Evaluation of endometrial thickness by transvaginal ultrasound and baseline risk factors as a predictor for endometrial abnormalities in postmenopausal women
Yerrisani, Jyothirmayi, Kothari, Anoushka, Collins, Kelly, Ballard, Emma, and Kothari, Alka (2022) Evaluation of endometrial thickness by transvaginal ultrasound and baseline risk factors as a predictor for endometrial abnormalities in postmenopausal women. Australasian Journal of Ultrasound in Medicine, 25 (4). pp. 157-210.
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Abstract
Introduction/Purpose: To evaluate the endometrial thickness (ET) as a predictor of endometrial abnormalities in postmenopausal women and whether consideration of baseline risk factors increases diagnostic accuracy.
Methods: This is a retrospective observational study of postmenopausal women presenting with bleeding or thickened endometrium (≥4 mm) on ultrasound, between 2003 and 2012. Risk factors for endometrial abnormality were analysed using logistic regression. Of 301 women, 220 were symptomatic and 81 were asymptomatic. The median ET was 6 mm (IQR 4–9) for symptomatic women and 9 mm (IQR 6–12) for asymptomatic women.
Results: Abnormal pathology was found in 35 symptomatic (15.9%) and 6 asymptomatic women (7.4%). For each 1 mm increase in ET, the odds of an abnormal diagnosis increased by 16.3% (95% CI 9.6–23.5) for symptomatic and 19.9% (95% CI 3.1–39.3) for asymptomatic women. The Youden's index method identified an ET threshold of ≥7.1mm for symptomatic and ≥14.5mm for asymptomatic women. In symptomatic women the sensitivity was 88.6% (95% CI 72.3–96.3) and specificity 69.2% (95% CI 61.9–75.6), while in asymptomatic women the sensitivity was 50.0% (95% CI 13.9–86.1) and specificity was 89.3% (95% CI 79.5–95.0). The addition of age in the symptomatic women model reduced the sensitivity (82.9% (95% CI 65.7–92.8)) but increased the specificity (72.4% (95% CI 65.3–78.6)).
Conclusion: ET is a significant predictor of abnormality. In the absence of risk factors, our study suggests that invasive procedures may be withheld until the ET is ≥7.1 mm with bleeding and ≥14.5 mm in asymptomatic women with no bleeding.
| Item ID: | 76585 |
|---|---|
| Item Type: | Article (Research - C1) |
| ISSN: | 2205-0140 |
| Keywords: | carcinoma, endometrium, hormone replacement therapy, post-menopausal, risk factors, transvaginal ultrasound |
| Copyright Information: | © 2022 The Authors. Australasian Journal of Ultrasound in Medicine published by John Wiley & Sons Australia, Ltd on behalf of Australasian Society for Ultrasound in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Date Deposited: | 27 Apr 2023 01:20 |
| FoR Codes: | 32 BIOMEDICAL AND CLINICAL SCIENCES > 3215 Reproductive medicine > 321502 Obstetrics and gynaecology @ 70% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320222 Radiology and organ imaging @ 30% |
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