New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know?

Abstract

Transvaginal ultrasound (TVUS) represents an accurate and noninvasive technique to investigate endometrial thickness (ET) in the early diagnosis of endometrial cancer (EC). In the literature, for maximum ET there is no consensus on the cutoff value for normal ET in postmenopause for either symptomatic or asymptomatic women. Most patients with EC present with postmenopausal bleeding (PMB) and in these patients is necessary to perform TVUS to evaluate ET as an indicator for endometrial biopsy. On the contrary, if ET is incidentally detected in postmenopausal patients without bleeding, endometrial sampling for a postmenopausal woman without bleeding should not be routinely performed, although it is estimated that up to 15% of EC occurs in women without vaginal bleeding. The aim of our review was to give clinicians necessary and useful knowledge on the role of TVUS and ET for early detection of EC in their daily routine practice. Based on the most important studies in the literature, we summarized that in premenopausal woman with abnormal uterine bleeding, an optimal cutoff for ET has not yet been established. For postmenopausal women with PMB, at low risk, and ET <4 mm, a follow-up scan could be offered, and for women with ET ≥4 mm, office hysteroscopy–guided endometrial sampling is recommended independently of ET results. On the other hand, in postmenopausal women with PMB and at high risk of EC, office hysteroscopy–guided endometrial sampling is necessary. In postmenopausal women without PMB and ET ≥4 mm, arbitrary endometrial sampling is not recommended, but evaluated case by case based on risk factors. In conclusion, there is broad consensus on the importance of TVUS and the need for further investigation based on risk factors of EC.

Counseling in menopausal women: How to address the benefits and risks of menopause hormone therapy. A FIGO position paper

“…Therefore, the need for further investigation should be based on the individual risk factors for endometrial cancer. 145,146 MHT may be continued as long as women maintain their health status and contraindications do not develop. The benefits must always outweigh the risks.…”

“…The monitoring of endometrial thickness in asymptomatic women is less specific and the ideal cutoff for invasive procedures has not been investigated thoroughly. Therefore, the need for further investigation should be based on the individual risk factors for endometrial cancer 145,146 …”

Three‐dimensional transvaginal ultrasound vs magnetic resonance imaging for preoperative staging of deep myometrial and cervical invasion in patients with endometrial cancer: systematic review and meta‐analysis

“…Endometrial cancer (EC) is the most common gynecological malignancy in Europe, and it represents the sixth most frequent cancer in women worldwide 1 , 2 , 3 . Office hysteroscopy‐guided endometrial sampling is the preferred tool for the histological diagnosis of EC 4 , 5 .…”

Comparative study between effect of both drugs Tamoxifen versus Letrozole on endometrial thickness as Hormonal adjuvant therapy in breast cancer

“…Its effect on endometrial cells leads to development of endometrial hyperplasia, polyps, growth of uterine fibroids, malignant transformation to endometrial carcinomas and uterine sarcomas (Jindal A. et al, 2015). In premenopausal women there is no increased risk of endometrial carcinoma with the use of Tamoxifen (Cheng W-F. et al, 1997).Postmenopausal women receiving Tamoxifen are at increased risk of developing endometrial carcinoma (Saccardi C. et al,2022).Women taking tamoxifen should be informed about the potential risks of Tamoxifen use on the endometrium and any abnormal vaginal bleeding, bloody vaginal discharge, staining, or spotting should be investigated. Routine endometrial surveillance has not proved to be effective in increasing the early detection of endometrial cancer in women using tamoxifen and is not recommended (Fleming CA.…”