THICK ENDOMETRIUM IN SYMPTOMATIC AND ASYMPTOMATIC POSTMENOPAUSAL WOMEN: SONOGRAPHIC AND HISTOPATHOLOGICAL CORRELATION
Keywords:Postmenopause, Endometrium, Ultrasound, Endometrial biopsy, Endometrial cancer
Incidence of premalignant and malignant endometrial diseases increase in postmenopausal women.
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.
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.
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.
Panay N. Menopause and Postmenopausal Health. In: Edmonds K. Dewhurst's Textbook of Obstetrics & Gynaecology. 8th ed. Canada: Wiley; 2018, pp. 672-88.
Otify M, Fuller J, Ross J, Shaikh H, Johns J. Endometrial pathology in the postmenopausal woman–an evidence based approach to management. Obstet Gynaecol. 2015;17(1):29-38.
Gambacciani M, Monteleone P, Ciaponi M, Sacco A, Genazzani AR. Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. Maturitas. 2004; 48(4):421-4.
Hans SA. Self-Assessment & review Gynecology. 11th ed. Delhi: Jaypee Brothers Medical Publishers: 2018, pp. 310-25.
Annan JJ, Aquilina J, Ball E. The management of endometrial polyps in the 21st century. Obstet Gynaecol. 2012;14(1):33-8.
Luesley DM, Kilby MD, editors. Obstetics & Gynecology: An evidence -based Text for the MRCOG. New York: Taylor and Francis: 2016, pp. 873-82.
Kotdawala P, Kotdawala S, Nagar N. Evaluation of endometrium in peri-menopausal abnormal uterine bleeding. J Midlife Health. 2013;4(1):16-21.
Manfredi R, Mirk P, Maresca G, Margariti PA, Testa A, Zannoni GF, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology. 2004; 231(2):372-8.
Christensen JW, Dueholm M, Hansen ES, Marinovskij E, Lundorf E, Ørtoft G. Assessment of myometrial invasion in endometrial cancer using three-dimensional ultrasound and magnetic resonance imaging. Acta obstetricia et gynecologica Scandinavica. 2016; 95(1):55-64.
Farrell T, Jones N, Owen P, Baird A. The significance of an 'insufficient' Pipelle sample in the investigation of post-menopausal bleeding. Acta obstetricia et gynecologica Scandinavica. 1999; 78(9):810-2.
Guin G, Sandhu SK, Lele A, Khare S. Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynaecol India. 2011;61(5):546-9.
Clark TJ, Cupta JK. Endometrial sampling of gynecological pathology. The obstetrician and gynecologist 2002;4(3):169-74.
Alison H, Franzco G. The woman with postmenopausal bleeding. Aust Fam Physician. 2007;36(3):116-20.
Dimitraki M, Tsikouras P, Bouchlariotou S, Dafopoulos A, Liberis V, Maroulis G, Teichmann AT. Clinical evaluation of women with PMB. Is it always necessary an endometrial biopsy to be performed? A review of the literature. Archives of gynecology and obstetrics. 2011 Feb 1;283(2):261-6.
Seckin B, Nadim M, Dickmen A. Diagnostic value of sonography for detecting endometrial pathologies in postmenopausal women with and without bleeding. J Clinical Ultrasound. 2016;44(6):399–45.
Ashur As, Fawzy T, Faisal M. Relationship between body mass index and transvaginal ultrasonographic endometrial thickness in postmenopausal women. Med J Cairo Univ. 2017;85(5):2017–23.
Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound in Obstetrics and Gynecology. 2004; 24(5):558–65.
Goldstein SR. Modern evaluation of the endometrium. Obstetrics & Gynecology. 2010; 116(1):168-76.
Giannella L, Mfuta K, Setti T, Cerami LB, Bergamini E, Boselli F. A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness> 4 mm. Biomed Res Int. 2014; 2014:130569.
Copyright (c) 2020 Shano A. Muhammad, Srwa J. Murad, and Ariana K. Jawad
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.