Long-term Risk of Endometrial Cancer Following Postmenopausal Bleeding and Reassuring Endometrial Biopsy

Abstract

Introduction Women with postmenopausal bleeding and endometrial thickness >4 mm undergo endometrial sampling to exclude endometrial cancer. The aim of this study is to investigate the relative risk of developing endometrial cancer in a prospective cohort after initial work‐up for postmenopausal bleeding showing reassuring histology or insufficient sampling. Material and methods All women presenting with postmenopausal bleeding were prospectively included from January 2009 to April 2011. Follow‐up data were collected from patient charts and PALGA (Dutch Pathology Registry). Hazard ratios for endometrial cancer were determined by calculating standardized incidence ratios. Results A total of 668 women were included and 568 women were available for follow‐up [median follow‐up time 47 (range 7–63) months]. Women who presented with postmenopausal bleeding, endometrial thickness >4 mm and hyperplasia without atypia on biopsy at the first presentation showed a significantly increased risk (standardized incidence ratio 17.15, 95% confidence interval 1.96–61.93) of being diagnosed with endometrial cancer during the first four years of follow up compared with the age‐specific population. All women that developed endometrial cancer after initial reassuring histology presented with recurrent postmenopausal bleeding. None of the women with endometrial thickness >4 mm and no or insufficient sample for histology at the first presentation developed endometrial cancer during the follow up. Conclusions Although in general, women with endometrial hyperplasia without atypia are considered to have a low risk for cancer, we observed a significant long‐term risk of endometrial cancer after postmenopausal bleeding. Whether additional diagnostics or a more stringent follow‐up regimen would be cost‐effective, needs to be studied.

Diagnostic accuracy of shear wave elastography for endometrial cancer: A meta-analysis

“…Previous studies have usually used transvaginal ultrasound to measure endometrial thickness to screen for EC in patients with abnormal uterine bleeding. [25,26] Despite the high Sen involved in diagnosing EC, transvaginal ultrasound also has a well-defined false negative rate. Measurement of endometrial thickness alone does not detect all ECs.…”

Relação entre o espessamento endometrial e o sangramento uterino anormal no diagnóstico de câncer de endométrio em pacientes na pós-menopausa / Relationship among endometrial thickening and abnormal uterine bleeding in the diagnosis of endometrial cancer in postmenopausal patients

“…Das 35 pacientes com câncer, apenas uma apresentava espessamento endometrial sem sangramento. Esse dado está de acordo com a literatura (10) . A obesidade é conhecida como fator de risco para o desenvolvimento de câncer, incluindo o endometrial (11) .…”

Comparison of three biopsy forceps for hysteroscopic endometrial biopsy in postmenopausal patients (HYGREB‐1): A multicenter, single‐blind randomized clinical trial

“…11 Similarly, in postmenopausal women, hysteroscopy and endometrial biopsy could be considered when the ET at transvaginal ultrasound (TVUS) is 5 mm or greater, when other endometrial abnormalities are detected, or when the ET cannot be adequately assessed. [12][13][14] Nevertheless, guidelines from the American College of Obstetricians and Gynecologists (ACOG) suggest avoiding further testing in case an endometrium 5 mm or greater is incidentally identified in asymptomatic postmenopausal women. Therefore, ET alone could not be considered a strict indication for hysteroscopy and endometrial biopsy.…”

“…The proportion of cases having endometrial cancer as the underlying cause of postmenopausal bleeding increases with age 11 . Similarly, in postmenopausal women, hysteroscopy and endometrial biopsy could be considered when the ET at transvaginal ultrasound (TVUS) is 5 mm or greater, when other endometrial abnormalities are detected, or when the ET cannot be adequately assessed 12‐14 . Nevertheless, guidelines from the American College of Obstetricians and Gynecologists (ACOG) suggest avoiding further testing in case an endometrium 5 mm or greater is incidentally identified in asymptomatic postmenopausal women.…”