Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology?

Figures & data

Table 1. Characteristics of postmenopausal women with AET finding >5 mm without postmenopausal bleeding (n = 267).

Age in years, mean (±SD)	63.93 ± 8.89 years
Years of menopause	<2 years: 13 (4.9%)
	2–5 years: 33 (12.5%)
	5–10 years: 42 (16%)
	>10 years: 175 (66.5%)
Parity	Nuliparous: 22 (8.6%)
	1 delivery: 35 (13.7%)
	≥ 2 deliveries: 198 (77.6%)
BMI	<20: 3 (1.3%)
	20–24.9: 37 (15.5%)
	25–29.9: 79 (33.2%)
	30–34.9: 72 (30.3%)
	35–39.9: 35 (14.7%)
	>40: 12 (5%)
BMI (overweight cut-off)	BMI < 25: 40 (16.8)
	BMI > 25: 198 (83.2%)
BMI (obesity cut-off)	BMI < 30: 119 (50%)
	BMI > 30: 119 (50%)
Risk factors	198 (74.4%)
Hypertension	176 (66.2%)
Diabetets	55 (20.7%)
Breast cancer	33 (12.4%)
Lynch syndrome	2 (0.8%)
Anti-hypertensive drugs	162 (60.9%)
Oral anti-diabetics	50 (18.8%)
Tamoxifeno	21 (7.9%)
Endometrial thickening	5–10 mm: 103 (38.7%)
	11–15 mm: 70 (26.3%)
	>15 mm: 93 (35%)
Endometrial thickness according to cut-off point 10 mm	<10 mm: 103 (38.7%)
	>10 mm: 163 (61.3%)
Ultrosound findings	Endometrial thickening: 136 (50.9%)
	Polyp: 117 (43.8%)
	Other: heterogeneous endometrium. increased vascularisation. endocavitary fluid: 14 (5.2%)
Hysteroscopic findings	Normal/ atrophy: 31 (11.6%)
	Polyps: 219 (81.9%)
	Hyperplasia without atypia: 4 (1.5%)
	Myoma: 9 (3.4%)
	Hyperplasia with atypia: 2 (0.7%)
	Neoplasia: 1 (0.4%)
	Endometritis: 1 (0.4%)
Pathological anatomy	Benign: 257 (96.3%)
	Malignant: 10 (3.7%)

Table 2. Characteristics of asymptomatic postmenopausal women with anatomical pathology finding of malignancy (n = 10).

Variable
Age in years, mean (±SD)	71.7 ± 9,154 years
Years of menopause	5–10 years: 1 (10%)
	>10 years: 9 (90%)
Parity	≥ 2 deliveries: 10 (100%)
BMI	20–24, 9: 1 (10%)
	25–29, 9: 6 (60%)
	30–34, 9: 2 (20%)
	35–39, 9: 1 (10%)
BMI (overweight cut-off)	BMI < 25: 1 (10%)
	BMI > 25: 9 (90%)
Risk factors	7 (70%)
Hypertension	6 (60%)
Diabetes	2 (20%)
Breast cancer	2 (20%)
Lynch syndrom	0
Anti-hypertensive drugs	6 (60%)
Oral anti-diabetics	2 (20%)
Tamoxifeno	1 (10%)
Endometrial thickening	5–10 mm: 0
	11–15 mm: 6 (60%)
	>15 mm: 4 (40%)
Endometrial thickness according to cut-off point 10 mm	<10 mm: 0
	>10 mm: 10 (100%)
Ultrasound findings	Endometrial thickening: 136 (50.9%)
	Polyp: 117 (43.8%)
	Other (heterogeneous endometrium, increased vascularity, fluid): 14 (5.2%)
Hysteroscopic findings	Normal/ atrophy: 0
	Polyp: 7 (70%)
	Hyperplasia without atypia: 0
	Myoma: 0
	Hyperplasia with atypia: 2 (20%)
	Neoplasia: 1 (10%)
	Endometritis: 0

Figure 1. Endometrial thickness receiver operator characteristic (ROC) curve for endometrial atypical hyperplasia and cancer. Area under the curve (AUC) for the endometrial thickness cut-off 10 mm is 0.7, 95% confidence interval (CI) = 0.56–0.83, p = 0.03, sensitivity= 90% (95% CI = 57–100%), specificity = 40% (95% CI = 33–45%).

Table 3. Results of the study using an endometrial thickness of 10 mm as a cut-off point in asymptomatic postmenopausal women. Comparing benign and malignant pathology in the sample.

Variable	AET > 10 mm n (%)	AET < 10 mm n (%)	p-value	Total
Benign pathology	153 (59.8%)	103 (40.2 %)		256
Malignant pathology	10 (100%)	0	0.008*	10

*The p-value was obtained using Fisher’s test. It is considered significant when it is <0.05.

AET: Endometrial thickening.