Retrospective Evaluation of Endometrial Thickness Measurement with Transvaginal Ultrasonography in Patients with Postmenopausal Hemorrhage and the Relationship to the Results of Histopathology

Abstract

Objective: Postmenopausal bleeding can be a sign of endometrial carcinoma and other endometrial pathologies. Patients underwent transvaginal ultrasonography (TvUSG) for comparison of riskfactors of endometrial pathology with results of probe curettage.Methods: In the present study, TvUSG was performed on 400 patients with postmenopausal bleeding and compared with results of probe curettage. The study was conducted retrospectively onpatients who were admitted to the İstanbul Okmeydanı Training and Research Hospital clinic between January 2014 and November 2016. Endometrial thickness and biopsy results were compared among patients with an endometrial thickness of >4 mm. Correlation between endometrialthickness and menopausal age; body mass index; diabetes mellitus; hypertension; smoking; age;parity; number of postmenopausal bleeding episodes; reproductive period; family history of colon,endometrial, and ovarian cancer; use of hormone replacement therapy, tamoxifen, oral contraceptive, and intrauterine device (IUD); gravidity; and age at menarche was evaluated statistically.400patients divided into2 groups according to patholohy results. Group1: Proliferative endometrium,secretory endometrium, endometrial polyp, simple atypical endometrium, endometritis, atrophicendometrium. Group2: Complex atypical hyperplasia, adenocarcinoma Ethical committee approval is taken from Okmeydanı Training and Research Hospital.Results: The distribution of the 400 women according to histological diagnosis was as follows: proliferative endometrium, 110 (27.5%); atrophic endometrium, 155 (38.8%); endometrial polyp, 65(16.3%); adenocarcinoma, 40 (%10), simple atypical hyperplasia 15 (3.8%), complex atypical endometrial hyperplasia, 5 (1.3%); endometritis, 5 (1.3%); and secretory endometrium, 5 (1.3%). Histopathology distribution according to endometrial thickness was as follows: atrophic endometrium, 6.44±2.23;secretory endometrium, 8±0; proliferative endometrium, 8.9±3.7; endometrial polyp, 12±5.16;endometrial hyperplasia, 5.9±1.6; atypical endometrial hyperplasia, 20± 0; and adenocarcinoma,12.75±4.43. During the reproductive period, endometrium thickness and endometrium cancer in thefamily history in Group 2 and parity; time to first bleeding; smoking; and use of tamoxifen, oral contraceptive, and IUD in Group 1 were statistically significant. The other risk factors were not significant.Conclusion: Endometrial thickness measurement with TvUSG provides prior knowledge of postmenopausal bleeding. Endometrial curettage is the gold standard treatment.