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
