Abstract
PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.
Highlights
With the routine use of ultrasound for the investigation of abnormal uterine bleeding or postmenopausal bleeding over the last 20 years, the diagnoses of endometrial thickening and endometrial polyps have become more frequent
180 hysteroscopies in which the histologic diagnosis of endometrial polyps was not confirmed, or the procedure was interrupted by complications or incomplete data in medical charts were excluded
The sensitivity, specificity, positive predictive value and negative predictive value were calculated for each value of sonographic endometrial thickness between 2 and 20 mm, resulting in a diagnostic accuracy of 68.6%
Summary
With the routine use of ultrasound for the investigation of abnormal uterine bleeding or postmenopausal bleeding over the last 20 years, the diagnoses of endometrial thickening and endometrial polyps have become more frequent. The prevalence of endometrial polyps ranges from 10 to 40% in women with abnormal uterine bleeding[1,2,3,4,5]. In postmenopausal women with risk factors associated with endometrial cancer, such as advanced age, obesity, hypertension, diabetes, tamoxifen use, or vaginal bleeding, hysteroscopic polypectomy has been adopted as a routine treatment. The value of sonographic endometrial thickness, which allows us to predict malignant focal endometrial lesions with a higher level of diagnostic accuracy, remains controversial. Postmenopausal patients with an endometrial thickness ≥5 mm are referred for endometrial biopsy performed via uterine curettage or surgical hysteroscopy, when they exhibit associated vaginal bleeding. A search in the literature found no other studies that have assessed the value of ultrasound for the prediction of malignancy in focal endometrial lesions
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