Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women

Carlo Saccardi,Michela Palumbo,Luciana Serena De Lorenzo,Amerigo Vitagliano,Marco Noventa,Sofia Tosatto,Salvatore Giovanni Vitale,Alice Lo Turco,Matteo Marchetti,Marco Scioscia

doi:10.3390/diagnostics10050257

Carlo Saccardi, Michela Palumbo + Show 8 more

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https://doi.org/10.3390/diagnostics10050257

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Abstract

We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according to the indication of diagnostic hysteroscopy: ET_Group (asymptomatic patients with endometrial thickness ≥ 4 mm) and AUB_Group (patients with a history of abnormal uterine bleeding). We further divided the AUB_Group into two subgroups based on endometrial thickness (AUB_Subgroup1: ET < 4 mm; AUB_Subgroup2: ET ≥ 4 mm). The primary outcome was the risk of endometrial cancer and atypical hyperplasia according to the indications of diagnostic hysteroscopy (AUB, ET ≥ 4 mm or both). The secondary outcome was to determine the best cut-off value of endometrial thickness to predict endometrial cancer in asymptomatic postmenopausal women. The prevalence of endometrial cancer and atypical hyperplasia in AUB_Group and ET_Group was 21% and 6.7% respectively. As well as for EC alone, higher prevalence of both conditions was observed in AUB_Subgroup2 (29.3%) in comparison to AUB_Subgroup1 (10.6%; p < 0.001). In asymptomatic patients the cut-off of endometrial thickness that showed the best sensitivity and specificity to diagnose endometrial cancer (100% and 80% respectively) was 11 mm (AUC of 91.4%; Expβ: 1067; CI 95%). In conclusion, considering the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory in cases of abnormal uterine bleeding in postmenopausal patients. Moreover, we want to emphasize the need for further evidence stating the clinical relevance of endometrial thickness value in asymptomatic patients and the impact of individual risk factors on endometrial cancer development.

Highlights

Endometrial cancer (EC) represents the most common and the second most lethal gynecological cancer in developed countries, with a lifetime risk of occurrence estimated at 2.5% [1,2].Diagnostics 2020, 10, 257; doi:10.3390/diagnostics10050257 www.mdpi.com/journal/diagnosticsendometrial cancer (EC) mainly occurs in postmenopausal age, especially in the sixth and seventh decades of life.In about the 95% of cases the diagnosis is preceded by at least one episode of abnormal uterine bleeding (AUB), while the remaining patients are asymptomatic at the time of diagnosis [1,2,3].The gold standard for diagnosis of EC is represented by endometrial biopsy (EB) with histopathological examination, preferably preceded by diagnostic hysteroscopy (HSC)
We considered eligible all patients with a history of natural menopause, defined as the spontaneous cessation of menses for at least twelve consecutive months after the age of forty years that could not be explained by medication or disease, in possession of a transvaginal ultrasound (TVUS) report with an endometrial thickness (ET) measurement dated no more than three months before the diagnostic hysteroscopy
Between June 2017 and June 2019, 903 postmenopausal patients referred to the Obstetrics included in the study

Summary

Introduction

Endometrial cancer (EC) represents the most common and the second most lethal gynecological cancer in developed countries, with a lifetime risk of occurrence estimated at 2.5% [1,2].Diagnostics 2020, 10, 257; doi:10.3390/diagnostics10050257 www.mdpi.com/journal/diagnosticsEC mainly occurs in postmenopausal age, especially in the sixth and seventh decades of life.In about the 95% of cases the diagnosis is preceded by at least one episode of abnormal uterine bleeding (AUB), while the remaining patients are asymptomatic at the time of diagnosis [1,2,3].The gold standard for diagnosis of EC is represented by endometrial biopsy (EB) with histopathological examination, preferably preceded by diagnostic hysteroscopy (HSC). Endometrial cancer (EC) represents the most common and the second most lethal gynecological cancer in developed countries, with a lifetime risk of occurrence estimated at 2.5% [1,2]. In about the 95% of cases the diagnosis is preceded by at least one episode of abnormal uterine bleeding (AUB), while the remaining patients are asymptomatic at the time of diagnosis [1,2,3]. The gold standard for diagnosis of EC is represented by endometrial biopsy (EB) with histopathological examination, preferably preceded by diagnostic hysteroscopy (HSC). Due to its invasiveness, associated pain, risk of complications (0.3%, according to ACOG Committee opinion of March 2020, but considerable) and higher costs compared to ultrasound, HSC plus EB is not currently considered an effective strategy for EC screening in the general population [4].

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