Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women

Abstract

We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according to the indication of diagnostic hysteroscopy: ET_Group (asymptomatic patients with endometrial thickness ≥ 4 mm) and AUB_Group (patients with a history of abnormal uterine bleeding). We further divided the AUB_Group into two subgroups based on endometrial thickness (AUB_Subgroup1: ET < 4 mm; AUB_Subgroup2: ET ≥ 4 mm). The primary outcome was the risk of endometrial cancer and atypical hyperplasia according to the indications of diagnostic hysteroscopy (AUB, ET ≥ 4 mm or both). The secondary outcome was to determine the best cut-off value of endometrial thickness to predict endometrial cancer in asymptomatic postmenopausal women. The prevalence of endometrial cancer and atypical hyperplasia in AUB_Group and ET_Group was 21% and 6.7% respectively. As well as for EC alone, higher prevalence of both conditions was observed in AUB_Subgroup2 (29.3%) in comparison to AUB_Subgroup1 (10.6%; p < 0.001). In asymptomatic patients the cut-off of endometrial thickness that showed the best sensitivity and specificity to diagnose endometrial cancer (100% and 80% respectively) was 11 mm (AUC of 91.4%; Expβ: 1067; CI 95%). In conclusion, considering the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory in cases of abnormal uterine bleeding in postmenopausal patients. Moreover, we want to emphasize the need for further evidence stating the clinical relevance of endometrial thickness value in asymptomatic patients and the impact of individual risk factors on endometrial cancer development.

Analysis of the results of invasive diagnostic procedures in patients referred to gynecologic department due to abnormal uterine bleeding

“…Doherty et al ., in their metanalysis, reported the risk of non-atypical hyperplasia progression to cancer at annual incidence rate at 2.6% and atypical hyperplasia at 8.2% [ 21 ]. Abnormal uterine bleeding is the most common symptom of endometrial hyperplasia and cancer [ 22 , 23 ]. Transvaginal ultrasound, because of accessibility and low cost, is the first-line imaging technique in diagnosis of the pathology of endometrium.…”

“…Endometrial thickness among postmenopausal women with abnormal uterine bleeding below 3-5 mm seems to have very high negative predictive value for endometrial cancer [ 24 , 25 ]. Unfortunately, there is no established consensus and standardized cut off for endometrial thickness for premenopausal women [ 22 , 26 , 27 ]. In this study, endometrium was significantly thicker in women with endometrial hyperplasia or cancer that in patients with nonpathological histopathological findings (in both pre- and postmenopausal group).…”

Evaluation of menopausal endometrial lesions via mathematical modeling clinical indicators and ultrasonographic parameters

“…The diagnostic efficacy of benign and malignant MEL obtained by regression equation is shown in In this study, the ET of 11.5 mm was the cut off value for clinical diagnosis. For menopausal women without abnormal bleeding, the sensitivity and specificity for the diagnosis of EC were the best at the ET of 11 mm [27]. More studies showed that ET was associated with EC in postmenopausal women [28][29][30].…”

For obese postmenopausal women, what options may decrease endometrial cancer risk?

“…5 Women with an elevated body mass index (BMI) have a markedly increased risk of both Types I and II endometrial cancer (TABLE, page 10). 6 Hence, endometrial cancer is highly prevalent in obese postmenopausal women. For these women health interventions that may reduce the risk of developing endometrial cancer include dieting, physical activity, bariatric surgery, and progestin therapy.…”