The study found that the overall accuracy of endometrial thickness for the detection of cancer appears poor with only 75% sensitivity and 48.3% specificity.
However, patients with an endometrial thickness ≥ 4 mm had a significantly higher prevalence of endometrial cancer than patients with an endometrial thickness <4 mm.
In addition, the Italian researchers discovered an “alarmingly high prevalence” of endometrial cancer in symptomatic patients with an endometrial thickness <4 mm: 8.5%.
This finding suggests that the endometrial thickness value in patients with abnormal uterine bleeding likely needs further investigation or should be combined with other risk factors in a new diagnostic score for endometrial cancer.
The study in the journal Diagnostics included 435 postmenopausal women referred to the Obstetrics and Gynecological Clinic in Padua, Italy for diagnostic hysteroscopy between June 2017 and June 2019.
Of these, 329 were asymptomatic and were referred to as diagnostic hysteroscopy because of an endometrial thickness ≥ 4 mm (ET group). The remaining 106 patients were referred for diagnostic hysteroscopy for abnormal uterine bleeding (AUB group).
The AUB group was further divided into two subgroups: women with an endometrial thickness <4 mm (n = 48) (AUB subgroup 1) and women with an endometrial thickness ≥ 4 mm (n = 58) (AUB subgroup 2).
After the hysteroscopy, an endometrial biopsy was performed for each patient. However, after the histological examination, four patients (three patients from the ETGroup and one patient from the AUB group) were excluded due to insufficient samples, leaving 431 patients for statistical analyzes.
The prevalence of endometrial cancer and atypical hyperplasia in the AUBGroup and the ETGroup was 21% and 6.7%, respectively.
A much higher probability of both conditions was also observed in AUB subgroup 2 (29.3%) compared to AUBS subgroup 1 (10.6%) (P <0.001).
The incidental finding of an endometrial thickness ≥ 4 mm was the main indication for diagnostic hysteroscopy in the entire study population (75.6%) with only a low prevalence of endometrial cancer (3.68%) and atypical hyperplasia (3.07%) in contrast to a high percentage of negative biopsy (93.25%).
The authors found that there is no consensus as to which endometrial warning limit is best for selecting patients with abnormal uterine bleeding in need of an endometrial biopsy. In symptomatic patients, the cut-off that showed the best sensitivity and specificity for diagnosing endometrial cancer was 11 mm: 100% and 80%, respectively.
“In view of the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory for abnormal uterine bleeding in postmenopausal patients,” the authors wrote of the effects of individual risk factors on the development of endometrial cancer. “
Based on their own experience, the researchers question the safety of endometrial thickness in ruling out cancer in patients with AUB, which raises the reasonable assumption that diagnostic hysteroscopy with endometrial biopsy could be performed in this patient population.
Photo credit: National Institute for Human Genome Research
- Saccardi C., Vitagliano A., Marchetti M. et al. Endometrial cancer risk prediction according to the indication of diagnostic hysteroscopy in postmenopausal women. Diagnosis (Basel). 2020; 10 (5): 257. Published 2020 April 27th doi: 10.3390 / diagnostics10050257
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