EVALUATION OF ULTRASONOGRAPHIC THICKENED ENDOMETRIUM IN ASYMPTOMATIC POSTMENOPAUSAL WOMEN

Volume 14 , Issue 1 , March 2024 , Pages 17-24

Authors

Gona Aziz Rahim 1

1 Chwarbakh Health Center, Ministry of Health, Sulaimani, Kurdistan Region, Iraq.

DOI logo 10.17656/jsmc.10446

Keywords

Abstract

Background
Asymptomatic thickened endometrium (ATE) in postmenopausal women (PMW) is a common condition, and
it’s a mostly incidental fi nding on a pelvic ultrasound done for unrelated problems in a case seeking medical
advice. The upper limit for hysteroscopic assessment of ATE in PMW by ultrasound is still debatable.
Objectives
To assess the histopathological abnormalities of asymptomatic thick endometrium in postmenopausal women
and to determine the cutoff point of endometrial thickness that is associated with atypical endometrium and
endometrial carcinoma.
Patients and methods
A cross-sectional study was conducted in private clinics and hospitals in Sulaimani City/Kurdistan region/
Iraq within a period between January 2020 to January 2023. It involved asymptomatic postmenopausal
women who visited a physician, surgeon, or gynaecologist for different unrelated conditions, and they advised
ultrasound which showed thickened endometrium ˃ 5 mm incidentally. These women were counseled about
their condition by the gynaecologists after referral to them and subjected to hysteroscopy and endometrial
biopsy after their agreement. The parameters observed were Age, residency, body mass index (BMI), duration
of menopause, chronic hypertension, diabetes mellitus (DM), vaginal discharge, and thickness of endometrium
by 2D transvaginal ultrasound (TVU). During hysteroscopy, the endometrium was observed for any focal
lesion, symmetrical thickness, or polyp, and an endometrial sample was taken, with the removal of the polyp
when present. Samples were sent for histopathological examination (HPE), and the result of HPE was recorded.
Results
A total of 40 postmenopausal women were included in this study; they offered Hysteroscopy after TVU, which
revealed ET ˃ 5mm. 40% of them had endometrial atrophy, 42.5% had endometrial polyp, 7.5% had simple
endometrial hyperplasia without atypia, 2.5% had atypical endometrial hyperplasia (EH), and another 7.5%
had endometrial carcinoma (EC). Endometrial thickness was a statistically signifi cant predictor of the presence
of EC and atypical EH (P value 0.014). ROC curve analysis identifi ed the cutoff point for differentiating
malignant and malignant potential from benign to be 11.5 mm, with sensitivity of (83.3%), specifi city (50%),
and high accuracy of (80%).
Conclusion
The risk of precancerous lesions and carcinoma of the endometrium is low in postmenopausal women with
ATE. Detailed TVU is an invaluable predictor for malignant and premalignant conditions, and no cutoff
thickness can precisely predict endometrial pathology; however, an ET of 11.5 can be used as the cutoff point
for predicting malignant and premalignant conditions in ATE.Objectives 

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  • Published at21 March 2024

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