Role of transvaginal ultrasonography in determining endometrium cancer risk in asymptomatic postmenopausal women with thickened endometrium
Öz
The aim of this study is to determine the cut-off value for the histopathological evaluation of premalignant-malignant endometrial pathologies from benign pathologies in postmenopausal asymptomatic patients with increased endometrial thickness. This cross-sectional study included a population that included asymptomatic 481 postmenopausal women with an endometrial thickness of more than 5mm in TVU who underwent diagnostic/ operative hysteroscopy and full curettage between January 2015 and January 2018. Demographic characteristics TVU, hysteroscopy findings of patients were recorded. As a result, in the histopathological outcome, 154(3%) women were evaluated as having normal endometrium, 189(39.3%) women as having endometrial polyps, 93(19.3%) women as having endometrial atrophy, and 23(4.6%) women as having endometrial simple hyperplasia, 5(1%) women as having endometrial simple hyperplasia, 17(3.5%) women as having endometrial atrophy and only one (0.1%) woman as having fibroids. In the 187 postmenopausal women with normal diagnostic hysteroscopic evaluation, histopathological findings were: 13(7%) endometrial hyperplasia, 2(1.1%) atypical endometrial hyperplasia, 27(14.4%) endometrial polyps, 4 2.1%) endometrial atrophy, and 2(1.1%) endometrial carcinoma. The endometrial thickness was analyzed with the ROC curve for cutoff value differentiating atypical endometrial hypreplasia/endometrial carcinoma from benign lesions and 10.5 mm was found with 90% sensitivity and 63% specificity. In conclusion, hysteroscopy is highly effective for identifying the endometrium and focal intracavitary pathologies such as polyps, myomas and foreign bodies in women with abnormal uterine bleeding. However, for the diagnosis of endometrial hyperplasia and cancer, hysteroscopic-guided biopsy with uterine curettage seems to be the best method.
Anahtar Kelimeler
Endometrial thickness Hysteroscopy Uterine intracavitary pathology.
Kaynakça
- 1. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol. 1996 Sep;175(3 Pt 2):766-9. doi: 10.1016/s0002-9378(96)80082-2. PMID: 8828559.
- 2. Haslam DW, James WP. Obesity. Lancet. 2005 Oct 1;366(9492):1197-209. doi: 10.1016/S0140-6736(05)67483-1. PMID: 16198769.
- 3. Bray F, Dos Santos Silva I, Moller H, Weiderpass E. Endometrial cancer incidence trends in Europe: underlying determinants and prospects for prevention. Cancer Epidemiol Biomarkers Prev. 2005 May;14(5):1132-42. doi: 10.1158/1055-9965.EPI-04-0871. PMID: 15894663.
- 4. Saccardi C, Vitagliano A, Marchetti M, Lo Turco A, Tosatto S, Palumbo M, et al. Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women. Diagnostics (Basel). 2020 Apr 27;10(5):257. doi: 10.3390/diagnostics10050257. PMID: 32349386; PMCID: PMC7277718.
- 5. Gull B, Carlsson S, Karlsson B, Ylöstalo P, Milsom I, Granberg S. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy? Am J Obstet Gynecol. 2000 Mar;182(3):509-15. doi: 10.1067/mob.2000.103092. PMID: 10739500.
- 6. 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 Obstet Gynecol. 2004 Oct;24(5):558-65. doi: 10.1002/uog.1704. PMID: 15386607.
- 7. Malkasian GD Jr, Annegers JF, Fountain KS. Carcinoma of the endometrium: stage I. Am J Obstet Gynecol. 1980 Apr 1;136(7):872-88. doi: 10.1016/0002-9378(80)91045-5. PMID: 7361835.
- 8. Worley MJ Jr, Dean KL, Lin SN, Caputo TA, Post RC. The significance of a thickened endometrial echo in asymptomatic postmenopausal patients. Maturitas. 2011 Feb;68(2):179-81. doi: 10.1016/j.maturitas.2010.10.007. Epub 2010 Nov 13. PMID: 21075567.
- 9. Lev-Sagie A, Hamani Y, Imbar T, Hurwitz A, Lavy Y. The significance of intrauterine lesions detected by ultrasound in asymptomatic postmenopausal patients. BJOG. 2005 Mar;112(3):379-81. doi: 10.1111/j.1471-0528.2004.00444.x. PMID: 15713160.
- 10. Park YR, Lee SW, Kim Y, Bae IY, Kim HK, Choe J, et al. Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women. Obstet Gynecol Sci. 2019 Nov;62(6):445-453. doi: 10.5468/ogs.2019.62.6.445. Epub 2019 Oct 7. PMID: 31777741; PMCID: PMC6856473.
- 11. Zhang G, Wang Y, Liang XD, Zhou R, Sun XL, Wang JL, et al. Microscale endometrial sampling biopsy in detecting endometrial cancer and atypical hyperplasia in a population of 1551 women: a comparative study with hysteroscopic endometrial biopsy. Chin Med J (Engl). 2020 Sep 30;134(2):193-199. doi: 10.1097/CM9.0000000000001109. PMID: 33009021; PMCID: PMC7817330.
- 12. Ozelci R, Dilbaz B, Akpınar F, Kınay T, Baser E, Aldemir O, et al. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci. 2019 Jul;62(4):273-279. doi: 10.5468/ogs.2019.62.4.273. Epub 2019 Jun 24. PMID: 31338345; PMCID: PMC6629991.
- 13. Kim MJ, Kim JJ, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci. 2016 May;59(3):192-200. doi: 10.5468/ogs.2016.59.3.192. Epub 2016 May 13. PMID: 27200309; PMCID: PMC4871935.
- 14. Wethington SL, Herzog TJ, Burke WM, Sun X, Lerner JP, Lewin SN, et al. Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol. 2011 Dec;18(13):3819-23. doi: 10.1245/s10434-011-1815-z. Epub 2011 Jun 24. PMID: 21701931.
- 15. Lynch HT, Lynch JF. Lynch syndrome: history and current status. Dis Markers. 2004;20(4-5):181-98. doi: 10.1155/2004/460240. PMID: 15528784; PMCID: PMC3839282.
- 16. Menon U, Gentry-Maharaj A, Ryan A, Sharma A, Burnell M, Hallett R, et al. Recruitment to multicentre trials--lessons from UKCTOCS: descriptive study. BMJ. 2008 Nov 13;337:a2079. doi: 10.1136/bmj.a2079. Erratum in: BMJ. 2008;337:a2976. PMID: 19008269; PMCID: PMC2583394.
- 17. Schmidt T, Breidenbach M, Nawroth F, Mallmann P, Beyer IM, Fleisch MC, et al. Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium. Maturitas. 2009 Feb 20;62(2):176-8. doi: 10.1016/j.maturitas.2008.11.018. Epub 2009 Jan 3. PMID: 19121901.
- 18. Korkmazer E, Solak N, Üstünyurt E. Hysteroscopic assessment of postmenopausal endometrial thickening. Prz Menopauzalny. 2014 Dec;13(6):330-3. doi: 10.5114/pm.2014.47985. Epub 2014 Dec 30. PMID: 26327874; PMCID: PMC4352917.
Öz
Kaynakça
- 1. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol. 1996 Sep;175(3 Pt 2):766-9. doi: 10.1016/s0002-9378(96)80082-2. PMID: 8828559.
- 2. Haslam DW, James WP. Obesity. Lancet. 2005 Oct 1;366(9492):1197-209. doi: 10.1016/S0140-6736(05)67483-1. PMID: 16198769.
- 3. Bray F, Dos Santos Silva I, Moller H, Weiderpass E. Endometrial cancer incidence trends in Europe: underlying determinants and prospects for prevention. Cancer Epidemiol Biomarkers Prev. 2005 May;14(5):1132-42. doi: 10.1158/1055-9965.EPI-04-0871. PMID: 15894663.
- 4. Saccardi C, Vitagliano A, Marchetti M, Lo Turco A, Tosatto S, Palumbo M, et al. Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women. Diagnostics (Basel). 2020 Apr 27;10(5):257. doi: 10.3390/diagnostics10050257. PMID: 32349386; PMCID: PMC7277718.
- 5. Gull B, Carlsson S, Karlsson B, Ylöstalo P, Milsom I, Granberg S. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy? Am J Obstet Gynecol. 2000 Mar;182(3):509-15. doi: 10.1067/mob.2000.103092. PMID: 10739500.
- 6. 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 Obstet Gynecol. 2004 Oct;24(5):558-65. doi: 10.1002/uog.1704. PMID: 15386607.
- 7. Malkasian GD Jr, Annegers JF, Fountain KS. Carcinoma of the endometrium: stage I. Am J Obstet Gynecol. 1980 Apr 1;136(7):872-88. doi: 10.1016/0002-9378(80)91045-5. PMID: 7361835.
- 8. Worley MJ Jr, Dean KL, Lin SN, Caputo TA, Post RC. The significance of a thickened endometrial echo in asymptomatic postmenopausal patients. Maturitas. 2011 Feb;68(2):179-81. doi: 10.1016/j.maturitas.2010.10.007. Epub 2010 Nov 13. PMID: 21075567.
- 9. Lev-Sagie A, Hamani Y, Imbar T, Hurwitz A, Lavy Y. The significance of intrauterine lesions detected by ultrasound in asymptomatic postmenopausal patients. BJOG. 2005 Mar;112(3):379-81. doi: 10.1111/j.1471-0528.2004.00444.x. PMID: 15713160.
- 10. Park YR, Lee SW, Kim Y, Bae IY, Kim HK, Choe J, et al. Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women. Obstet Gynecol Sci. 2019 Nov;62(6):445-453. doi: 10.5468/ogs.2019.62.6.445. Epub 2019 Oct 7. PMID: 31777741; PMCID: PMC6856473.
- 11. Zhang G, Wang Y, Liang XD, Zhou R, Sun XL, Wang JL, et al. Microscale endometrial sampling biopsy in detecting endometrial cancer and atypical hyperplasia in a population of 1551 women: a comparative study with hysteroscopic endometrial biopsy. Chin Med J (Engl). 2020 Sep 30;134(2):193-199. doi: 10.1097/CM9.0000000000001109. PMID: 33009021; PMCID: PMC7817330.
- 12. Ozelci R, Dilbaz B, Akpınar F, Kınay T, Baser E, Aldemir O, et al. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci. 2019 Jul;62(4):273-279. doi: 10.5468/ogs.2019.62.4.273. Epub 2019 Jun 24. PMID: 31338345; PMCID: PMC6629991.
- 13. Kim MJ, Kim JJ, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci. 2016 May;59(3):192-200. doi: 10.5468/ogs.2016.59.3.192. Epub 2016 May 13. PMID: 27200309; PMCID: PMC4871935.
- 14. Wethington SL, Herzog TJ, Burke WM, Sun X, Lerner JP, Lewin SN, et al. Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol. 2011 Dec;18(13):3819-23. doi: 10.1245/s10434-011-1815-z. Epub 2011 Jun 24. PMID: 21701931.
- 15. Lynch HT, Lynch JF. Lynch syndrome: history and current status. Dis Markers. 2004;20(4-5):181-98. doi: 10.1155/2004/460240. PMID: 15528784; PMCID: PMC3839282.
- 16. Menon U, Gentry-Maharaj A, Ryan A, Sharma A, Burnell M, Hallett R, et al. Recruitment to multicentre trials--lessons from UKCTOCS: descriptive study. BMJ. 2008 Nov 13;337:a2079. doi: 10.1136/bmj.a2079. Erratum in: BMJ. 2008;337:a2976. PMID: 19008269; PMCID: PMC2583394.
- 17. Schmidt T, Breidenbach M, Nawroth F, Mallmann P, Beyer IM, Fleisch MC, et al. Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium. Maturitas. 2009 Feb 20;62(2):176-8. doi: 10.1016/j.maturitas.2008.11.018. Epub 2009 Jan 3. PMID: 19121901.
- 18. Korkmazer E, Solak N, Üstünyurt E. Hysteroscopic assessment of postmenopausal endometrial thickening. Prz Menopauzalny. 2014 Dec;13(6):330-3. doi: 10.5114/pm.2014.47985. Epub 2014 Dec 30. PMID: 26327874; PMCID: PMC4352917.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Research Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 18 Mart 2023 |
| Yayımlanma Tarihi | 18 Mart 2023 |
| Gönderilme Tarihi | 18 Mart 2022 |
| Kabul Tarihi | 16 Temmuz 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 40 Sayı: 1 |
Kaynak Göster
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