospital, Kurdistan Region, Iraq.
b Department of Gynecology and Obstetrics, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
C Department of Gynecology and Obstetrics, College of Medicine, University of Hawler, Kurdistan Region, Iraq.
 

Submitted: 16/5/2019; Accepted: 17/2/2020; Published: 21/3/2020

ABSTRACT


Background 

Incidence of premalignant and malignant endometrial diseases increase in postmenopausal women. 


Objectives 

to identify at which endometrial thickness in symptomatic and asymptomatic postmenopausal women endometrial sampling is optimal and cost effective. Besides, use of ultrasound as a screening tool for detection of endometrial pathology.


Materials and Methods

A cross-sectional study was conducted in Sulaymaniyah Maternity Teaching Hospital during April 2018 to April 2019. 100 postmenopausal women with thick endometrium were recruited; 61 women with bleeding and 39 women without symptoms. All women subjected to endometrial biopsy. The results were recorded, T Test and Chi-Squared Test was used to identify statistical differences between the two groups at a P-value of 0.05 and Receiver Operating Characteristic (ROC) curve of endometrial thickness measurement for prediction of endometrial cancer were analyzed.


Results

Endometrial cancer was detected in 16.5% symptomatic women and 5% asymptomatic women. Best cutoff point of endometrial thickness in predicting endometrial carcinoma in symptomatic women was 14.5 mm, which provided 70% sensitivity and 66.7% specificity. Area under curve (AUC) was 0.71, and P-value was 0.32. While in asymptomatic women, cutoff point of endometrial thickness in predicting cancer was 17.25 mm which provided 50% sensitivity and 86.5% specificity. Besides, AUC was 0.49, and P-value was 0.97.


Conclusion

Ultrasound measurement alone for endometrial thickness has no diagnostic value in asymptomatic women at cutoff point of 17.5 mm. Therefore, it is not a good predictor for endometrial cancer; we should consider other ultrasound features and risk factors while assessing symptomatic and asymptomatic postmenopausal women. 




KEYWORDS

Postmenopause, Endometrium, Ultrasound, Endometrial biopsy, Endometrial cancer.