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A study on the knowledge and management practices of hypertension in establishing a threshold for endometrial sampling in post-menopausal women with an incidentally found thickened endometrium: A retrospective cohort study

Patricia Ann A. Factor, MD and Lisa T. Prodigalidad-Jabson, MD, FPOGS
Department of Obstetrics and Gynecology, Philippne General Hospital, University of the Philippines - Manila

Background: Pelvic ultrasonography is currently not recommended as a screening tool for endometrial cancer, particularly in asymptomatic women; however, its use for other indications such as pelvic masses has led to incidental findings of thickened endometrium in post menopausal women.

Objectives: The aim of the study is to evaluate the clinical utility of endometrial ultrasound in asymptomatic Filipino postmenopausal women and to provide a threshold for invasive endometrial sampling.

Methodology: A cohort of postmenopausal women (aged ?50 years) who underwent pelvic ultrasonography at a tertiary hospital for indications other than vaginal bleeding was retrospectively evaluated. Women were included if they had an endometrial lining of at least 5 mm and had an endometrial biopsy. Receiver operating characteristic (ROC) analysis was used to determine the endometrial thickness threshold for which endometrial thickness is able to correctly differentiate benign endometrial pathology from endometrial hyperplasia and carcinoma.

Results: Out of 90 women included in the study, carcinoma was identified in 3 (3.33%) and hyperplasia was noted in 4 (4.44%). The most common histopathology noted was: endometrial polyp (35.56%), atrophic endometrium (30%) and benign endometrial tissues (18.98%). The calculated area under ROC curve was 54.39% (95% CI 34.38-79.41%), which indicates the inability of endometrial thickness to differentiate benign endometrium from endometrial carcinoma or hyperplasia in asymptomatic women with an incidentally found thickened endometrium.

Conclusion: Based on the results of the study, endometrial thickness alone cannot be used as basis for deciding whether to perform endometrial sampling, there is no endometrial thickness threshold for which the endometrial hyperplasia and carcinoma can be correctly identified. The decision to perform an endometrial biopsy should be done on a case to case basis. In the absence of a high index of suspicion for endometrial hyperplasia and carcinoma even in the presence of thickened endometrium, endometrial sampling is unnecessary.