Skip to main content
Top
Published in: Archives of Gynecology and Obstetrics 4/2019

01-04-2019 | Gynecologic Oncology

The incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection

Authors: Zhe Li, Lei Li

Published in: Archives of Gynecology and Obstetrics | Issue 4/2019

Login to get access

Abstract

Objective

To investigate the incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection (EFC).

Methods

All patients with EFC diagnosed by transvaginal sonography (TVS) were retrospectively reviewed if they had undergone biopsy of the endometrium from January 2008 to January 2016 in a tertiary teaching hospital. Follow-up ended in June 2017. The incidence of gynecologic malignancies was described, and predictive factors were determined by comparing the epidemiological and clinico-pathological characteristics of the patients.

Results

During the study period, 273 women with EFC (3.4%) were enrolled. Biopsy pathology and the following hysterectomy revealed 29 (10.6%) cases of gynecological cancer. In the multivariable analysis, patient-reported genital symptoms [odds ratio (OR) 16.2, 95% confidence interval (CI) 1.9–139.3], abnormal serum CA125 (OR 14.5, 95% CI 4.5–46.5), lesions in the uterine cavity (OR 18.8, 95% CI 6.0–59.1) and endometrial thickness (OR 1.1, 95% CI 1.0–1.2) determined by TVS were independent factors associated with malignancy. Only 1.1% (1/90) of the asymptomatic patients had gynecologic cancer. During the follow-up, gynecologic cancer was diagnosed in nine patients, six of whom had vaginal bleeding at the time of initial enrollment. The prognosis of patients with cancer was worse than that of patients with benign results.

Conclusion

The risk of gynecologic malignancies in postmenopausal patients with EFC is related to genital symptoms, TVS findings and CA 125 levels. Asymptomatic EFC is associated with an extremely low risk of malignancy.
Literature
1.
go back to reference Carlson JA Jr, Arger P, Thompson S, Carlson EJ (1991) Clinical and pathologic correlation of endometrial cavity fluid detected by ultrasound in the postmenopausal patient. Obstet Gynecol 77(1):119–123PubMed Carlson JA Jr, Arger P, Thompson S, Carlson EJ (1991) Clinical and pathologic correlation of endometrial cavity fluid detected by ultrasound in the postmenopausal patient. Obstet Gynecol 77(1):119–123PubMed
2.
go back to reference Gull B, Karlsson B, Wikland M, Milsom I, Granberg S (1998) Factors influencing the presence of uterine cavity fluid in a random sample of asymptomatic postmenopausal women. Acta Obstet Gynecol Scand 77(7):751–757CrossRefPubMed Gull B, Karlsson B, Wikland M, Milsom I, Granberg S (1998) Factors influencing the presence of uterine cavity fluid in a random sample of asymptomatic postmenopausal women. Acta Obstet Gynecol Scand 77(7):751–757CrossRefPubMed
3.
go back to reference Vuento MH, Pirhonen JP, Mäkinen JI, Tyrkkö JE, Laippala PJ, Grönroos M et al (1996) Endometrial fluid accumulation in asymptomatic postmenopausal women. Ultrasound Obstet Gynecol 8(1):37–41CrossRefPubMed Vuento MH, Pirhonen JP, Mäkinen JI, Tyrkkö JE, Laippala PJ, Grönroos M et al (1996) Endometrial fluid accumulation in asymptomatic postmenopausal women. Ultrasound Obstet Gynecol 8(1):37–41CrossRefPubMed
4.
go back to reference Epstein E, Ramirez A, Skoog L, Valentin L (2001) Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet Gynecol 18(2):157–162CrossRefPubMed Epstein E, Ramirez A, Skoog L, Valentin L (2001) Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet Gynecol 18(2):157–162CrossRefPubMed
5.
go back to reference Goldstein SR (1994) Postmenopausal endometrial fluid collections revisited: look at the doughnut rather than the hole. Obstet Gynecol 83(5 Pt 1):738–740PubMed Goldstein SR (1994) Postmenopausal endometrial fluid collections revisited: look at the doughnut rather than the hole. Obstet Gynecol 83(5 Pt 1):738–740PubMed
6.
go back to reference Breckenridge JW, Kurtz AB, Ritchie WG, Macht EL Jr (1982) Postmenopausal uterine fluid collection: indicator of carcinoma. AJR Am J Roentgenol 139(3):529–534CrossRefPubMed Breckenridge JW, Kurtz AB, Ritchie WG, Macht EL Jr (1982) Postmenopausal uterine fluid collection: indicator of carcinoma. AJR Am J Roentgenol 139(3):529–534CrossRefPubMed
7.
go back to reference Smith PP, O’Connor S, Gupta J, Clark TJ (2014) Recurrent postmenopausal bleeding: a prospective cohort study. J Minim Invasive Gynecol 21(5):799–803CrossRefPubMed Smith PP, O’Connor S, Gupta J, Clark TJ (2014) Recurrent postmenopausal bleeding: a prospective cohort study. J Minim Invasive Gynecol 21(5):799–803CrossRefPubMed
8.
go back to reference Topcu HO, Tasdemir U, Islimye M, Bayramoglu H, Yilmaz N (2015) The clinical significance of endometrial fluid collection in asymptomatic postmenopausal women. Climacteric 18(5):733–736CrossRefPubMed Topcu HO, Tasdemir U, Islimye M, Bayramoglu H, Yilmaz N (2015) The clinical significance of endometrial fluid collection in asymptomatic postmenopausal women. Climacteric 18(5):733–736CrossRefPubMed
9.
go back to reference Leone FP, Timmerman D, Bourne T, Valentin L, Epstein E, Goldstein SR et al (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35(1):103–112CrossRefPubMed Leone FP, Timmerman D, Bourne T, Valentin L, Epstein E, Goldstein SR et al (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35(1):103–112CrossRefPubMed
10.
go back to reference Goldstein SR (1997) The presence of endometrial fluid in asymptomatic postmenopausal women is associated with clinically relevant cervical stenosis. J Ultrasound Med 16(3):208CrossRefPubMed Goldstein SR (1997) The presence of endometrial fluid in asymptomatic postmenopausal women is associated with clinically relevant cervical stenosis. J Ultrasound Med 16(3):208CrossRefPubMed
11.
go back to reference Takacs P, De Santis T, Nicholas MC, Verma U, Strassberg R, Duthely L (2005) Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease. J Ultrasound Med 24(11):1477–1481CrossRefPubMed Takacs P, De Santis T, Nicholas MC, Verma U, Strassberg R, Duthely L (2005) Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease. J Ultrasound Med 24(11):1477–1481CrossRefPubMed
12.
go back to reference Bedner R, Rzepka-Gorska I (1998) Diagnostic value of uterine cavity fluid collection in the detection of pre-neoplastic lesions and endometrial carcinoma in the asymptomatic post-menopausal women. Ginekol Pol 69(5):237–240PubMed Bedner R, Rzepka-Gorska I (1998) Diagnostic value of uterine cavity fluid collection in the detection of pre-neoplastic lesions and endometrial carcinoma in the asymptomatic post-menopausal women. Ginekol Pol 69(5):237–240PubMed
13.
go back to reference Seckin NC, Sener AB, Gozen A, Kutlay L, Cobanoglu O, Gokmen O (1996) The importance of endometrial fluid collection in postmenopause. Gynecol Obstet Invest 41(4):244–246CrossRefPubMed Seckin NC, Sener AB, Gozen A, Kutlay L, Cobanoglu O, Gokmen O (1996) The importance of endometrial fluid collection in postmenopause. Gynecol Obstet Invest 41(4):244–246CrossRefPubMed
14.
go back to reference Inceboz U, Uyar Y, Baytur Y, Kandiloglu AR (2009) Endometrial fluid in postmenopausal women. Int J Gynaecol Obstet 107(2):154–155CrossRefPubMed Inceboz U, Uyar Y, Baytur Y, Kandiloglu AR (2009) Endometrial fluid in postmenopausal women. Int J Gynaecol Obstet 107(2):154–155CrossRefPubMed
15.
go back to reference Schmidt T, Nawroth F, Breidenbach M, Hoopmann M, Mallmann P, Valter MM (2005) Differential indication for histological evaluation of endometrial fluid in postmenopause. Maturitas 50(3):177–181CrossRefPubMed Schmidt T, Nawroth F, Breidenbach M, Hoopmann M, Mallmann P, Valter MM (2005) Differential indication for histological evaluation of endometrial fluid in postmenopause. Maturitas 50(3):177–181CrossRefPubMed
16.
go back to reference Debby A, Malinger G, Glezerman M, Golan A (2006) Intra-uterine fluid collection in postmenopausal women with cervical stenosis. Maturitas 55(4):334–337CrossRefPubMed Debby A, Malinger G, Glezerman M, Golan A (2006) Intra-uterine fluid collection in postmenopausal women with cervical stenosis. Maturitas 55(4):334–337CrossRefPubMed
17.
go back to reference Epstein E, Valentin L (2006) Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 28(1):89–95CrossRefPubMed Epstein E, Valentin L (2006) Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 28(1):89–95CrossRefPubMed
18.
go back to reference Zalel Y, Tepper R, Cohen I, Goldberger S, Beyth Y (1996) Clinical significance of endometrial fluid collections in asymptomatic postmenopausal women. J Ultrasound Med 15(7):513–515CrossRefPubMed Zalel Y, Tepper R, Cohen I, Goldberger S, Beyth Y (1996) Clinical significance of endometrial fluid collections in asymptomatic postmenopausal women. J Ultrasound Med 15(7):513–515CrossRefPubMed
19.
go back to reference Krissi H, Bar-Hava I, Orvieto R, Levy T, Ben-Rafael Z (1998) Endometrial carcinoma in a post-menopausal woman with atrophic endometrium and intra-cavitary fluid: a case report. Eur J Obstet Gynecol Reprod Biol 77(2):245–247CrossRefPubMed Krissi H, Bar-Hava I, Orvieto R, Levy T, Ben-Rafael Z (1998) Endometrial carcinoma in a post-menopausal woman with atrophic endometrium and intra-cavitary fluid: a case report. Eur J Obstet Gynecol Reprod Biol 77(2):245–247CrossRefPubMed
20.
go back to reference Giannella L, Mfuta K, Setti T, Cerami LB, Bergamini E, Boselli F (2014) A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness > 4 mm. Biomed Res Int 2014:130569CrossRefPubMedPubMedCentral Giannella L, Mfuta K, Setti T, Cerami LB, Bergamini E, Boselli F (2014) A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness > 4 mm. Biomed Res Int 2014:130569CrossRefPubMedPubMedCentral
21.
go back to reference Knific T, Osredkar J, Smrkolj S, Tonin I, Vouk K, Blejec A et al (2017) Novel algorithm including CA-125, HE4 and body mass index in the diagnosis of endometrial cancer. Gynecol Oncol 147(1):126–132CrossRefPubMed Knific T, Osredkar J, Smrkolj S, Tonin I, Vouk K, Blejec A et al (2017) Novel algorithm including CA-125, HE4 and body mass index in the diagnosis of endometrial cancer. Gynecol Oncol 147(1):126–132CrossRefPubMed
22.
go back to reference Savelli L, De Iaco P, Santini D, Rosati F, Ghi T, Pignotti E et al (2003) Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 188(4):927–931CrossRefPubMed Savelli L, De Iaco P, Santini D, Rosati F, Ghi T, Pignotti E et al (2003) Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 188(4):927–931CrossRefPubMed
Metadata
Title
The incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection
Authors
Zhe Li
Lei Li
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-4997-9

Other articles of this Issue 4/2019

Archives of Gynecology and Obstetrics 4/2019 Go to the issue