[Early diagnosis of endometrial carcinoma and its precursors in asymptomatic postmenopausal women. Proposal of a diagnostic protocol].

BACKGROUND

Endometrial carcinoma is presently the most frequent malignant tumor of the female genital tract. In most cases it concerns menopausal women mostly affected by chronic hyperestrogenism not balanced by progesterone. Among the useful techniques for early diagnosis in asymptomatic postmenopausal patients, only echography and hysteroscopy have obtained high reliability levels. Particularly the echographic evaluation of the endometrial thickness is the technique on which the screening of asymptomatic patients should concentrate. Nonetheless its employment on so many people would involve too expensive a social cost.

METHODS

In the attempt to identify a limited group of patients to undergo the echographic test, the authors have determined, in a group of 330 asymptomatic postmenopausal women, the maturation degree of squamous cells in PAP-Smear executed for the prevention of the cervical carcinoma, in order to select subjects through a suitable estrogenic stimulation. In cases of high maturation degree (16%) and in a compared group of examinations, a progestin test (MAP-Test) has been carried out to verify the presence of possible pathological endometrial proliferation. They have thus identified a small group of asymptomatic women (6%) to undergo transvaginal echography. In this way 1.8% of the examined patients have undergone hysteroscopy with guided biopsy because of a high risk of carcinoma.

RESULTS

The prevalence of endometrial carcinoma so detected was 3/1000.

CONCLUSIONS

The authors, intend to continue their experience, end by hoping that protocol adopted by them, should become part of a global prevention program for gynecological oncology.