Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia.

Ozkaya E, Korkmaz V, Ozkaya Y, Alptekin Tosun, Küçükozkan T, Bostan H
Journal of the Turkish German Gynecological Association · 2013 · doi:10.5152/jtgga.2013.05 · PMID:24592065 · PMC3881729
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This study found that baseline endometrial thickness measured by ultrasound predicts treatment response to medroxyprogesterone acetate in women with simple endometrial hyperplasia without atypia, with a cutoff of 16.5 mm indicating higher failure risk.

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This prospective study evaluated predictors of treatment response in 67 women diagnosed with simple endometrial hyperplasia without atypia who received cyclic oral medroxyprogesterone acetate. Researchers analyzed various clinical and demographic parameters, including age, BMI, and baseline endometrial thickness, to determine which factors correlated with persistent hyperplasia after three months of therapy. The findings indicated that an initial endometrial thickness greater than 16.5 mm was significantly associated with treatment failure, serving as a predictive marker for non-response to the prescribed hormonal regimen. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

ObjectiveWe sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia.Material and methodsWe prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success.ResultsPersistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03).ConclusionResults of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia.
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Abstract

Objective: We sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia.

Material and methods

We prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success.

Results

Persistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03).

Conclusion

Results of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia.

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