Endometrial thickness - Is there an optimum cut-off value in postmenopausal women with bleeding?
Milly Boulas, University of Derby
Background:
Endometrial cancer (EC) is the 4th most common gynaecological cancer in the UK. More than 90% of patients with EC present with vaginal bleeding. Transvaginal ultrasound examination, which allows close range magnification and high resolution imaging, is routinely performed as part of a pelvic ultrasound assessment and is the first approach in evaluating a postmenopausal woman (PMW) with an initial episode of bleeding. There have been debates in the literatures on the optimal endometrial threshold separating normal form abnormally thickened endometrium, ranging from 3-5mm. The objective of this literature review was to explore an optimal endometrial thickness cut-off value in non- medicated patients with postmenopausal bleeding for the detection of EC.
Method:
A literature search of published articles using the University of Derby digital databases was performed to identify articles reporting on EC and endometrial thickness measurements in women with postmenopausal bleeding. Two retrospective studies and a prospective case-control study were reviewed with consideration given to their sample sizes, methodology and the use of statistical analysis.
Results:
Endometrial thickness was significantly higher in women with EC than without in all three studies. The study with the largest sample size recommends a cut-off value of 5mm in symptomatic women with postmenopausal bleeding with a sensitivity of 80.5% and a specificity of 85%. A threshold of 3mm provides a high sensitive for the diagnosis of EC. However such a low cut-off value could raise false positive results and can also increase anxiety levels in patients.