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Kaur H, Qadri S, Nevill AM, Ewies AAA. The optimal endometrial thickness threshold for prediction of endometrial cancer in postmenopausal women without bleeding remains uncertain-Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2024; 53:102831. [PMID: 39127112 DOI: 10.1016/j.jogoh.2024.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
The incidental finding of endometrial thickness (ET) >4 mm in the absence of postmenopausal bleeding (PMB) is a common cause of referring women to secondary care. However, there is lack of consensus amongst gynecologists as regards the management. It is estimated that up to 15 % of endometrial cancers occur in women without PMB. The aim this study was to determine the optimal ET threshold, on trans-vaginal ultrasound scan, that discriminates normal endometrium from endometrial hyperplasia and cancer in this cohort. On using a thorough search strategy, a total 16 studies including 4088 women were deemed eligible. However, the data were not amenable to meta-analysis. There were wide variations in the thresholds reported with potential bias given the retrospective nature of the majority of the studies. Despite contacting authors, we could not obtain the primary data to generate a Receiver Operating Characteristic (ROC) Curve. No linear or curvilinear association was found between ET thresholds and the percentage of women diagnosed with endometrial hyperplasia and cancer using either Pearson's correlation, linear or curvilinear regression, or a simple visual scan/scatter diagram. The result of this study reveals the lack of evidence to inform clinical practice in this area, and there is a need for a well-designed multi-center prospective study.
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Affiliation(s)
- Harpreet Kaur
- Speciality trainee in Department of Gynecology, Sandwell and West Birmingham Hospitals NHS Trust (SWBH), Birmingham, UK
| | - Shahin Qadri
- Speciality registrar in Department of Gynecology, Sandwell and West Birmingham Hospitals NHS Trust (SWBH), Birmingham, UK
| | | | - Ayman A A Ewies
- Consultant Gynecologist in Sandwell and West Birmingham Hospitals NHS Trust (SWBH) and Visiting Senior Lecturer in University of Aston, Birmingham, UK.
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Lin WH, Chang CL. Ultrasonic presentation variation of patients with pathological evidence of endometrial atrophy. Taiwan J Obstet Gynecol 2023; 62:719-723. [PMID: 37679001 DOI: 10.1016/j.tjog.2023.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Post-menopausal bleeding is one of the most common reasons for attending the gynecology outpatient clinic. The major proportion of the symptoms is endometrial atrophy (about 60%) despite of the endometrial thickness is over 4 mm. Therefore, the aim of this study is to evaluate the endometrial thickness under sonogram in the women with atrophic endometrium, with or without post-menopausal vaginal bleeding. MATERIALS AND METHODS This is a retrospective study and we enrolled 237 post-menopausal women with pathological evidence of atrophic endometrium from Jan. 2014 to Dec. 2018 in Mackay Memorial hospital. Patient's characteristics taken into account were age, vaginal bleeding status, the methods of obtaining endometrial tissue, hormonal replacement therapy and breast cancer history under tamoxifen treatment. Endometrial thickness was classified as ≤ 4 mm, >4 mm-10 mm and >10 mm. We calculated the proportion of the characteristic mentioned before. RESULTS In total, 237 patients were enrolled and 35 patients were excluded; therefore, the remaining 202 patients were analyzed. There were 42 (20.8%), 109 (54%) and 51 (25.2%) patients with endometrial thickness ≤4 mm, >4 mm-10 mm and >10 mm respectively. There was significant difference in the numbers of patients with post-menopausal bleeding (p = 0.002) and breast cancer history under tamoxifen therapy (p < 0.05) among the three groups. CONCLUSION In the patients with endometrial atrophy, the endometrial thickness may be variable. There were only 20.8% of patients with endometrial thickness less than 4 mm in our study. Before endometrial sampling, comprehensive evaluation of the morphology of endometrium under image study, the patient's symptoms and medical history is important.
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Affiliation(s)
- Wen-Hsuan Lin
- Department of Obstetric & Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Long Chang
- Department of Obstetric & Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
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Value of endometrial thickness and Doppler parameters of uterine artery in predicting endometrial cancer in postmenopausal women with abnormal uterine bleeding: a cross-sectional study in Vietnam. Obstet Gynecol Sci 2022; 65:430-440. [PMID: 35488358 PMCID: PMC9483670 DOI: 10.5468/ogs.22053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the value of endometrial thickness (ET) and Doppler indices of uterine artery (UtA) as sonographic markers in predicting endometrial cancer (EC) among postmenopausal bleeding (PMB) women in low-resource settings as Vietnam. Methods This cross-sectional study was conducted at the Hue University Hospital and Hue Central Hospital between June 2016 and June 2019. The study enrolled all women who complained of PMB and were followed by transvaginal Doppler ultrasound. Their definitive histopathological examination was the gold standard for comparison. Results The UtA Doppler indices, including resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV), were significantly lower in the malignant group than in the benign group. The threshold values of the UtA, RI ≤0.73 and PI ≤1.42, were found with an area under receiver operating characteristic curve (AUC) of 0.85–0.88, and the sensitivity and specificity were 91.3% and 83.3%, respectively. Unlike PSV, the diagnostic value was the lowest, with an AUC of 0.72. ET was a good predictor for the diagnosis of EC, with an AUC of 0.89. In women with PMB, when using the cutoff value of EC more than 12.5 mm, the sensitivity and specificity were 93.8% and 77.8%, respectively. In addition, the higher the stage of EC, the lower the RI and PI and the greater the EC. Conclusion ET, and RI, PI, and PSV of the UtA could help in differentiating malignant from benign endometrial changes. Pulsed ultrasonic Doppler velocimetry seems to play a role in predicting the higher stages of EC. Further studies are needed to confirm these findings.
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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 2021; 37:853-856. [PMID: 33148069 DOI: 10.1080/09513590.2020.1843621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence and risk factors for endometrial malignancies in asymptomatic postmenopausal women. METHODS Multicentric retrospective analytical study in two Brazilian Reference Centers. All women without postmenopausal bleeding who were submitted to hysteroscopy with biopsy were included (1665). Excluded women without anatomopathological results (625) and whose medical records were incomplete (37). The variables analyzed were age; parity; body mass index; duration of menopausal status; systemic arterial hypertension; diabetes mellitus; use of hormone replacement therapy; use of tamoxifen; duration of use of tamoxifen; endometrial thickness and biopsy results. RESULTS The frequency of endometrial malignancies in asymptomatic postmenopausal women was 2.39%. Endometrial thickness ≥8 mm increased the chance of endometrial malignancies, even more, with an endometrial thickness ≥12.55 mm the chance of endometrial malignancies increased by 4.68 times (p < .001 and 95% CI: 1.99-11.03). CONCLUSION The prevalence of endometrial malignancies was low and the only risk factor for endometrial malignancies in asymptomatic postmenopausal women was endometrial thickness.
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Affiliation(s)
- Maria Beatriz Bracco Suarez
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cristina Laguna Benetti-Pinto
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luciano Gibran
- Reference Center for Women's Health, Pérola Byington Hospital, São Paulo, Brazil
| | - Daniela Angerame Yela
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Long B, Clarke MA, Morillo ADM, Wentzensen N, Bakkum-Gamez JN. Ultrasound detection of endometrial cancer in women with postmenopausal bleeding: Systematic review and meta-analysis. Gynecol Oncol 2020; 157:624-633. [PMID: 32008795 DOI: 10.1016/j.ygyno.2020.01.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the performance of endometrial thickness (ET) cut-offs for detecting endometrial cancer (EC) in women with postmenopausal bleeding (PMB) and evaluate the clinical utility of additional ultrasound measures such as endometrial volume (EV), vascular flow index (VFI), vascularization index (VI), and uterine artery flow index (FI). METHODS Clinicaltrials.gov and MEDLINE database via PubMed were queried for studies published between 1/1990 and 3/2016 using specific MeSH terms. Original, peer-reviewed cohort studies reporting EC outcomes and specific ultrasound findings by PMB status were included. RESULTS Study design, country, clinical setting inclusion/exclusion criteria, aggregate study-level demographic and clinical data were extracted from 44 studies including 17,339 women with PMB and 1341 cases of EC (7.7%). In women with PMB and EC (n = 417), pooled mean ET was 16.4 mm (95% CI, 14.8-18.1 mm). In women with PMB without EC, pooled mean ET was 4.1 mm. 31 studies reported outcomes using different ET cut-off values ranging from 3 to 20 mm. Compared to ≥3 or 4 mm, a cutoff of ≥5 mm had similar sensitivity (96.2, 95%CI 92.3, 98.1) with improved specificity for EC (51.5, 95%CI 42.3-60.7), allowing to reduce the rate of invasive workup for PMB by 17%. EV, VI, VFI, and FI were significantly correlated with EC, but performance of specific cut-offs was not analyzed due to limited data. CONCLUSION Among women with PMB mean ET is substantially higher in women with EC compared to those without EC. An ET cutoff of ≥5 mm shows an acceptable tradeoff between sensitivity and specificity for diagnosis of EC.
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Affiliation(s)
- Beverly Long
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
| | - Megan A Clarke
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, United States of America
| | - Arena Del Mar Morillo
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, United States of America
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, United States of America
| | - Jamie N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology Surgery, Mayo Clinic, Rochester, MN, United States of America
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Vaginoscopic hysteroscopy in management for women with post-menopausal vaginal bleeding. Taiwan J Obstet Gynecol 2019; 58:497-500. [DOI: 10.1016/j.tjog.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 01/23/2023] Open
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Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1210-1222. [PMID: 30083701 PMCID: PMC6142981 DOI: 10.1001/jamainternmed.2018.2820] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE As the worldwide burden of endometrial cancer continues to rise, interest is growing in the evaluation of early detection and prevention strategies among women at increased risk. Focusing efforts on women with postmenopausal bleeding (PMB), a common symptom of endometrial cancer, may be a useful strategy; however, PMB is not specific for endometrial cancer and is often caused by benign conditions. OBJECTIVE To provide a reference of the prevalence of PMB in endometrial cancers and the risk of endometrial cancer in women with PMB. DATA SOURCES For this systematic review and meta-analysis, PubMed and Embase were searched for English-language studies published January 1, 1977, through January 31, 2017. STUDY SELECTION Observational studies reporting the prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB in unselected populations were selected. DATA EXTRACTION AND SYNTHESIS Two independent reviewers evaluated study quality and risk of bias using items from the Newcastle-Ottawa Quality Assessment Scale and the Quality Assessment of Diagnostic Accuracy Studies tool. Studies that included highly selected populations, lacked detailed inclusion criteria, and/or included 25 or fewer women were excluded. MAIN OUTCOMES AND MEASURES The pooled prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB. RESULTS A total of 129 unique studies, including 34 432 unique patients with PMB and 6358 with endometrial cancer (40 790 women), were analyzed. The pooled prevalence of PMB among women with endometrial cancer was 91% (95% CI, 87%-93%), irrespective of tumor stage. The pooled risk of endometrial cancer among women with PMB was 9% (95% CI, 8%-11%), with estimates varying by use of hormone therapy (range, 7% [95% CI, 6%-9%] to 12% [95% CI, 9%-15%]; P < .001 for heterogeneity) and geographic region (range, 5% [95% CI, 3%-11%] in North America to 13% [95% CI, 9%-19%] in Western Europe; P = .09 for heterogeneity). CONCLUSIONS AND RELEVANCE Early detection strategies focused on women with PMB have the potential to capture as many as 90% of endometrial cancers; however, most women with PMB will not be diagnosed with endometrial cancer. These results can aid in the assessment of the potential clinical value of new early detection markers and clinical management strategies for endometrial cancer and will help to inform clinical and epidemiologic risk prediction models to support decision making.
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Affiliation(s)
- Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Beverly J Long
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Arena Del Mar Morillo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Endometrial Biopsy in an Outpatient Gynaecological Setting: Overinvestigation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1309-1314. [PMID: 29937135 DOI: 10.1016/j.jogc.2018.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/08/2018] [Accepted: 01/06/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We reviewed the indications for endometrial biopsy at the general gynaecology outpatient clinic of the Université de Montréal Hospital Center and measured their compliance with the Society of Obstetricians and Gynaecologists of Canada and other international guidelines. METHODS Three hundred and seventy-one files of patients who had an endometrial biopsy between January and October 2015 were reviewed. Indication for endometrial biopsy and pathology results were noted. Files were separated into four categories. RESULTS In the postmenopausal bleeding category, all files complied with the SOGC. We found hyperplasia or neoplasia in 13% of patients. In the asymptomatic endometrial thickening category, 9% of the files did not show sufficient indication for biopsy. None of the patients presented hyperplasia or neoplasia. In the abnormal uterine bleeding (AUB) - under 41 years old category, there was no indication for biopsy in 23% of the files. We found hyperplasia or neoplasia in 13% of patients, but only in patients with an indication for biopsy. In patients with AUB - over 40, non-compliance with SOGC was 3%. But according to international guidelines, 42% of patients with AUB between 41 and 45 years old did not have an indication for biopsy and none showed hyperplasia or neoplasia. CONCLUSION We demonstrated clinically significant overinvestigation in patients with AUB. Indications should be reviewed carefully before performing an endometrial biopsy in women under 41. In addition, the value of endometrial biopsies in patients between 41 and 45 years old with menorrhagia and no additional risk factor should be reevaluated.
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Seckin B, Cicek MN, Dikmen AU, Bostancı EI, Muftuoglu KH. Diagnostic value of sonography for detecting endometrial pathologies in postmenopausal women with and without bleeding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:339-346. [PMID: 26857098 DOI: 10.1002/jcu.22329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To investigate the diagnostic value of endometrial thickness measurement on sonography in predicting endometrial pathologies in postmenopausal women with vaginal bleeding and in those with asymptomatic thickened endometrium. METHODS Six hundred two postmenopausal women with vaginal bleeding or asymptomatic thickened endometrium were evaluated in this study. Two hundred seventy-four women with postmenopausal bleeding regardless of endometrial thickness (group 1: symptomatic) and 328 women with an incidental finding of thickened endometrium (≥5 mm) without bleeding (group 2: asymptomatic) underwent endometrial biopsy for histopathologic examination. The receiver operating characteristics curves of endometrial thickness measurement for prediction of endometrial pathologies were analyzed. RESULTS Endometrial carcinoma was detected in eight women (2.9%) in group 1 and in three (0.9%) in group 2. The best cutoff point for endometrial thickness in predicting endometrial carcinoma in group 1 was 8.2 mm, which provided 75% sensitivity (95% confidence interval [CI], 40.9-92.9%) and 74% specificity (95% CI, 68-78.5%); area under the receiver operating characteristics curve (AUC), 0.88; 95% CI, 0.76-1.00%; p = 0.0001. In group 2, the AUC was 0.76 (95% CI, 0.46-1.00; p = 0.114); the evidence was inconclusive as to the relationship between endometrial thickness and malignancy. For the prediction of polyps, the AUCs of endometrial thickness were 0.77 for group 1 (95% CI, 0.71-0.83%; p = 0.0001) and 0.61 for group 2 (95% CI, 0.54-0.67%; p = 0.002). CONCLUSIONS Sonographically determined endometrial thickness measurement shows high diagnostic performance for detection of endometrial cancer in symptomatic postmenopausal women at the optimal cutoff thickness of approximately 8 mm, although the evidence supporting the use of sonography for predicting malignancy in asymptomatic women is inconclusive. For polyp detection, this technique shows moderate diagnostic ability in symptomatic women, but its predictive value is low in asymptomatic women. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:339-346, 2016.
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Affiliation(s)
- Berna Seckin
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Mahmut Nedim Cicek
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Esra Isci Bostancı
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Kamil Hakan Muftuoglu
- Department of Pathology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Ozer A, Ozer S, Kanat-Pektas M. Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding. J Obstet Gynaecol Res 2016; 42:573-8. [DOI: 10.1111/jog.12937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/08/2015] [Accepted: 11/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Alev Ozer
- Departments of Obstetrics and Gynecology; Kahramanmaras Sutcu Imam University Medical Faculty Hospital; Kahramanmaras Turkey
| | - Serdar Ozer
- Department of Obstetrics and Gynecology; Pazarcik State Hospital; Kahramanmaras Turkey
| | - Mine Kanat-Pektas
- Department of Obstetrics and Gynecology; Afyon Kocatepe University Medical Faculty Hospital; Afyonkarahisar Turkey
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Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding. Int J Gynaecol Obstet 2015; 132:314-7. [DOI: 10.1016/j.ijgo.2015.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/05/2015] [Accepted: 11/03/2015] [Indexed: 11/17/2022]
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Hysteroscopic chasing for endometrial cancer in a low-risk population: risks of overinvestigation. Arch Gynecol Obstet 2015; 293:851-6. [DOI: 10.1007/s00404-015-3868-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/18/2015] [Indexed: 01/13/2023]
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Otify M, Fuller J, Ross J, Shaikh H, Johns J. Endometrial pathology in the postmenopausal woman - an evidence based approach to management. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/tog.12150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mohamed Otify
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
| | - Joanna Fuller
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
| | - Jackie Ross
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
| | - Hizbullah Shaikh
- Kings College Hospital Histopathology Department; Denmark Hill London SE5 9RS UK
| | - Jemma Johns
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
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Giannella L, Mfuta K, Setti T, Boselli F, Bergamini E, Cerami LB. Diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies and appropriateness of performed hysteroscopies among asymptomatic postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2014; 177:29-33. [PMID: 24766900 DOI: 10.1016/j.ejogrb.2014.03.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/25/2014] [Accepted: 03/05/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To measure the diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies among asymptomatic postmenopausal women, and to test the diagnostic accuracy and appropriateness of performed hysteroscopies. STUDY DESIGN Prospective study of 268 asymptomatic postmenopausal women with endometrial thickness ≥4 mm referred to diagnostic hysteroscopy. The diagnostic accuracy of various endometrial thickness cut-off values was tested. Histological and hysteroscopic results were compared to measure the diagnostic accuracy of outpatient hysteroscopies. RESULTS No endometrial thickness cut-off values had optimal diagnostic accuracy [positive likelihood ratio (LR+) >10 and negative likelihood ratio (LR-) <0.1]. The best endometrial thickness cut-off value for the detection of all intra-uterine pathologies was ≥8 mm (LR+ 10.05 and LR- 0.22). An endometrial thickness cut-off value ≥10 mm did not miss any cases of endometrial cancer. The success rate of diagnostic hysteroscopy was 89%, but 97% of these revealed a benign intra-uterine pathology. The diagnostic accuracy of hysteroscopy was optimal for all intra-uterine pathologies, except endometrial hyperplasia (LR- 0.52). CONCLUSION Using an endometrial thickness cut-off value ≥4 mm, only 3% of performed hysteroscopies were useful for the detection of pre-malignant or malignant lesions. Despite the finding that endometrial thickness did not show optimal diagnostic accuracy, using the best cut-off value (≥8 mm) may be helpful to decrease the number of false-positive results. No cases of endometrial cancer were diagnosed in asymptomatic postmenopausal women with endometrial thickness <10mm.
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Affiliation(s)
- L Giannella
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy.
| | - K Mfuta
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy
| | - T Setti
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy
| | - F Boselli
- Mother-Infant Department, Institute of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Bergamini
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy
| | - L B Cerami
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy
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Abstract
OBJECTIVE To estimate the prevalence of Bartholin gland cysts in asymptomatic women serving as control participants who underwent pelvic magnetic resonance imaging (MRI) as part of research studies. The secondary aim was to investigate potential demographic characteristics associated with Bartholin gland cysts. METHODS Pelvic MRIs from 430 control participants enrolled in five research projects were evaluated. All images were evaluated by at least two authors. The presence, laterality, and size of Bartholin gland cysts were recorded. Demographic information for each participant was obtained at the time of enrollment in the respective parent study. RESULTS Approximately 3% of the participants had visible Bartholin gland cysts on MRI scans. Fifty percent of the cysts were identified on the right side, 42.9% were seen on the left side, and 7.1% were bilateral. The cysts were, on average, 1.3×1.2×1.3 cm with dimensions ranging from 0.5 to 2.7 cm. There were no demographic differences between women with and without visible Bartholin gland cysts. CONCLUSION Bartholin gland cysts occur in 3% of adult women. The cysts affect women of broad ranges of age and parity. Women with visible Bartholin gland cysts are demographically similar to women without cysts on pelvic imaging. LEVEL OF EVIDENCE II.
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