Transvaginal Ultrasonography of the Endometrium in Postmenopausal Japanese Women

Abstract

Aims: To determine the cut-off level of endometrial thickness for detecting endometrial disease on a large scale of screening and to examine the usefulness of transvaginal ultrasonography (TVS) for endometrial disease screening in asymptomatic postmenopausal Japanese women. Methods: The study involved 1,400 postmenopausal women in whom endometrial thickness was measured with TVS, and then compared with the histopathological diagnosis of endometrial specimens. Results: The prevalence of endometrial disease in asymptomatic and symptomatic cases was 2.3 and 21%. In symptomatic cases, at a cut-off limit of 3 mm for endometrial thickness, the sensitivity for detecting endometrial disease was 94%, specificity 70% and positive predictive value 46%. With an endometrial thickness ≤3 mm, the probability that endometrial disease would be overlooked was 0.025.In asymptomatic cases, the corresponding figures at a cut-off limit of 3 mm were 90, 84, 12% and 0.003. Conclusions: TVS does not appear to be an effective screening method in asymptomatic postmenopausal Japanese women because of the low prevalence of endometrial disease in this population. We recommend a normal cut-off level for endometrial thickness of 4 mm in symptomatic postmenopausal Japanese women.

Endometrial Thickness in 1,500 Asymptomatic Postmenopausal Women Not on Hormone Replacement Therapy

“…However, currently routine screening for endometrial cancer is not recommended in asymptomatic women, either for the premenopausal [14] or the postmenopausal population [2,5,6]. Some of the main justifications against its utilization are the poor positive predictive value of TVUS and the low incidence of endometrial cancer in asymptomatic postmenopausal women [15,16,17,18]. …”

“…Even with 52.7% of these patients (78/148) currently taking tamoxifen or HRT, there was only a single case of each complex atypical hyperplasia (0.7%) and endometrial cancer (0.7%) [16]. In a study published in this journal, Tsuda et al [17] screened 1,400 postmenopausal Japanese women not taking HRT by TVUS and endometrial cytology sampling, of which 883 (63.1%) were asymptomatic. Endometrial pathology, ranging from simple hyperplasia to endometrial cancer, was detected in 2.3% (20/883) and the probability of missing a pathological diagnosis was 0.004 if the ET was ≤4 mm.…”

Liquid‐based endometrial cytology in the management of sonographically thickened endometrium

“…There is no unanimous agreement regarding the endometrial thickness that have to be considered pathologic. [13][14][15][16][17][18] The endometrial thickness physiologically changes in relation to the age and, in cyclic women, to the endometrial phase. The administration of hormonal therapy may also influence the endometrial thickness.…”

“…Thickened endometrium as evaluated by TVS may be the consequence of many pathological and nonpathological conditions different from carcinoma or hyperplasia such as endometrial polyps or cystic endometrium, which is typically induced by tamoxifen. [13][14][15][16][17][18] Often, TVS does not provide a definitive diagnoses particularly due to its high false-positive rate. A recent meta-analysis of the diagnostic accuracy of endometrial thickness measurements by transvaginal or transabdominal ultrasound involving 9,031 women with postmenopausal bleeding reported that using a 5 mm cut-off level, a positive test raised the probability of carcinoma from 14.0% to 31.3%, while a negative test reduced it to 2.5%.…”

“…Analogously, in 2005 Tsuda et al documented that the prevalence of endometrial disease in asymptomatic and symptomatic women whit thickened endometrium was 2.3% and 21%. 17 Regarding traditional endometrial cytology, despite several encouraging results have been reported with sensibility and specificity reaching 96%, [20][21][22][23][24] its diffusion has been hampered because of technical and diagnostic difficulties.…”