Risk of endometrial cancer and endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness ≥11 mm: A systematic review and meta‐analysis

Alcázar, Juan Luis; Bonilla, Laura; Marucco, Julia; Padilla, Ana Isabel; Chacón, Enrique; Manzour, Nabil; Salas, Alba

doi:10.1002/jcu.22631

Cited by 41 publications

(34 citation statements)

References 22 publications

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“…Indeed, the incidence of ET ≥ 4 mm in asymptomatic postmenopausal women have been reported to be up to 17%, extremely high in comparison to the incidence of endometrial cancer (lower than 2/1000) [4,8,11]. In this regard, according to Smith-Bindman et al, we interestingly found a significant risk of cancer only for values of ET considerably higher than 4 mm, starting from 11 mm [14,32]. Intriguingly, the cut-off value 11 mm showed a 100% sensitivity and 80% specificity for EC detection, with a progressive increase of cancer risk for ascending values up to 30 mm.…”

Section: Main Findingssupporting

confidence: 49%

“…On the other hand, ACOG stated that TVUS is appropriate for an initial evaluation of postmenopausal bleeding, because an ET of 4 mm or lower seems to have a 99% negative predictive value for EC. We must consider that ET < 4 mm does not exclude all the disease and it remains unclear if an ET cut-off could also be associated with EC in patients without AUB [3,[8][9][10]13,14].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Main Findingssupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…During the 12.5 y (range: 0.3-13.8 y) follow-up period, however, only 14 women developed endometrial carcinoma. More recently, a systematic review found that the risk of endometrial cancer/ endometrial hyperplasia was 2.6 times greater in women with endometrial thickness !11 mm vs women with endometrial thickness 5-10 mm, although there was significant heterogeneity in estimates across studies (Alc azar et al 2018).…”

Section: Clinical Studiesmentioning

confidence: 90%

Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data

Messina

Mejía

Cassidy

et al. 2021

Critical Reviews in Food Science and Nutrition

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Soybeans are a rich source of isoflavones, which are classified as phytoestrogens. Despite numerous proposed benefits, isoflavones are often classified as endocrine disruptors, based primarily on animal studies. However, there are ample human data regarding the health effects of isoflavones. We conducted a technical review, systematically searching Medline, EMBASE, and the Cochrane Library (from inception through January 2021). We included clinical studies, observational studies, and systematic reviews and meta-analyses (SRMA) that examined the relationship between soy and/or isoflavone intake and endocrine-related endpoints. 417 reports (229 observational studies, 157 clinical studies and 32 SRMAs) met our eligibility criteria. The available evidence indicates that isoflavone intake does not adversely affect thyroid function. Adverse effects are also not seen on breast or endometrial tissue or estrogen levels in women, or testosterone or estrogen levels, or sperm or semen parameters in men. Although menstrual cycle length may be slightly increased, ovulation is not prevented. Limited insight could be gained about possible impacts of in utero isoflavone exposure, but the existing data are reassuring. Adverse effects of isoflavone intake were not identified in children, but limited research has been conducted. After extensive review, the evidence does not support classifying isoflavones as endocrine disruptors.

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“…There are many studies showing the cut off of endometrial thickness in asymptomatic postmenopausal women to predict premalignant and malignant lesion-the cut off being 10-11mm. [8][9][10] Asymptomatic postmenopausal women with ET>12mm and positive doppler flow signals are best predictor of malignancy. 11 Postmenopausal women with recurrent bleeding, who are diabetic have higher risk of endometrial malignancy with ET>11mm.In a study by Ulu et al ET of 15 mm and above, risk of malignancy is 3.043 times higher and symptomatic women have higher risk than asymptomatic women.…”

Section: Discussionmentioning

confidence: 99%

Clinical study of risk factors and ultrasonographic correlation of endometrial hyperplasia according to the WHO classification 2014

Kanthi

Sumathy

Vasudevan

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Type 1 endometrial carcinoma is usually preceded by atypical hyperplasia. Nonatypical hyperplasia should be managed conservatively and atypical hyperplasia have to be managed aggressively. So, the diagnosis is crucial for its management.Methods: The study population included women diagnosed with endometrial hyperplasia by histopathology as per WHO classification 2014 from the year January 2015 to February 2020.Women with endometrial polyp diagnosed by transvaginal ultrasonography and histopathology were excluded. Primary objective was to compare the endometrial thickness between the two types of hyperplasia. Secondary objective was to analyses the risk factors of the two types.Results: In multivariate analysis of logistic regression, diabetic women have 1.57 times risk of developing atypia and obese women have 3.12 times risk of developing atypia. Polycystic ovarian disease is having borderline significance for causing atypia. There was significant difference in endometrial thickness between atypical and nonatypical hyperplasia (P=0.040). In premenopausal women, (P=0.069) the thickness difference in atypia is of only borderline significance. Heteroechoic pattern or cystic spaces in the endometrium also didn’t predict atypia.Conclusions: Mean endometrial thickness is significantly different in atypical hyperplasia. Heteroechoic pattern of endometrium do not predict atypia. We need color doppler sonography to gain knowledge about atypia. Obesity and diabetes mellitus are significant risk factors of atypia.

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Risk of endometrial cancer and endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness ≥11 mm: A systematic review and meta‐analysis

Abstract: Overall the risk for EC/EHA was 2.6 times greater in women with ET ≥11 mm vs women with ET 5-10 mm, although there was significant heterogeneity in estimates across studies.

Cited by 41 publications

References 22 publications

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

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

Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data

Clinical study of risk factors and ultrasonographic correlation of endometrial hyperplasia according to the WHO classification 2014

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