Diagnosing Endometrial Carcinoma in a Patient With Atrophic Endometrium and Postmenopausal Bleeding

Abstract

Endometrial carcinoma is the leading cause of gynecologic malignancies in the United States. Unlike other malignancies, endometrial carcinoma presents early with the most common clinical symptom being uterine bleeding (including irregular menses, inter-menstrual bleeding, and postmenopausal bleeding, or PMB). Hence, the evaluation of PMB should have efficient and effective strategies to prevent a missed diagnosis of malignancy and to facilitate an early diagnosis for potentially curative treatment.Transvaginal ultrasound is appropriate to evaluate PMB initially. If imaging reveals an endometrial thickness of ≤4 mm, endometrial sampling is not warranted, given the high negative predictive value (>99%) of this finding for endometrial carcinoma. In women with persistent or recurrent bleeding, if blind endometrial sampling does not show endometrial hyperplasia or malignancy, further testing with hysteroscopy with dilation and curettage is indicated. However, in cases of PMB with an endometrial thickness of ≤4 mm on transvaginal ultrasound, little information can be gained from endometrial sampling alone as the chance of getting an adequate sample is low and malignancy is rare. For such patients, outpatient hysteroscopy has become a convenient and cost-effective procedure that may be done before an endometrial sampling.

Reliability Of Transvaginal Ultrasound Measured Endometrial Thickness In Diagnosis Of Endometrial Cancer In Postmenopausal Women

“…18 If the bleeding is recurrent and persistent, regardless of apparently thin endometrial echo, office hysteroscopy followed by biopsy should be done. 19 A recent metanalysis has recommended that the TVS measured endometrial thickness of 4-10mm found incidentally in asymptomatic, low-risk post-menopausal women without vaginal bleeding does not necessitate further workup as the incidence of cancer is low but ET ≥10mm requires hysteroscopy and biopsy. 20 In our study, we used a manual vacuum aspirator for acquiring endometrial samples for histopathology as a reference standard instead of the conventional dilatation & curettage to avoid anaesthesia and hospital admission.…”