Management of Asymptomatic Postmenopausal Women Referred to Outpatient Hysteroscopy Service with Incidental Finding of Thickened Endometrium – A UK District General Hospital Experience

Aggarwal, Aakriti; Hatti, Archana; Tirumuru, Sakunthala Sahithi; Nair, Sabita Sivaraman

doi:10.1016/j.jmig.2021.02.012

Cited by 21 publications

(20 citation statements)

References 17 publications

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“…Our findings are comparable to thresholds of ≥11 and ≥10 mm suggested by earlier studies 7,27 . Aggarwal et al’s retrospective study suggests that cases of non‐benign endometrial pathologies in endometrium <10 mm thick were each associated with at least one other risk factor for endometrial cancer.…”

Section: Discussionsupporting

confidence: 90%

“…Aggarwal et al’s retrospective study suggests that cases of non‐benign endometrial pathologies in endometrium <10 mm thick were each associated with at least one other risk factor for endometrial cancer. Risk factors included patient history factors, such as diabetes, obesity, hypertension, nulliparity, tamoxifen use and HRT, and ultrasound findings, including cystic endometrium, fluid in the cavity and suspected polyps 27 …”

Section: Discussionmentioning

confidence: 99%

“…7,27 Aggarwal et al's retrospective study suggests that cases of non-benign endometrial pathologies in endometrium <10 mm thick were each associated with at least one other risk factor for endometrial cancer. Risk factors included pa-…”

mentioning

confidence: 99%

“…tient history factors, such as diabetes, obesity, hypertension, nulliparity, tamoxifen use and HRT, and ultrasound findings, including cystic endometrium, fluid in the cavity and suspected polyps 27. …”

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confidence: 99%

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Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Chan

Johansson

2022

Aust NZ J Obst Gynaeco

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Background Asymptomatic postmenopausal women incidentally found to have thickened endometrium (>4 mm) on transvaginal ultrasound (TVUS) often undergo hysteroscopy and dilatation and curettage despite having a low absolute risk of endometrial cancer. A low threshold for investigation may be unnecessary in these women. Aim This systematic literature review examines whether an increased TVUS endometrial thickness threshold has superior diagnostic accuracy for endometrial malignancies and premalignancies in asymptomatic postmenopausal women than the current threshold of ≥4 mm. Methods Pubmed, EMBASE and Cochrane Database of Systematic Reviews were systematically searched using keywords for publications between 2011 and 2021. Studies were included if they reported TVUS endometrial thickness analysis in asymptomatic postmenopausal women and excluded if they were written in a non‐English language. Quality of evidence in the included articles was evaluated according to recommendations by the Grading of Recommendations Assessment Development and Evaluation Working Group and reported results were tabulated. Results Of seven studies (N = 2986), better evidence identified 12 mm as the optimal diagnostic threshold (area under the curve receiver operating characteristic (AUC ROC) 0.716, 95% CI 0.534–0.897, P = 0.019) for endometrial cancer in asymptomatic postmenopausal women. Two higher quality studies (n = 488 and n = 4751) identified 11 mm as optimal for diagnosing both endometrial carcinoma and atypical hyperplasia (AUC ROC 0.587, 95% CI 0.465–0.708, P = 0.144 and 2.59 relative risk, 95% CI 1.66–4.05, P < 0.001). Conclusion Evidence for improved detection of endometrial premalignancies and malignancies using alternative endometrial thickness thresholds is not rigorous. Evidence for improved outcomes using alternative thresholds is inadequate. Observation of asymptomatic postmenopausal women without risk factors and with an endometrial thickness of less than 10 mm may be reasonable.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Chan

Johansson

2022

Aust NZ J Obst Gynaeco

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“…For asymptomatic women with ET 4–10 mm, decisions about further investigations should be made on a case-by-case basis, taking into account such risk factors as diabetes, hypertension, obesity, and additional findings on US. 41 …”

Section: Endometrial Thickness In Pre- and Postmenopausal Womenmentioning

confidence: 99%

New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know?

Saccardi¹,

Spagnol²,

Bonaldo³

et al. 2022

CMAR

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Transvaginal ultrasound (TVUS) represents an accurate and noninvasive technique to investigate endometrial thickness (ET) in the early diagnosis of endometrial cancer (EC). In the literature, for maximum ET there is no consensus on the cutoff value for normal ET in postmenopause for either symptomatic or asymptomatic women. Most patients with EC present with postmenopausal bleeding (PMB) and in these patients is necessary to perform TVUS to evaluate ET as an indicator for endometrial biopsy. On the contrary, if ET is incidentally detected in postmenopausal patients without bleeding, endometrial sampling for a postmenopausal woman without bleeding should not be routinely performed, although it is estimated that up to 15% of EC occurs in women without vaginal bleeding. The aim of our review was to give clinicians necessary and useful knowledge on the role of TVUS and ET for early detection of EC in their daily routine practice. Based on the most important studies in the literature, we summarized that in premenopausal woman with abnormal uterine bleeding, an optimal cutoff for ET has not yet been established. For postmenopausal women with PMB, at low risk, and ET <4 mm, a follow-up scan could be offered, and for women with ET ≥4 mm, office hysteroscopy–guided endometrial sampling is recommended independently of ET results. On the other hand, in postmenopausal women with PMB and at high risk of EC, office hysteroscopy–guided endometrial sampling is necessary. In postmenopausal women without PMB and ET ≥4 mm, arbitrary endometrial sampling is not recommended, but evaluated case by case based on risk factors. In conclusion, there is broad consensus on the importance of TVUS and the need for further investigation based on risk factors of EC.

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A self-supervised classification model for endometrial diseases

Fang,

Wei,

Liu

et al. 2023

J Cancer Res Clin Oncol

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Purpose Ultrasound imaging is the preferred method for the early diagnosis of endometrial diseases because of its non-invasive nature, low cost, and real-time imaging features. However, the accurate evaluation of ultrasound images relies heavily on the experience of radiologist. Therefore, a stable and objective computer-aided diagnostic model is crucial to assist radiologists in diagnosing endometrial lesions. Methods Transvaginal ultrasound images were collected from multiple hospitals in Quzhou city, Zhejiang province. The dataset comprised 1875 images from 734 patients, including cases of endometrial polyps, hyperplasia, and cancer. Here, we proposed a based self-supervised endometrial disease classification model (BSEM) that learns a joint unified task (raw and self-supervised tasks) and applies self-distillation techniques and ensemble strategies to aid doctors in diagnosing endometrial diseases. Results The performance of BSEM was evaluated using fivefold cross-validation. The experimental results indicated that the BSEM model achieved satisfactory performance across indicators, with scores of 75.1%, 87.3%, 76.5%, 73.4%, and 74.1% for accuracy, area under the curve, precision, recall, and F1 score, respectively. Furthermore, compared to the baseline models ResNet, DenseNet, VGGNet, ConvNeXt, VIT, and CMT, the BSEM model enhanced accuracy, area under the curve, precision, recall, and F1 score in 3.3–7.9%, 3.2–7.3%, 3.9–8.5%, 3.1–8.5%, and 3.3–9.0%, respectively. Conclusion The BSEM model is an auxiliary diagnostic tool for the early detection of endometrial diseases revealed by ultrasound and helps radiologists to be accurate and efficient while screening for precancerous endometrial lesions.

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Management of Asymptomatic Postmenopausal Women Referred to Outpatient Hysteroscopy Service with Incidental Finding of Thickened Endometrium – A UK District General Hospital Experience

Cited by 21 publications

References 17 publications

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know?

A self-supervised classification model for endometrial diseases

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