Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding

Aims and background To test the reliability of endometrial sonography in selecting women with abnormal postmenopausal vaginal bleeding for further diagnostic assessment. Methods Endometrial thickness was measured in 368 consecutive women by abdominal or vaginal sonography prior to invasive assessment (hysteroscopy, curettage). The association of abnormal endometrial thickness (4 mm or greater) with endometrial cancer was determined. Results Abnormal endometrial thickness was observed in 116 of 368 women. Subsequent assessment diagnosed endometrial carcinoma in 16 subjects, 15 of whom had abnormal endometrial thickness. One case with normal endometrial thickness was suspected at sonography because of the irregular appearance of the endometrium. Conclusions Had it been used to select subjects for further assessment, sonography would have missed no cancer, and unnecessary invasive assessment (under general anesthesia in 20% of cases) would have been spared in 68% (251/368) of the subjects. Endometrial sonography should be routinely used to select women with postmenopausal vaginal bleeding for further investigations.

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Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding

Obstetrics and Gynecology ◽

10.1016/s0029-7844(01)01771-9 ◽

2002 ◽

Vol 99 (4) ◽

pp. 663-670 ◽

Cited By ~ 57

Author(s):

A Tabor

Keyword(s):

Endometrial Cancer ◽

Vaginal Bleeding ◽

Endometrial Thickness ◽

Postmenopausal Vaginal Bleeding

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Vaginal bleeding during menopause hormone therapy. Is it always endometrial cancer? How to choose the appropriate tactics for examination and management of patients?

GYNECOLOGY ◽

10.26442/20795696.2020.5.200419 ◽

2020 ◽

Vol 22 (5) ◽

pp. 37-43

Author(s):

Anna E. Protasova ◽

Irina A. Solntseva ◽

Ekaterina N. Vandeeva

Keyword(s):

Endometrial Cancer ◽

Hormone Therapy ◽

Genital Tract ◽

Vaginal Bleeding ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Menopausal Hormone Therapy ◽

Modern Analysis ◽

Menopause Hormone Therapy ◽

Postmenopausal Vaginal Bleeding

The article provides an overview of the possible causes of bleeding from the genital tract in peri- and postmenopausal women. The correct approach to patients with abnormal uterine bleeding during menopausal hormone therapy is described. A modern analysis of data on the diagnosis and treatment of postmenopausal vaginal bleeding against the background of menopausal hormone therapy was carried out. The modern possibilities of endometrial diagnostics and treatment are shown.

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Endometrial cancer: Diagnostic methods in postmenopausal vaginal bleeding

Archive of oncology ◽

10.2298/aoo0302097m ◽

2003 ◽

Vol 11 (2) ◽

pp. 97-101

Author(s):

Aljosa Mandic ◽

Tamara Vujkov

Keyword(s):

Endometrial Cancer ◽

Vaginal Bleeding ◽

Transvaginal Ultrasound ◽

Correct Diagnosis ◽

False Negative ◽

Endometrial Biopsy ◽

Diagnostic Methods ◽

Histological Evaluation ◽

Leading Symptom ◽

Postmenopausal Vaginal Bleeding

Postmenopausal vaginal bleeding (PMB) is the leading symptom of endometrial cancer. More than 70% of patients with endometrial cancer are postmenopausal. Despite PMB as a leading symptom in diagnosis of endometrial cancer, PMB could be caused by some benign processes in endometrium such as hyperplasia and focal endometrial disease, such as a polyp. The golden standard for histological evaluation of the endometrium is curettage. Transvaginal ultrasound (TVS) and measurement of endometrium thickness is also one of the favored methods in the last decade. Sonographic imaging of the endometrium can be extremely helpful, because endometrial cancer is nearly always associated with thickening and heterogeneity of the endometrium except in case of atrophy-associated adenocarcinoma of the endometrium, which is not associated with thickening. Hysteroscopy found place as a favored method in diagnosis of focal endometrial lesions. Saline infusion sonohysterography (SIS) is a relatively new imaging procedure. The SIS will show whether the endometrium is diffusely thickened, in which case curettage would be the next step, or focally thickened, in which case hysteroscopy with biopsy would be the next step. Combination of some diagnostic procedures, such as TVS, SIS, hysteroscopy, endometrial biopsy and curettage, should decrease false positive and false negative results which may affect the correct diagnosis and treatment.

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A Risk-Scoring Model for the Prediction of Endometrial Cancer among Symptomatic Postmenopausal Women with Endometrial Thickness > 4 mm

BioMed Research International ◽

10.1155/2014/130569 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Luca Giannella ◽

Kabala Mfuta ◽

Tiziano Setti ◽

Lillo Bruno Cerami ◽

Ezio Bergamini ◽

...

Keyword(s):

Endometrial Cancer ◽

Postmenopausal Women ◽

Vaginal Bleeding ◽

Risk Model ◽

Endometrial Thickness ◽

Patient Characteristics ◽

Roc Curve Analysis ◽

Decision Algorithm ◽

Scoring Model ◽

Risk Scoring

Objective. To develop and test a risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women at risk of intrauterine malignancy.Methods. We prospectively studied 624 postmenopausal women with vaginal bleeding and endometrial thickness > 4 mm undergoing diagnostic hysteroscopy. Patient characteristics and endometrial assessment of women with or without endometrial cancer were compared. Then, a risk-scoring model, including the best predictors of endometrial cancer, was tested. Univariate, multivariate, and ROC curve analysis were performed. Finally, a split-sampling internal validation was also performed.Results. The best predictors of endometrial cancer were recurrent vaginal bleeding (odds ratio(OR)=2.96), the presence of hypertension(OR=2.01)endometrial thickness > 8 mm(OR=1.31), and age > 65 years(OR=1.11). These variables were used to create a risk-scoring model (RHEA risk-model) for the prediction of intrauterine malignancy, with an area under the curve of 0.878 (95% CI 0.842 to 0.908;P<0.0001). At the best cut-off value (score ≥ 4), sensitivity and specificity were 87.5% and 80.1%, respectively.Conclusion. Among symptomatic postmenopausal women with endometrial thickness > 4 mm, a risk-scoring model including patient characteristics and endometrial thickness showed a moderate diagnostic accuracy in discriminating women with or without endometrial cancer. Based on this model, a decision algorithm was developed for the management of such a population.

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How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.1704 ◽

2004 ◽

Vol 24 (5) ◽

pp. 558-565 ◽

Cited By ~ 136

Author(s):

R. Smith-Bindman ◽

E. Weiss ◽

V. Feldstein

Keyword(s):

Postmenopausal Women ◽

Vaginal Bleeding ◽

Endometrial Thickness

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Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽

10.3390/diagnostics11030442 ◽

2021 ◽

Vol 11 (3) ◽

pp. 442

Author(s):

Norbert Stachowicz ◽

Agata Smoleń ◽

Michał Ciebiera ◽

Tomasz Łoziński ◽

Paweł Poziemski ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Menopausal Status ◽

Power Doppler ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Scoring Systems ◽

Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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