EVALUATION OF ULTRASONOGRAPHIC THICKENED ENDOMETRIUM IN ASYMPTOMATIC POSTMENOPAUSAL WOMEN

Background Asymptomatic thickened endometrium (ATE) in postmenopausal women (PMW) is a common condition, and it’s a mostly incidental fi nding on a pelvic ultrasound done for unrelated problems in a case seeking medical advice. The upper limit for hysteroscopic assessment of ATE in PMW by ultrasound is still debatable. Objectives To assess the histopathological abnormalities of asymptomatic thick endometrium in postmenopausal women and to determine the cutoff point of endometrial thickness that is associated with atypical endometrium and endometrial carcinoma. Patients and methods A cross-sectional study was conducted in private clinics and hospitals in Sulaimani City/Kurdistan region/ Iraq within a period between January 2020 to January 2023. It involved asymptomatic postmenopausal women who visited a physician, surgeon, or gynaecologist for different unrelated conditions, and they advised ultrasound which showed thickened endometrium ˃ 5 mm incidentally. These women were counseled about their condition by the gynaecologists after referral to them and subjected to hysteroscopy and endometrial biopsy after their agreement. The parameters observed were Age, residency, body mass index (BMI), duration of menopause, chronic hypertension, diabetes mellitus (DM), vaginal discharge, and thickness of endometrium by 2D transvaginal ultrasound (TVU). During hysteroscopy, the endometrium was observed for any focal lesion, symmetrical thickness, or polyp, and an endometrial sample was taken, with the removal of the polyp when present. Samples were sent for histopathological examination (HPE), and the result of HPE was recorded. Results A total of 40 postmenopausal women were included in this study; they offered Hysteroscopy after TVU, which revealed ET ˃ 5mm. 40% of them had endometrial atrophy, 42.5% had endometrial polyp, 7.5% had simple endometrial hyperplasia without atypia, 2.5% had atypical endometrial hyperplasia (EH), and another 7.5% had endometrial carcinoma (EC). Endometrial thickness was a statistically signifi cant predictor of the presence of EC and atypical EH (P value 0.014). ROC curve analysis identifi ed the cutoff point for differentiating malignant and malignant potential from benign to be 11.5 mm, with sensitivity of (83.3%), specifi city (50%), and high accuracy of (80%). Conclusion The risk of precancerous lesions and carcinoma of the endometrium is low in postmenopausal women with ATE. Detailed TVU is an invaluable predictor for malignant and premalignant conditions, and no cutoff thickness can precisely predict endometrial pathology; however, an ET of 11.5 can be used as the cutoff point for predicting malignant and premalignant conditions in ATE.Objectives