Top

Published in:

01-08-2017 | Gynecologic Oncology

Value of endometrial thickness assessed by transvaginal ultrasound for the prediction of endometrial cancer in patients with postmenopausal bleeding

Authors: Amelie Schramm, Florian Ebner, Emanuel Bauer, Wolfgang Janni, Ulrike Friebe-Hoffmann, Miriam Pellegrino, Nikolaus De Gregorio, Thomas W. P. Friedl

Published in: Archives of Gynecology and Obstetrics | Issue 2/2017

Abstract

Purpose

Histological confirmation of endometrial cancer by dilatation/curettage (D/C) in women with postmenopausal bleeding (PMB) can be challenging due to anesthesiological and/or surgical risks. Thus, less invasive methods for diagnostics are required to identify patients with minimal risk for endometrial cancer (EC) to avoid unnecessary surgical intervention. The objective of this single-center cohort study was to assess the diagnostic validity of transvaginal ultrasound (TVUS) measurements of endometrial thickness (ET) in patients with PMB for the detection of EC.

Methods

A retrospective analysis of data from patients presenting between January 2005 and August 2014 at the Department of Obstetrics and Gynecology, University Hospital Ulm, Germany, with PMB and subsequent D/C was performed. Complete data with TVUS documentation of ET and histological results of tissue samples were available from 254 patients. In addition, data on age, body mass index (BMI), ASA-score, diabetes, hypertension, and hematological laboratory values (for a smaller subsample) were recorded. To identify independent risk factors, a multivariate logistic regression with endometrial cancer as binary response variable (yes/no) was performed. Diagnostic efficacy data for different ET cutoff points (≤1 to ≤26 mm) were obtained by a receiver operator characteristic (ROC) curve analysis.

Results

The multivariate logistic regression revealed a significant independent predictive value for age and ET. However, none of the analyzed ET cutoff points showed optimal diagnostic validity, as all cutoff points with sensitivity rates above 90% (≤1 to ≤5 mm) had false positive rates of 70% and higher.

Conclusions

There is no ET cutoff point that provides good diagnostic accuracy and/or reliably excludes the presence of endometrial cancer in patients with PMB. Thus, our data analysis supports the actual German approach of histological evaluation of any PMB to confirm or exclude EC.

Moodley M, Roberts C (2004) Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol 24:736–741. doi:10.1080/014436104100009394 CrossRefPubMed

Astrup K, de Olivarius NF (2004) Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand 83:203–207CrossRefPubMed

Smith-Bindman R, Weiss E, Feldstein V (2004) How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 24:558–565. doi:10.1002/uog.1704 CrossRefPubMed

Munro MG, Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group (2014) Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J 18:55–70. doi:10.7812/TPP/13-072 PubMedPubMedCentral

Denschlag D, Ulrich U, Emons G (2010) The diagnosis and treatment of endometrial cancer: progress and controversies. Dtsch Ärzteblatt Int 108:571–577. doi:10.3238/arztebl.2011.0571

Colombo N, Creutzberg C, Amant F et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer 26:2–30. doi:10.1097/IGC.0000000000000609 CrossRefPubMed

Liao C, Zhang D, Mungo C et al (2014) Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies. Gynecol Oncol 135:163–171. doi:10.1016/j.ygyno.2014.07.095 CrossRefPubMedPubMedCentral

Schouten LJ, Goldbohm RA, van den Brandt PA (2004) Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst 96:1635–1638. doi:10.1093/jnci/djh291 CrossRefPubMed

Secord AA, Hasselblad V, Von Gruenigen VE et al (2016) Body mass index and mortality in endometrial cancer: a systematic review and meta-analysis. Gynecol Oncol 140:184–190. doi:10.1016/j.ygyno.2015.10.020 CrossRefPubMed

10.

Orekoya O, Samson ME, Trivedi T et al (2016) The impact of obesity on surgical outcome in endometrial cancer patients: a systematic review. J Gynecol Surg 32:149–157. doi:10.1089/gyn.2015.0114 CrossRefPubMedPubMedCentral

11.

Tung A (2010) Anaesthetic considerations with the metabolic syndrome. Br J Anaesth 105(Suppl):i24–i33. doi:10.1093/bja/aeq293 CrossRefPubMed

12.

Joshi GP, Ahmad S, Riad W et al (2013) Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Anesth Analg 117:1082–1091. doi:10.1213/ANE.0b013e3182a823f4 CrossRefPubMed

13.

Bouwman F, Smits A, Lopes A et al (2015) The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—an institutional study and systematic review of the literature. Gynecol Oncol 139:369–376CrossRefPubMed

14.

Cullen A, Ferguson A (2012) Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anaesth (J Can d’anesthésie) 59:974–996. doi:10.1007/s12630-012-9760-2 CrossRef

15.

Hodgson LE, Murphy PB, Hart N (2015) Respiratory management of the obese patient undergoing surgery. J Thorac Dis 7:943–952. doi:10.3978/j.issn.2072-1439.2015.03.08 PubMedPubMedCentral

16.

Demirkiran F, Yavuz E, Erenel H et al (2012) Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obstet 286:1277–1282. doi:10.1007/s00404-012-2438-8 CrossRefPubMed

17.

Guido RS, Kanbourshakir A, Rulin MC, Christopherson WA (1995) Pipelle endometrial sampling—sensitivity in the detection of endometrial cancer. J Reprod Med 40:553–555PubMed

18.

Karlsson B, Granberg S, Wikland M et al (1995) Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding—a nordic multicenter study. Am J Obstet Gynecol 172:1488–1494. doi:10.1016/0002-9378(95)90483-2 CrossRefPubMed

19.

Goldstein SR, Nachtigall M, Snyder JR, Nachtigall L (1990) Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol 163:119–123CrossRefPubMed

20.

Ferrazzi E, Torri V, Trio D et al (1996) Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study. Ultrasound Obstet Gynecol 7:315–321. doi:10.1046/j.1469-0705.1996.07050315.x CrossRefPubMed

21.

American College of Obstetricians and Gynecologists (2009) ACOG Committee Opinion No. 426: the role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol 113:462–464. doi:10.1097/AOG.0b013e31819930cc CrossRef

22.

Smith-Bindman R, Kerlikowske K, Feldstein VA et al (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280:1510–1517CrossRefPubMed

23.

Timmermans A, Opmeer BC, Khan KS et al (2010) Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 116:160–167. doi:10.1097/AOG.0b013e3181e3e7e8 CrossRefPubMed

24.

Özdemir S, Batmaz G, Ates S et al (2015) Relation of metabolic syndrome with endometrial pathologies in patients with abnormal uterine bleeding. Gynecol Endocrinol 31:725–729. doi:10.3109/09513590.2015.1058355 CrossRefPubMed

25.

Bueloni-Dias FN, Spadoto-Dias D, Delmanto LRMG et al (2016) Metabolic syndrome as a predictor of endometrial polyps in postmenopausal women. Menopause 23:759–764. doi:10.1097/GME.0000000000000616 CrossRefPubMed

26.

Breijer MC, Peeters JAH, Opmeer BC et al (2012) Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 40:621–629. doi:10.1002/uog.12306 CrossRefPubMed

27.

Worley MJ, Dean KL, Lin SN et al (2011) The significance of a thickened endometrial echo in asymptomatic postmenopausal patients. Maturitas 68:179–181. doi:10.1016/j.maturitas.2010.10.007 CrossRefPubMed

28.

Yasa C, Dural O, Bastu E et al (2016) Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women. Arch Gynecol Obstet 294:311–316. doi:10.1007/s00404-016-4054-5 CrossRefPubMed

29.

Wong AS-W, Cheung CW, Fung LW-Y et al (2016) Development and validation of prediction models for endometrial cancer in postmenopausal bleeding. Eur J Obstet Gynecol Reprod Biol 203:220–224. doi:10.1016/j.ejogrb.2016.05.004 CrossRefPubMed

30.

Di Spiezio Sardo A, Bettocchi S, Spinelli M et al (2010) Review of new office-based hysteroscopic procedures 2003–2009. J Minim Invasive Gynecol 17:436–448. doi:10.1016/j.jmig.2010.03.014 CrossRef

31.

Dijkhuizen FPHLJ, Mol BWJ, Brölmann HAM, Heintz APM (2000) The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 89:1765–1772. doi:10.1002/1097-0142(20001015)89:8<1765:AID-CNCR17>3.0.CO;2-F CrossRefPubMed

32.

Rose PG, Baker S, Kern M et al (1993) Primary radiation therapy for endometrial carcinoma: a case controlled study. Int J Radiat Oncol Biol Phys 27:585–590CrossRefPubMed

Title: Value of endometrial thickness assessed by transvaginal ultrasound for the prediction of endometrial cancer in patients with postmenopausal bleeding
Authors: Amelie Schramm
Florian Ebner
Emanuel Bauer
Wolfgang Janni
Ulrike Friebe-Hoffmann
Miriam Pellegrino
Nikolaus De Gregorio
Thomas W. P. Friedl
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4439-0

At a glance: The STEP trials

Springer Medicine

Value of endometrial thickness assessed by transvaginal ultrasound for the prediction of endometrial cancer in patients with postmenopausal bleeding

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

Three studies in the focus of pelvic organ prolapse research

Congenital cytomegalovirus infection in Central Germany: an underestimated risk

Metabolic and androgen profile in underweight women with polycystic ovary syndrome

Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels

Listeriosis during pregnancy

Impact of surgery for endometriomas on pregnancy outcomes following in vitro fertilization-intracytoplasmic sperm injection. Who should be the preferred laparoscopists: gynecologists or reproductive surgeons?