Ghoubara Ahmed, Emovon Emmanuel, Sundar Sudha, Ewies Ayman
a Institute of Cancer and Genomic Sciences, University of Birmingham , Birmingham , UK.
b Obstetrics and Gynaecology Department , Aswan University , Aswan , Egypt.
J Obstet Gynaecol. 2018 Nov;38(8):1146-1149. doi: 10.1080/01443615.2018.1458081. Epub 2018 Jun 3.
There is a lack of consensus about the significance and the management of an incidental finding of endometrial thickness (ET) > 4 mm on transvaginal ultrasound scans in postmenopausal women without postmenopausal bleeding (PMB). The data of 1995 consecutive women attending PMB clinic were collected prospectively; of them 81 (4.1%) were referred because of ET >4 mm without PMB. The prevalence of endometrial atypical hyperplasia and cancer was 4/81 (4.9%), and polyp was 20/81 (24.7%). On using a receiver operator characteristic curve, the diagnosis of endometrial atypical hyperplasia and cancer using the ET threshold of ≥10 mm had a sensitivity of 100% (95% CI = 40-100%), a specificity of 60% (95% CI = 48-71%) with AUC = 0.8 (95% CI = 0.66-0.93), p = .04. For the 35 women with an ET ≥10 mm, the prevalence of endometrial atypical hyperplasia and cancer was 4/35 (11.4%) and benign endometrial polyps was 16/35 (45.7%). The use of ≥10 mm ET threshold to prompt investigations did not miss any case of endometrial atypical hyperplasia or cancer. Impact Statement What is already known on this subject? Unlike women with PMB in whom an endometrial thickness (ET) ≤ 4 mm is considered as low risk for endometrial hyperplasia and cancer, in postmenopausal women without PMB, the threshold that separates normal from a pathologically thickened endometrium has not been standardised. A decision-analysis study in a hypothetical cohort found that ET threshold of 11 mm yields a similar separation as ≤4 mm in those with PMB. What the results of this study add? The study uses prospectively collected data from consecutive patients using a standardised format, thus minimising bias from incomplete data. This study is the third prospective series in the literature to address the dilemma of the management of asymptomatic postmenopausal women with an incidental finding of a thickened endometrium. It showed that the prevalence of endometrial atypical hyperplasia and cancer is high enough to justify investigation and for the clinical problem not to be trivialised. All cases of endometrial atypical hyperplasia and cancer had ET of ≥10 mm. What are the implications of these findings for clinical practice and/or future research? Our data strengthen the current body of literature to help the development of clinical practice guidelines about the management work-up. However, a well-designed multi-centre large prospective study is required to confirm the findings since most studies in the literature are either retrospective or small.
对于绝经后无绝经后出血（PMB）的女性，经阴道超声检查偶然发现子宫内膜厚度（ET）>4mm的意义及管理，目前尚无共识。前瞻性收集了1995例连续到PMB门诊就诊女性的数据；其中81例（4.1%）因ET>4mm且无PMB而被转诊。子宫内膜非典型增生和癌症的患病率为4/81（4.9%），息肉为20/81（24.7%）。使用受试者工作特征曲线，采用ET阈值≥10mm诊断子宫内膜非典型增生和癌症，敏感性为100%（95%CI=40-100%），特异性为60%（95%CI=48-71%），曲线下面积（AUC）为0.8（95%CI=0.66-0.93），p=0.04。对于35例ET≥10mm的女性，子宫内膜非典型增生和癌症的患病率为4/35（11.4%），良性子宫内膜息肉为16/35（45.7%）。采用≥10mm的ET阈值来促使进行检查，没有漏诊任何子宫内膜非典型增生或癌症病例。影响声明关于该主题已知的信息有哪些？与有PMB的女性不同，对于她们来说子宫内膜厚度（ET）≤4mm被认为是子宫内膜增生和癌症的低风险，而在无PMB的绝经后女性中，区分正常子宫内膜与病理性增厚子宫内膜的阈值尚未标准化。一项针对假设队列的决策分析研究发现，ET阈值为11mm与有PMB女性中≤4mm的阈值产生的区分效果相似。本研究的结果增加了什么？该研究使用标准化格式前瞻性收集连续患者的数据，从而将不完整数据导致的偏倚降至最低。本研究是文献中第三个前瞻性系列研究，旨在解决偶然发现子宫内膜增厚的无症状绝经后女性的管理困境。研究表明，子宫内膜非典型增生和癌症的患病率高到足以证明进行检查的合理性，且该临床问题不应被轻视。所有子宫内膜非典型增生和癌症病例的ET均≥10mm。这些发现对临床实践和/或未来研究有何影响？我们的数据强化了现有文献，有助于制定关于管理检查的临床实践指南。然而，由于文献中的大多数研究要么是回顾性的，要么规模较小，因此需要一项设计良好的多中心大型前瞻性研究来证实这些发现。
