Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia

Abstract

Objective: We sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia. Material and Methods:We prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success.Results: Persistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03). Conclusion:Results of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia. (J Turkish-German Gynecol Assoc 2013; 14: 19-22) Key words: Endometrial hyperplasia, medroxyprogesterone acetate, endometrial thickness, ultrasonography, atypia Received: 13 October, 2012 Accepted: 8 February, 2013 Amaç: Bu çalışma ile atipisiz endometriyal hiperplazide tedaviye cevabı öngören faktörlerin belirlenmesi amaçlandı. Gereç ve Abstract ÖzetOriginal Investigation 19

Improving response to progestin treatment of low-grade endometrial cancer

“…Many studies investigating BMI reported that obesity was associated with failure to achieve disease regression and increased recurrence (105,(127)(128)(129)(130) . However, a recent study of Japanese women reported that lower BMI was associated with increased recurrence (131) , whilst numerous studies have reported no association between BMI and outcome (132)(133)(134)(135)(136)(137) . The association between age or menopause status and outcome are also conflicting, with two studies reporting younger age or premenopausal status were associated with disease regression or reduced recurrence (127,132) , whilst another reported younger age was associated with increased recurrence (136) .…”

“…Multiple studies have reported no association between age or menopause status and outcome (105, 128-131, 133-135, 137) . A thinner endometrium has been associated with disease regression or reduced recurrence in one study each of women with endometrial hyperplasia (128,134) . Diabetes has been associated with increased recurrence in one study (128) but not in other studies (127,129,130,137) .…”

“…Diabetes has been associated with increased recurrence in one study (128) but not in other studies (127,129,130,137) . Numerous other clinical factors including gravidity (127,129,134) , parity (105,(127)(128)(129)(130)(134)(135)(136)(137) , polycystic ovarian syndrome (105,127,129,131) , smoking (129,133,134) , family history of cancer (127,133) and hypertension (128,130,137) have been investigated in multiple studies, but none has shown an association with outcome.…”

Efficacy of the Levonorgestrel-Releasing Intrauterine System on IVF-ET Outcomes in PCOS With Simple Endometrial Hyperplasia

“…In patients with PCOS, unfortunately, there are no clear clinical guidelines to determine when an endometrial biopsy should be performed to exclude endometrial disease. 33 Physicians perform the biopsy for the following clinical indications: sonographic endometrial stripe thickness of 9, 7, or 9.35 mm patient history of irregular bleeding or >12 months of amenorrhea. 34,35 In order better to understand the distribution of endometrial lesions in infertility patients with PCOS before undergoing IVF, we investigated the endometrial histology of each women with PCOS in this study.…”

Risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age

“…Как указано в работе Е. Ozkaya и др. [10], толщина эндометрия свы-ше 16,5 мм значимо связана с риском рециди-ва: отношение шансов (ОШ) 4,4 (95% ДИ 1,2-17,4; р < 0,03). В нашем исследовании М-эхо свыше 15 мм наблюдалось у 24 (27,3%) жен-щин группы Рц и 25 (13,3%) группы К (ОШ 2,45; 95% ДИ 0,57-4,32; р < 0,005), а М-эхо свыше 16 мм -у 19 (21,6%) и 23 (12,2%) соответственно (ОШ 1,98; 95% ДИ 0,02-3,93; р < 0,04).…”