Endometrial thickness in abnormal uterine bleeding may predict endometrial cancer among peri and post menopausal women: Study
The endometrium constitutes a dynamic organ in female
reproductive years subjected to cyclical hormonal variations. Perimenopause is
a transition phase of women’s life marked by erratic cycle and fluctuating
hormonal milieu. Abnormal uterine bleeding constitutes majority of
gynecological consultations and responsible for all two – third hysterectomies.
The investigations in them should be targeted to exclude serious pathology such
as endometrial cancer and its precursor lesion endometrial hyperplasia.
Trans vaginal sonography (TVS), which is a simple,
non-invasive technique for endometrial evaluation plays a major role in this
regard. Use of high resolution transvaginal probes and colour Doppler further
enhanced the ability to study the endometrium beyond its thickness. Findings
such as focal thickening, heterogenecity in the endometrium, irregular
endometrial thickening, polypoidal mass lesion, intrauterine fluid collection
and disruption of sub endometrial halo prompt further evaluation to rule out
serious pathology even if the endometrial thickness is normal.
In postmenopausal lady the cut-off for endometrial thickness
for further evaluation is almost defined. However, there is a lack of clear
cut-off criteria for abnormal endometrial thickness for peri-menopausal women.
The present study tries to correlate the endometrial thickness in TVS
evaluation with the histolpathological abnormality in the peri menopausal and
post-menopausal women.
Present study by Mishra et al. was conducted with the
following objectives: 1. To assess the endometrial thickness by trans vaginal
ultrasonography. 2. To see correlation of histopathology with endometrial
thickness in abnormal uterine bleeding (AUB) in perimenopausal and
post-menopausal women. 3. The current study also throws some light about
various causes of AUB as per PALM-COIEN prevalent in our locality. 4. To find
the cutoff for endometrial thickness that delineates the abnormal from normal
histology.
This was an observational study conducted on 242
peri-menopausal and postmenopausal women ≥40 years of age presenting with
abnormal uterine bleeding (AUB). Based on the ROC curve, the cutoff point that
delineates the abnormal histology and normal histology for endometrial
thickness was 14.20 mm. Area under the curve (AUC) was 0.783 with 95% CI as
0.686 – 0.880 having sensitivity 71% and specificity 90% (p < 0.001)
In the present study peri menopausal AUB may present to
gynecological outpatient department with varied complaints. Out of them heavy
menstrual bleed and frequent cycle were found to be commonly associated with
gynaecological pathology in these age groups. In all peri menopausal AUB Trans
vaginal sonography for endometrial thickness is the initial best modality of
investigation. Combining colour Doppler is complementary and it enhances
further diagnostic accuracy of endometrial evaluation. Endometrial biopsy for
histopathological examination should be offered to all perimenopausal AUB with
cut off value equal to or more than 13mm. However, with positive doppler
findings, focal abnormality, coexisting risk factors such as obesity, diabetes,
age greater than or equal to 45 years or presence of post-menopausal bleeding,
endometrial biopsy should be considered irrespective of the thickness as there
is increased chance of having significant endometrial pathology.
Source: Mishra et al. / Indian Journal of Obstetrics and
Gynecology Research 2024;11(2):185–190
https://doi.org/10.18231/j.ijogr.2024.038
