Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study

Abstract

Objective To estimate the accuracy of transvaginal ultrasound (TVS) measurement of endometrial thickness (ET) in diagnosing endometrial cancer in postmenopausal women with vaginal bleeding (PMB).Design Retrospective cohort study.Setting One-stop PMB clinic in a Hong Kong teaching hospital. Main outcome measures Accuracy data for TVS ET presented as sensitivity, specificity, and area under the receiver operator characteristic (ROC) curve.Results Endometrial cancer was diagnosed in 3.8% of women. The median ET in those with endometrial cancer was significantly higher than those with benign conditions (15.7 versus 3.2 mm, P < 0.001). The area under the ROC curve was 0.92 (95% CI 0.89-0.94). The sensitivity for the detection of endometrial cancer at 3-, 4-, and 5-mm cut-offs were 97.0% (95% CI 94.5-99.6%), 94.1% (95% CI 90.5-97.6%), and 93.5% (95% CI 89.7-97.2%), respectively. The corresponding estimates of specificity at these thresholds were 45.3% (95% CI 43.8-46.8%), 66.8% (65.4-68.2%), and 74.0% (72.7-75.4%).Conclusions Transvaginal ultrasound using a 3-mm cut-off has high sensitivity for detecting endometrial cancer and can identify women with PMB who are highly unlikely to have endometrial cancer, thereby avoiding more invasive endometrial biopsy.

Authors' reply re: Diagnostic work up for postmenopausal bleeding: a randomised controlled trial

“…We agree fully with the comment that in women with postmenopausal bleeding (PMB) a thick endometrium should be further evaluated to rule out malignancy. Thin endometrium rules out endometrial cancer . Measurement of endometrial thickness should therefore be the first step in the diagnostic work‐up of women with PMB.…”

Common Causes of Postmenopausal Bleeding in Korean Women: 10-Year Outcomes from a Single Medical Center

“…Endometrial and cervical polyps were more prevalent and endometrial cancer was relatively rare. Although requiring further studies, a report from Hong Kong (3) showed that the prevalence of endometrial cancer among women with PMB in Hong Kong was 3.8%, which is much lower than the previously reported 10% in developed countries (17). This is one representative example which depicts the possibility that endometrial cancer prevalence rate may be quite different in the Asian population.…”

“…It is important to evaluate the cause of PMB because of its association with gynecologic malignancies (23456). Early diagnosis may help improve survival rates, hence several diagnostic tools such as transvaginal ultrasonography or hysteroscopy have been implemented for early and accurate detection of malignancy (1478910).…”

Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis

“…Transvaginal sonography is a widely accepted method of endometrial evaluation and many authors believe that normal sonography endometrial imaging sufficiently establishes absence of pathology in perimenopausal patients with abnormal uterine bleeding [10][11][12].…”

“…In the group of 105 patients sonohysteroscopy failed to detect endometrial polyps in 30 cases [18], SIS may also lead to erroneous diagnosis of blood clots as endometrial polyps [20]. Many authors do not regard sonohysterography results as sufficient evidence to confirm or exclude endometrial abnormalities [4,6,12,[21][22][23][24].…”