Correlation Between Endometrial Thickening And Histopathology Findings In Postmenopausal Women

Problem Statement Endometrial cancer is the most common gynaecologic malignancy in developed countries. According to data from the national oncologic registry, at Portugal in 2010 the incidence of endometrial cancer was 17,8 new cases per 100.000 women, with a mortality of 1,9/100.000. Ultrasound measurement of endometrial thickness is a non-invasive diagnostic toll for assessment of endometrial pathology in menopausal women, asymptomatic or with vaginal bleeding. Thickened endometrium is an indication for an invasive evaluation as endometrial sampling or hysteroscopy. The cut-off value of endometrial thickness that should warrant an endometrial study is not consensual between different guidelines, varying from 3 to 5 mm. Most studies suggest that transvaginal ultrasound is an effective first line exam for endometrium evaluation in postmenopausal women, however it cannot substitute endometrial sampling. Our aim is to correlate endometrial thickening with histopathology findings and understand the diagnostic value of ultrasound endometrial thickness measurement in predicting endometrial pathology in postmenopausal women in our hospital. Methods This retrospective study analysed one hundred postmenopausal women from gynaecology appointment in Faro’s Hospital in Algarve, Portugal. All patients underwent transvaginal ultrasound and endometrial sampling. There was recorded a complete gynaecological and obstetric history as well as body mass index and smoke habits. This data was analysed in SPSS vs 10. Results We studied one hundred postmenopausal women from gynaecology appointments with vaginal bleeding or asymptomatic endometrial thickening. The mean age was 66,7 years and median menopause age was 50,2 years. About 16% of the women studied have smoking habits and more than half had hypertension. The average body mass index was 31 and 29% of the women were obese. Sixty-tree women performed hysteroscopy were the main finding was polyps. We found that 79% of the women had endometrial thickening superior to 5mm. Seventy-two presented vaginal bleeding. Furthermore almost 91% of women with endometrial pathology had vaginal bleeding and all women with endometrial carcinoma had symptoms. In 96% of the women with endometrial hyperplasia and carcinoma was found endometrial thickening. Moreover average endometrial thickening was superior (16,7 vs 14,25 mm) in woman with malignant and premalignant lesions, however this difference is not statistical significant. A great percentage of women with benign lesions, like polyps, also had endometrial thickening, which reduces the specificity of the ultrasound endometrial thickening measurement. There were drawn ROC curves to understand the specificity and sensibility of ultrasound measurement to detect malignant or premalignant endometrial lesions, but the number of patients was small and the evidence was inconclusive. Conclusion: Our study found that endometrial thickening tends to correlate with endometrial pathology, however ultrasound measurement alone is not a good predictor of malignant and premalignant lesions, so it is required further invasive diagnostic testing. Future perspectives of our work are to expand this sample and draw ROC curves to determine the cut-off value of endometrial thickening at our population and adjust our clinical practice.