Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

Abstract

Background: To assess the role of sonographic endometrial thickness and hysteroscopic polyp size in predicting premalignant and malignant polyps in postmenopausal women. Materials and Methods: A total of 328 postmenopausal women with abnormal uterine bleeding and thickened endometrium underwent operative hysteroscopy due to detection of endometrial polyps were included in this retrospective study. Preoperative endometrial thickness measured by transvaginal ultrasonography and polyp size on hysteroscopy were noted. Hysteroscopic resection with histology was performed for endometrial polyps. Endometrial thickness and polyp size were evaluated on the basis of final diagnosis established by histologic examination. Receiver operator characteristic curves were calculated to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of endometrial thickness and polyp size for detecting pemalignant and malignant polyps. Results: Premalignant and malignant polyps were identified in 26 (7.9%) of cases. Sonographic measurement showed a greater endometrial thickness in cases of premalignant and malignant polyps when compared to benign polyps. On surgical hysteroscopy, premalignant and malignant polyps were also larger. Endometrial thickness demonstrated a sensitivity of 53.8%, specificity of 85.8%, PPV of 24.6% and NPV of 95.6% at a cut-off limit of 11.5 mm with diagnostic accuracy of 83.2%. Polyp size has a diagnostic accuracy of 94.8% with a sensitivity of 92.3%, specificity of 95.0%, PPV of 61.5% and NPV of 99.3% at a cut-off point of 19.5mm. Conclusions: Endometrial thickness measured by transvaginal ultrasonography is not sufficient in predicting premalignant and malignant endometrial polyps in postmenopausal women with abnormal uterine bleeding and thickened endometrium. Polyp size on hysteroscopy is a more accurate parameter, because of better sensitivity and specificity. However, while polyp size ≥19.5mm seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.

Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases

“…Güner et al found an endometrial thickness average of 22.7 mm for endometrial cancer and did not encounter malignant endometrial pathologies in subjects with endometrial thickness < 8 mm [10]. Another study found that endometrial thickness determined by transvaginal ultrasonography has 92.3% sensitivity and 95% specificity for endometrial cancer detection in cases with endometrial thickness ≥ 19.50 mm [13]. In our study, we found that endometrial thickness increased in malignant endometrial pathologies, and we did not encounter endometrial carcinoma in cases where the endometrial thickness was < 7 mm.…”

“…In postmenopausal women, ≤ 4 mm endometrial thickness has a negative predictive value of 99% for endometrial cancer [6][7][8]. Above 4 mm endometrial thickness is a nonspecific finding and may be associated with endometrial polyp, submucous myomas or endometrial hyperplasia [9][10][11][12][13].…”

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

“…An optimal cut-off of 5 mm is being proposed (418) and our data clearly exceeds this limit. Hysteroscopy also aids the diagnosis, allowing visual confirmation and endometrial biopsy during the procedure, evidently increasing the screening sensitivity (781018). For patients without PMB, the 5 mm cut-off could be recommended as described from previous studies (418).…”

“…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). Recently, cancer prevalence rates have been changing due to better cancer screening modalities and health insurance coverage.…”

Establishing patterns on hysteroscopy in abnormal uterine bleeding (AUB)

“…The need for hysteroscopic assessment of endometrium is being emphasized more and more in evidence based medicine. 7 8 9 10 11 …”