Asymptomatic Postmenopausal Endometrial Thickening: A Comparison between Transvaginal Ultrasound and Hysteroscopy
Journal of Minimally Invasive Gynecology(2021)
摘要
Study Objective Compare the ultrasonography and the hysteroscopy findings in asymptomatic postmenopausal patients showing endometrial thickening. Design Observational study (Canadian Task Force Classification II-2). Setting San Salvatore Hospital of L'Aquila, Department of Obstetrics and Gynecology. Patients or Participants 315 asymptomatic postmenopausal women with endometrial thickening >4 mm. Interventions Diagnostic hysteroscopy, endometrial biopsy. Measurements and Main Results That patients had normal endometrium (8.6%), atrophic endometrium (26.7%), single benign polyp (47.6%), multiple polyps (8.6%), myoma (1.9%), focal hyperplasia (3.8%), diffuse hyperplasia (0.9%) and endometrial carcinoma (1.9%). In 30 women under therapy for breast cancer (thickening >5 mm) the hysteroscopic exam showed normal endometrium (50%), multiple polyps (20%), focal hyperplasia (20%) and diffuse hyperplasia (10%). For this subcategory of patients, the histopathological analysis confirmed the hysteroscopic diagnosis in 100% of case. It is not statistically valid to give to the homogeneity data of the endometrial thickening a direct association with the suspicion of polyp, as well as the ascription of a direct association with all the other suspicions except polyp to a non-homogeneous thickening cannot be considered statistically valid. The ROC analysis shows that the best cut-off for suspected polyp in ultrasonography is ≤6 mm (sensibility of just 66.0%, specificity of just 58.18%). By the ROC analysis, an 8 mm cut-off of ultrasound thickness was identified, above which the suspicion of endometrial carcinoma is strongly solid (specificity of 84.47% and a sensibility of 100%). Conclusion Hysteroscopy has a positive predictive value (PPV) of 100%and a negative predictive value (NPV) of 97.952% in detecting a risk of malignancy, with a specificity of 100% and a sensibility of 77.78%, demonstrating that hysteroscopy is the gold standard for the diagnosis of malignant endometrial pathology or an endometrial condition at severe risk of malignancy. A direct endoscopic exam is the only valid exam in the diagnosis of the intracavitary pathologies, especially in asymptomatic postmenopausal patients.
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关键词
asymptomatic postmenopausal endometrial thickening,transvaginal ultrasound
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