Rate of premalignant and malignant endometrial lesion in “low-risk” premenopausal women with abnormal uterine bleeding undergoing endometrial biopsy

Abstract

To determine the incidence of endometrial hyperplasia and endometrial cancer (EH/EC) in low-risk premenopausal women with abnormal uterine bleeding (AUB) undergoing endometrial biopsy and to build a predictive model that includes clinical variables for predicting EH/EC in these women. MethodsThis retrospective study was conducted between January 2015 and March 2020. All premenopausal women aged <55 years with AUB who underwent endometrial sampling during a specified time period were included. Data regarding baseline characteristics, sonographic findings, and histological reports were collected from patient record sheets. ResultsDuring the specified time period, 1,089 premenopausal women underwent endometrial biopsy for AUB. Complete data analysis was done for 1,084 women. Of the endometrial samples, 95.3% revealed benign pathology, whereas 4.7% of the samples had major endometrial pathology EH/EC. On step-wise logistic regression analysis, intermenstrual bleeding (IMB) (OR, 3.15), body mass index (BMI) >25 (OR, 4.4705), age >40 years (OR, 1.14), endometrial thickness (ET) >13 mm (OR, 2.5), and hypothyroidism (OR, 1.3) were significantly associated with EH/EC. Considering the pretest probability for an EH/EC of 4.7%, this prediction model with a likelihood ratio of 14.2% demonstrated a post-test probability of 41% in the presence of the above-mentioned variables. ConclusionThe risk of EH/EC was lower in low-risk premenopausal women with AUB. However, premenopausal women with IMB aged >40 years, hypothyroidism, BMI >25, and thickened endometrium (ET >13 mm) are at high risk of EH/EC; therefore, endometrial biopsy should be considered early in their management plan.

Endometrial Thickness Measurement as Predictor of Endometrial Hyperplasia and Cancer in Perimenopausal Uterine Bleeding: Cross-Sectional Study

“…In the present study, EH/EC was reported at 9.7 (22/254) percent. From previous literatures, prevalence of EH/EC were reported ranging from 4 to 15.7 percent (Sattanakho et al, 2020;Jha et al, 2021;Dhakwa et al, 2021;Soja et al, 2020;Kumari et al, 2022). Our prevalence of EH/EC was within the range of previous works above.…”

“…Age and BMI of Jha and current study looked similar. Heavy menstrual bleeding of Jha and the current study were 86.9 (941/1084) and 40.9 (104/254) percent, respectively (Jha et al, 2021). The pattern of bleeding in Jha and current study were different.…”

“…Sattanakho et al reported from Northeast Thailand in year 2020 that prevalence of EH/EC among perimenopause was only 4 percent (Sattanakho et al, 2020). Jha et al, (2021) reporting the prevalence of EH/EC from India and Nepal were 4.6 and 6.2 percent, respectively (Dhakwa (Sattanakho et al, 2020;Jha et al, 2021). Prevalence of EH/EC of Soja's and Kumari's population from Poland and India were 14.4 and 15.7 percent, respectively (Soja et al, 2020;Kumari et al, 2022).…”

“…ET less than 4 mm in menopausal women was less likely endometrial cancer (ACOG, 2018). However, there was no cut-point level of ET for perimenopausal women who had abnormal uterine bleeding (Jha et al, 2021).…”

Development and Validation of a Nomogram Prediction Model for Endometrial Malignancy in Patients with Abnormal Uterine Bleeding

“…A recent study from India reported that BMI ≥25 kg/m 2 increases the risk for EC/AEH in premenopausal women with AUB. 15 In our study, obesity was defined as BMI ≥25 kg/m 2 , which is suitable for Asian population characteristics.…”