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Non-assessable endometrium in women with post-menopausal bleeding: to investigate or ignore.

Abstract：

BACKGROUND:In women presenting with post-menopausal bleeding (PMB), the incidence of endometrial cancer is 1-10 %; Trans-vaginal scan (TVS) is offered as the first line of investigation to triage women further and a thick endometrium (>4 mm) merits endometrial tissue sampling for further evaluation. When it is difficult and not possible to assess the endometrium sonographically, decision to investigate further lies with the clinician. AIM:Study outcomes for women with PMB and endometrium not assessable on TVS. METHODS:We collected data retrospectively between September 2007 and December 2010. We identified our study group from the radiology database. Data collected include ultrasound findings, methods of endometrial sampling, and the result of cytology/histology. RESULTS:In our study period of 40 months, 671 women with post-menopausal bleeding were referred to the ultrasound department for TVS to assess endometrial thickness. 92 % (614/671) women had the assessment. In 57 women (8 %), endometrial thickness was not assessable and this formed our study group. 3/57 records were not retrievable and excluded from our study. 43/54 (79 %) had some form of endometrial sampling done. Among the 81 % adequate samples (35/43), 7 (20 %) had endometrial cancer; 1 (3 %) had CAH, 1 (3 %) was diagnosed with cervical cancer. In women who had thickened endometrium (>4 mm; n = 448), there were 29 cases of endometrial cancers detected giving an incidence of 6.4 %. In women with PMB and non-assessable endometrial thickness, there is increased incidence of endometrial cancer when compared to the group where endometrial thickness could be measured. (Odds ratio = 3.3 [95 % CI = 1.2-9]). This is a statistically (p = 0.017) and clinically significant finding. CONCLUSION:In women with PMB, there will be a subgroup in which ultrasound cannot assess endometrial thickness. When compared to women where endometrial thickness is measurable, this group stands a higher risk of endometrial cancer and hysteroscopy/ hysterosonography with endometrial sampling is recommended in this group.

journal_name

Arch Gynecol Obstet

journal_title

Archives of gynecology and obstetrics

authors

Ragupathy K,Cawley N,Ridout A,Iqbal P,Alloub M

doi

10.1007/s00404-013-2746-7

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

375-8

issue

eissn

0932-0067

issn

1432-0711

journal_volume

288

pub_type

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Non-assessable endometrium in women with post-menopausal bleeding: to investigate or ignore.