Risks and benefits of hysteroscopy and endometrial sampling as a standard procedure for assessing serendipitous findings of endometrial thickening in postmenopausal women

Weaver, Edward

doi:10.1111/ajo.12259

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…The estimated cost of one hysteroscopy and D&C procedure is AUD$2614 including operating theatre, anaesthetics, medical labour, supplies, allied health, pathology, imaging and pharmacy costs. 4 In asymptomatic postmenopausal women, a low threshold for investigation may be unnecessary and may be potentially harmful.…”

Section: Introductionmentioning

confidence: 99%

“…Inpatient D&C is an invasive procedure that requires general anaesthesia and carries risks such as uterine and bowel perforation, contributing to patient anxiety and potentially serious patient outcomes as well as significant healthcare costs. The estimated cost of one hysteroscopy and D&C procedure is AUD$2614 including operating theatre, anaesthetics, medical labour, supplies, allied health, pathology, imaging and pharmacy costs 4 . In asymptomatic postmenopausal women, a low threshold for investigation may be unnecessary and may be potentially harmful.…”

Section: Introductionmentioning

confidence: 99%

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Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Chan

Johansson

2022

Aust NZ J Obst Gynaeco

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Background Asymptomatic postmenopausal women incidentally found to have thickened endometrium (>4 mm) on transvaginal ultrasound (TVUS) often undergo hysteroscopy and dilatation and curettage despite having a low absolute risk of endometrial cancer. A low threshold for investigation may be unnecessary in these women. Aim This systematic literature review examines whether an increased TVUS endometrial thickness threshold has superior diagnostic accuracy for endometrial malignancies and premalignancies in asymptomatic postmenopausal women than the current threshold of ≥4 mm. Methods Pubmed, EMBASE and Cochrane Database of Systematic Reviews were systematically searched using keywords for publications between 2011 and 2021. Studies were included if they reported TVUS endometrial thickness analysis in asymptomatic postmenopausal women and excluded if they were written in a non‐English language. Quality of evidence in the included articles was evaluated according to recommendations by the Grading of Recommendations Assessment Development and Evaluation Working Group and reported results were tabulated. Results Of seven studies (N = 2986), better evidence identified 12 mm as the optimal diagnostic threshold (area under the curve receiver operating characteristic (AUC ROC) 0.716, 95% CI 0.534–0.897, P = 0.019) for endometrial cancer in asymptomatic postmenopausal women. Two higher quality studies (n = 488 and n = 4751) identified 11 mm as optimal for diagnosing both endometrial carcinoma and atypical hyperplasia (AUC ROC 0.587, 95% CI 0.465–0.708, P = 0.144 and 2.59 relative risk, 95% CI 1.66–4.05, P < 0.001). Conclusion Evidence for improved detection of endometrial premalignancies and malignancies using alternative endometrial thickness thresholds is not rigorous. Evidence for improved outcomes using alternative thresholds is inadequate. Observation of asymptomatic postmenopausal women without risk factors and with an endometrial thickness of less than 10 mm may be reasonable.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Chan

Johansson

2022

Aust NZ J Obst Gynaeco

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“…Currently, there is no consensus nor guidelines regarding treatment of postmenopausal endometrial polyps[ 19 , 20 ]. Aston et al [ 21 ] have reported that endometrium polyps are benign lesions which are most frequently detected in asymptomatic postmenopausal women, and suggested that routine practice of D&C in asymptomatic postmenopausal women should be re-evaluated. Bel et al [ 22 ] reported that malignancy was detected in 30/631 (4.75%) patients diagnosed with polyps by ultrasonography or diagnostic hysteroscopy prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite a high accuracy in diagnosis, there is no consensus regarding hysteroscopy for endometrial diagnosis because of the cost associated with this method[ 21 , 29 ] and the risks of surgical complications ( e.g ., uterine perforation, bowel damage, excessive fluid absorption, anesthetic complications)[ 30 ]. In the present study, hysteroscopies were performed in the women in a clinical setting without hospitalization, and this reduced the cost of the patients.…”

Section: Discussionmentioning

confidence: 99%

Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium

Xue¹,

Weishou²,

Zhang³

2022

WJCC

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BACKGROUND Postmenopausal bleeding and an endometrial thickness ≥ 5 mm on sonograms of menopausal women can indicate the presence of endometrial lesions. Diagnostic hysteroscopy is a powerful method for endometrial diseases. AIM To investigate the pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or asymptomatic thickened endometrium diagnosed by hysteroscopy. METHODS A total of 187 postmenopausal women with bleeding or asymptomatic thickened endometrium underwent diagnostic hysteroscopy. The women were subsequently divided into three groups: Postmenopausal bleeding (PMB) group ( n = 84), asymptomatic group ( n = 94), and additional group ( n = 9). Women in the additional group manifested abdominal pain and leukorrhagia. RESULTS Among the 187 patients examined, 84 (44.9%) were diagnosed with PMB and 94 (50.3%) with asymptomatic thickened endometrium. Endometrial polyp was the most common endometrial abnormality, which was detected in 51.2%, 76.6% and 77.8% of the PMB, asymptomatic, and additional groups, respectively. In the PMB group, 7 (8.3%) women had hyperplasia with atypia and 14 (16.7%) had endometrial adenocarcinoma. Fewer malignant lesions were detected in the asymptomatic group. Endometrial hyperplasia without atypia was found in 8.3% of the PMB group and 7.4% of the asymptomatic group. CONCLUSION Endometrial polyp was the most common pathology in the PMB group. Diagnostic hysteroscopy is recommended for women with PMB and asymptomatic thickened endometrium.

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“…Hysteroscopic investigation, rather than dilatation and curettage is a widely accepted diagnostic method for of endometrial cancer. In a recent report, only one of 35 asymptomatic post-menopausal women with an endometrial thickness exceeding 4 mm presented with adenocarcinoma [1]. In a study of 268 women undergoing diagnostic hysteroscopy, Giannella reported only four cases of endometrial cancer and two cases of atypical endometrial hyperplasia [2].…”

Section: Introductionmentioning

confidence: 99%

Do endometrial lesions require removal? A retrospective study

et al. 2019

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Background This study aimed to evaluate the management of asymptomatic intrauterine lesions detected by ultrasonography. Methods Patients who underwent diagnostic hysteroscopy for asymptomatic lesions, including pre- and post-menopausal endometrial polyps, post-menopausal endometrial thickening (ET ≥5 mm) and reduplicative endometrial heterogeneity detected by transvaginal ultrasonography (TVUS), were recruited for this study. Results In the 792 recruited patients, the symptom-free focal masses within the uterine cavity detected by TVUS included 558 patients with pre- or post-menopausal endometrial polyps and 234 patients with postmenopausal endometrial thickening. No pre-menopausal patient presented with carcinoma. The polyp diameter (PD) was not identified as an independent risk factor for malignancy in this study. A significant difference ( P = 0.036, < 0.05) in both benign and malignant endometrial lesions was observed between two groups of post-menopausal women stratified using an endometrial thickness cut-off of ≥11 mm. The TVUS was highly sensitive (94%) for pre-menopausal polyps. This technique had a specificity and positive predictive value of 84.4 and 92.7%, respectively, for postmenopausal polyps. The TVUS was clearly valuable for ruling out polyps, as indicated by a negative likelihood ratio (LR-) of 0.087. Among postmenopausal women with endometrial thickening, the area under the receiver operating characteristic curve was 0.828 ( P < 0.001). An ET cut-off value of 12.5 mm yielded a sensitivity of 72.7% and specificity of 86%. Conclusion We recommend follow-up alone for women with asymptomatic uterine polyps, particularly those who are pre-menopausal. Additionally, gynaecologists should consider risk factors such as age, obesity, polycystic ovarian syndrome, and diabetes. Prospective long-term follow-up studies should be conducted after hysteroscopic polypectomy to evaluate the recurrence rate of endometrial lesions.

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Risks and benefits of hysteroscopy and endometrial sampling as a standard procedure for assessing serendipitous findings of endometrial thickening in postmenopausal women

Cited by 11 publications

References 11 publications

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium

Do endometrial lesions require removal? A retrospective study

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