Display options
Cite
Li JXL, Chan F, Johansson CYM. Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review. Aust N Z J Obstet Gynaecol. 2022;doi: 10.1111/ajo.13472.
Li, J. X. L., Chan, F., & Johansson, C. Y. M. (2022). Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review. The Australian & New Zealand journal of obstetrics & gynaecology, . https://doi.org/10.1111/ajo.13472
Li, Jessica X L, et al. "Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review." The Australian & New Zealand journal of obstetrics & gynaecology vol. (2022). doi: https://doi.org/10.1111/ajo.13472
Li JXL, Chan F, Johansson CYM. Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review. Aust N Z J Obstet Gynaecol. 2022 Jan 07; doi: 10.1111/ajo.13472. Epub 2022 Jan 07. PMID: 34994399.
Copy Download .nbib Format: NLM
Share it on

Aust N Z J Obstet Gynaecol. 2022 Jan 07; doi: 10.1111/ajo.13472. Epub 2022 Jan 07.

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

The Australian & New Zealand journal of obstetrics & gynaecology

Jessica X L Li, Felix Chan, Cherynne Yuin Mun Johansson

Affiliations

  1. Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  2. Westmead Private Hospital, Westmead, New South Wales, Australia.
  3. Macquarie University Hospital, North Ryde, New South Wales, Australia.
  4. Minimally Invasive Gynaecology Unit, Liverpool Hospital, Liverpool, New South Wales, Australia.

PMID: 34994399 DOI: 10.1111/ajo.13472

Abstract

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.

© 2022 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Keywords: asymptomatic; carcinoma of the endometrium; postmenopause; systematic review; ultrasonography

References

  1. Australian Institute of Health and Welfare (AIHW). 2020 Cancer Data in Australia. (AIHW, Canberra, 2020). - PubMed
  2. Wang Q, Wang QI, Zhao L, et al. Endometrial cytology as a method to improve the accuracy of diagnosis of endometrial cancer: case report and meta-analysis. Front Oncol 2019; 9: 256. - PubMed
  3. Clark TJ, Voit D, Gupta JK, et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002; 288(13): 1610-1621. - PubMed
  4. Aston B, Weaver E. Risks and benefits of hysteroscopy and endometrial sampling as a standard procedure for assessing serendipitous findings of endometrial thickening in postmenopausal women. Aust N Z J Obstet Gynaecol 2014; 54(6): 597-599. - PubMed
  5. ACOG Committee Opinion No. 734. The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet. Gynecol 2018; 131(5): e124-e129. - PubMed
  6. Breijer MC, Peeters JAH, Opmeer BC, et al. Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2012; 40(6): 621-629. - PubMed
  7. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 2004; 24(5): 558-565. - PubMed
  8. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. - PubMed
  9. Schünemann HJ, Oxman AD, Brozek J, et al. GRADE: grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008; 336(7653): 1106-1110. - PubMed
  10. Alcázar JL, Bonilla L, Marucco J, et al. Risk of endometrial cancer and endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness ≥11 mm: A systematic review and meta-analysis. J Clin Ultrasound 2018; 46(9): 565-570. - PubMed
  11. Bracco Suarez MB, Benetti-Pinto CL, Gibran L, Yela DA. Asymptomatic postmenopausal women: what are the risk factors for endometrial malignancies? A multicentric retrospective study. Gynecol Endocrinol 2020; 37(9): 853-856. - PubMed
  12. Ghoubara A, Emovon E, Sundar S, Ewies A. Thickened endometrium in asymptomatic postmenopausal women - determining an optimum threshold for prediction of atypical hyperplasia and cancer. J Obstet Gynaecol 2018; 38(8): 1146-1149. - PubMed
  13. Giannella L, Delli Carpini G, Di Giuseppe J, et al. Atrophic endometrium in postmenopausal women referred to diagnostic hysteroscopy: a study to avoid unnecessary examinations. Eur Rev Med Pharmacol Sci 2020; 24(10): 5217-5222. - PubMed
  14. Hefler L, Lafleur J, Kickmaier S, et al. Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium: data from the FAME-Endo study: an observational register study. Arch Gynecol Obstet 2018; 298(4): 813-820. - PubMed
  15. Kanmaz AG, İnan AH, Beyan E, Budak A. Importance of transvaginal ultrasonography before endometrial sampling in asymptomatic postmenopausal patients. J Gynecol Obstet Hum Reprod 2019; 48(1): 25-28. - PubMed
  16. Li Z, Li L. Risk of malignancies among asymptomatic postmenopausal women with thickened endometrium: A cohort study. Medicine (Baltimore) 2019; 98(6): e14464. - PubMed
  17. Louie M, Canavan TP, Mansuria S. Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding. Int J Gynaecol Obstet 2016; 132(3): 314-317. - PubMed
  18. Ozelci R, Dilbaz B, Akpınar F, et al. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci 2019; 62(4): 273-279. - PubMed
  19. Saccardi C, Vitagliano A, Marchetti M, et al. Endometrial cancer risk prediction according to indication of diagnostic hysteroscopy in post-menopausal women. Diagnostics 2020; 10(5): 257. - PubMed
  20. Seckin B, Cicek MN, Dikmen AU, et al. Diagnostic value of sonography for detecting endometrial pathologies in postmenopausal women with and without bleeding. J Clin Ultrasound 2016; 44(6): 339-346. - PubMed
  21. Yasa C, Dural O, Bastu E, et al. Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women. Arch Gynecol Obstet 2016; 294(2): 311-316. - PubMed
  22. Wong A-W, Lao T-H, Cheung CW, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. Int J Obstet Gynaecol 2016; 123(3): 439-446. - PubMed
  23. Timmermans A, Opmeer BC, Khan KS, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 2010; 116(1): 160-167. - PubMed
  24. Ferrazzi E, Zupi E, Leone FP, et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol 2009; 200(3): 235.e231-236. - PubMed
  25. Propst AM, Liberman RF, Harlow BL, Ginsburg ES. Complications of hysteroscopic surgery: predicting patients at risk. Obstet Gynecol 2000; 96(4): 517-520. - PubMed
  26. Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC Fam Pract 2018; 19(1): 135. - PubMed
  27. Aggarwal A, Hatti A, Tirumuru SS, Nair SS. Management of asymptomatic postmenopausal women referred to outpatient hysteroscopy service with incidental finding of thickened endometrium - a UK district general hospital experience. J Minim Invasive Gynecol 2021; 28(10): 1725-1729. - PubMed
  28. Segev Y, Dain-Sagi L, Lavie O, et al. Is there a survival advantage in diagnosing endometrial cancer in asymptomatic patients? A systemic review and meta-analysis. J Obstet Gynaecol can 2020; 42(4): 481-487.e482. - PubMed
  29. Royal College of Obstetricians & Gynaecologists. Management of Endometrial Hyperplasia. in Green-top Guideline No. 67 (ed. RCOG/BSGE Joint Guideline) 2016. - PubMed
  30. Obermair A, et al. Risk of endometrial cancer for women diagnosed with HNPCC-related colorectal carcinoma. Int J Cancer 2010; 127(11): 2678-2684. - PubMed
  31. Felix AS, Weissfeld JL, Pfeiffer RM, et al. Endometrial thickness and risk of breast and endometrial carcinomas in the prostate, lung, colorectal and ovarian cancer screening trial. Int J Cancer 2014; 134(4): 954-960. - PubMed

Publication Types