Cut-off Value Of Endometrial Thickness Research Articles

When is it necessary to perform biopsy in asymptomatic postmenopausal women with incidental finding of thickened endometrium?

ObjectiveTo determine the cutoff value for endometrial thickness (ET) that prompts a biopsy in asymptomatic postmenopausal women with an incidental finding of thickened endometrium, and to develop a risk prediction model. MethodsThis is a retrospective cohort analysis of the clinical records of the Hysteroscopic Center of Fu Xing Hospital, Capital Medical University, Beijing, China. We collected asymptomatic postmenopausal women who presented with an ET of ≥4 mm (double-layer) as an incidental finding. We stratified the participants into non-malignant and malignant groups based on pathology results and assessed differences between the two groups. A receiver operating characteristic curve (ROC) was used to identify the cutoff value of ET for predicting endometrial malignancy. Logistic regression models were also constructed to predict the risk of malignancy. ResultsA total of 581 consecutive eligible cases were included. The optimal cutoff value for ET was 8 mm, with a maximum area under the curve (AUC) of 0.755 (95 % CI: 0.645–0.865). In addition to ET, the regression model incorporated diabetes, blood flow signal, BMI, and hypertension to predict the risk of malignancy. A ROC curve constructed for the model yielded an AUC of 0.834 (95 % CI: 0.744–0.924). ConclusionIt is reasonable to offer hysteroscopy and visually-directed endometrial biopsy for asymptomatic postmenopausal women when ET is 8 mm or above. For those with an ET between 4 and 8 mm, further decision to perform biopsy should be determined on an individual basis, considering risk factors and blood flow signals of the endometrium.

Reliability Of Transvaginal Ultrasound Measured Endometrial Thickness In Diagnosis Of Endometrial Cancer In Postmenopausal Women

Abstract Objective: Dilatation and curettage have been replaced by ultrasound measurement of uterine endometrial thickness (ET) especially by Transvaginal ultrasound (TVS) as a first step in the workup of women with postmenopausal bleeding for many years. Still, there is no unanimity for endometrial thickness cut-off value to define abnormality. We used an endometrial thickness of 4mm as a cut-off value in this study. Methods: This cross-sectional validation study included 120 patients who presented with postmenopausal bleeding in OPD of POF hospital from 01-12-2017 to 1-06-2018.TVS measured endometrial thickness ≥4mm was assumed positive for malignancy and ˂ 4 mm was taken negative for malignancy. The TVS findings of patients were compared with the histopathology report of endometrial sampling, which was performed in OPD by manual vacuum aspirator (MVA). Histopathology report was taken as a reference standard to confirm or refute the diagnosis of transvaginal ultrasound. Results: On TVS, 54 patients had ≥ 4mm endometrial thickness (taken positive for malignancy) while 66 patients had <4 mm endometrial thickness (taken negative for malignancy). Histopathology of the endometrium (reference standard) revealed that 47 (39.17%) patients had malignancy and 73(60.83%) patients did not have malignancy. The reliability of transvaginal ultrasound (TVS) using 4mm cut-off point ET in detecting endometrial malignancy in patients presenting with uterine bleeding after menopause, keeping histopathological findings as a reference standard showed 89.36% sensitivity, 83.56%, specificity, 92.42% negative predictive value and 77.78% positive predictive value & 85.83% accuracy rate. Conclusion: We concluded that there was a low probability of endometrial malignancy in women with ˂ 4 mm transvaginal ultrasound (TVS)measured endometrial thickness (ET).TVS may replace invasive endometrial sampling in cases of postmenopausal bleeding with ˂ 4mm ET.

Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes. This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and β-hCG. The cut-off value of β-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + β-hCG + endometrial thickness were used together. The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate.

Endometrial Thickness Measurement as Predictor of Endometrial Hyperplasia and Cancer in Perimenopausal Uterine Bleeding: Cross-Sectional Study.

Endometrial thickness (ET) measurement was an alternative method for predicting abnormal endometrial pathology in postmenopausal bleeding. Cut-off value of ET measurement could not be use in perimenopausal bleeding. Aim of this study was to investigate appropriate ET cut-off value for perimenopause women with abnormal uterine bleeding (PEMB) and abnormal endometrial histopathology. This was a cross-sectional study. PEMB at Bhumibol Adulyadej Hospital between July 2018 and June 2022 were recruited. Subjects who met inclusion criteria underwent ET measurement and endometrial biopsy via endometrial aspirator. Participants who had histopathology report of endometrial hyperplasia and more were classified as the study group. The Control group were subjects with no endometrial hyperplasia or cancer. Demographic and clinical character data were included. Correlation of ET and endometrial histopathology were calculated for statistical significance. A total of 304 cases were included. After exclusion, 254 subjects were recruited for this study. There were 22 and 232 cases in the study and control groups, respectively. The mean age and body mass index (BMI) of participants were 44.7 years old and 27.5 kg/m2, respectively. Prevalence of endometrial hyperplasia and cancer in perimenopausal uterine bleeding were 7.5 (19/254) and 1.2 (3/254) percent, respectively. Endometrial thickness equal to and more than 8 mm was associated with abnormal endometrial histopathology with statistical significance. Age, BMI, nulliparity, anovulatory bleeding history, hypothyroidism, diabetes mellitus and anovulation state of both groups were comparable. Endometrial thickness equal or more than 8 mm were significantly associated with endometrial hyperplasia or more among perimenopausal women with abnormal uterine bleeding.

Two subtypes of surgery-categorized upper-lateral intracavitary pregnancy identified by MRI, a retrospective study

The pregnancy outcomes in women with surgery-categorized upper-lateral intracavitary pregnancy (ULIP), previously named angular pregnancy, demonstrate higher heterogeneity than in women with ultrasonography-categorized ULIP. We aimed to use preoperative MRI and correlated clinical characteristics to explore whether the surgery-categorized ULIP comprises obstetric conditions undefined by the current ultrasonography-based diagnostic criteria. This retrospective study involved 28 women with surgically and pathologically confirmed ULIP from January 2016 to July 2022. Two board-certified radiologists, blinded to the patients' information, independently reviewed the MRI images, and determined each MRI feature, including endometrial thickness (EMT) and peri-gestational sac (GS) endometrial interruption. Disagreements were resolved by discussion to achieve a consensus. Based on the cutoff value of EMT (11.5 mm), the patients were divided into above-cutoff EMT (n = 22) and below-cutoff EMT (n = 6) groups. Two subtypes of surgery-categorized ULIP were identified. Type-I ULIP (n = 22; EMT ≥ 11.5 mm), when compared to the type-II ULIP (n = 6; EMT < 11.5 mm), demonstrated lower incidence of peri-GS endometrial interruption (2/22 [9.1%] vs 6/6 [100%]; P = 0.001), higher logarithmic ß-human chorionic gonadotropin (ß-hCG) concentration (4.7 ± 0.4 mIU/ml vs 4.2 ± 0.6 mIU/ml; P = 0.026), lower rate of repeated dilatation and curettage (1/22 [4.6%] vs 4/6 [66.7%]; P = 0.003), less intraoperative blood loss (10.1 ± 6.3 ml vs 28.3 ± 18.3 ml; P = 0.001), and shorter hospital stay (2.8 ± 1.7 days vs 7.5 ± 3.8 days; P = 0.001). The peri-GS endometrial interruption negatively correlated with EMT (Odds ratio [OR] = 0.55; P = 0.001) and logarithmic ß-hCG concentration (OR = 0.08; P = 0.045). The below-cutoff EMT negatively correlated with ß-hCG concentration (OR = 0.06; P = 0.021). Surgery-categorized ULIP comprised two obstetric conditions among which the type-II ULIP, possessing unique imaging features undocumented in the literature, requires further attention during clinical practice.

Clinicopathological features of endometrial lesions in asymptomatic postmenopausal women with thickened endometrium.

To analyze the clinical and pathological features of asymptomatic postmenopausal women with an incidentally detected increase in endometrial thickness (ET) by transvaginal ultrasound examination and discuss the cutoff value of ET for the timely discovery of endometrial malignancy. This was a retrospective study of postmenopausal women with asymptomatic thickened endometrium (greater than or equal to 5 mm) screened by transvaginal ultrasound who were referred to the gynecology department at Xuanwu Hospital between January 2018 and March 2021. Data on participant demographics, clinical characteristics, and histopathology outcomes were collected. We stratified the participants into the benign group and malignant group according to pathology results and assessed differences between the two groups. A receiver operating characteristic curve was used to identify the cutoff value of ET for predicting endometrial malignancy in postmenopausal women with asymptomatic thickened endometrium. A total of 163 eligible cases were included in the analysis. The results showed that only ET was significantly different between the two groups. The median ET was significantly higher in the malignant group than in the benign group (1.20 vs 0.80, P = 0.023). The optimal cutoff value of ET was 10 mmwith the maximum AUC (0.881, 95% CI 0.810-0.952, P = 0.024), and the sensitivity and specificity for the diagnosis of endometrial malignancy were 100%and 80%, respectively. Among the 47 women with ET ≥ 10mm, the prevalence of endometrial malignancy was 6.3%, which was significantly higher than that among women with ET < 10mm ( P = 0.023). For postmenopausal women with asymptomatic endometrial thickening, the prevalence of endometrial malignancy is significantly higher when ET is ≥ 10 mm. If ET is ≥ 10mm, further histopathological testing should be recommended to exclude endometrial malignancy. Further large-sample and prospective studies are needed to determine the predictive value of ET.

Endometrial carcinoma in asymptomatic post-menopausal women with a thickened endometrium and its influencing factors - A cross-sectional study.

ABSTRACTBackground:A thickened endometrium upon trans-vaginal ultrasound in asymptomatic post-menopausal women always poses a clinical dilemma.Objectives:To investigate the frequency of endometrial malignancies by histopathological examination and identify the associated factors influencing the thickened endometrium in asymptomatic post-menopausal women.Methods:In trans-vaginal ultrasonography, we enrolled 72 asymptomatic post-menopausal women with a thickened endometrium (>5 mm). Dilatation and curettage were performed for all cases, and the specimen was sent for histopathological examination. According to the data distribution, all the continuous variables were stated as mean ± standard deviation/median (inter-quartile range), categorical variables were expressed in frequency, and percentage will be compared using the Chi-square test/Fisher exact test.Results:In our study, most of the women were multipara. The age of post-menopausal women ranged from 46 to 68 years, and the mean duration of menopause was 8.10. The most common histological findings were benign in 72.22% of the cases. We identified pre-malignant and malignant lesions of the endometrium in 18.05% and 9.72% of the cases, respectively. To predict the condition of the lesion, we noticed no definite cut-off value of endometrial thickness to indicate the state of the lesion. We observed that none of the patient’s characteristics showed a significant difference with a thickened endometrium.Conclusion:We observed an increased frequency of endometrial pathology irrespective of the presence or absence of risk factors. The result of this study is justified enough for the need of further evaluation of a thickened endometrium in asymptomatic post-menopausal women.

Thickened Endometrium: When to Intervene? A Clinical Conundrum.

The endometrium is a dynamic target organ in a woman's reproductive life. It undergoes cyclical change regulated by the fine balance between oestrogen and progesterone. The endometrial thickness (ET) varies according to the phases of the menstrual cycle. Endometrium contains both oestrogen and progesterone receptors, which respond to above hormones, irrespective of whether the woman is in reproductive or menopausal phase. Abundance of oestrogen leads to endometrial hyperplasia, and paucity causes endometrial atrophy. The initial best modality of assessing ET or aberration is high resolution transvaginal ultrasonogram. Thickened endometrium is always a clinical conundrum. Dilemma does remain as to the thickness of endometrium which requires intervention, mostly in symptomatic pre and perimenopausal women. In post-menopausal women with bleeding, the cut-off of ET that warrants investigation is almost defined. However, the cut-off value of ET in asymptomatic postmenopausal women; beyond which intervention is required, is still debated. Dilemma also exists about the cut-off of ET in both symptomatic and asymptomatic women on HRT and Tamoxifen. This article will discuss the above issues and reach at some consensus about the cut-off of ET after critical analysis of evidence and experience and will help clinicians in arriving at a proper decision in dealing with such clinically confounding situations.

Clinicopathological and ultrasound features of endometrial cancer in postmenopausal women: a retrospective study in a single institute in South Korea.

Introductionendometrial cancer is the most common type of cancer in the female genital tract. Most patients are diagnosed during postmenopausal periods. This study aimed to investigate the demographic characteristics as well as cutoff value of endometrial thickness and ultrasound characteristics of endometrial cancer in postmenopausal patients.Methodswe retrospectively analyzed 244 postmenopausal women who underwent endometrial sampling from February 2016 to December 2019. Information of patients was obtained through medical records. The patients were divided into two groups according to histopathological results. Group A included patients with endometrial cancer and group B included patients with non-malignant lesions. Data were summarized based on demographic and ultrasound characteristics.Resultshypertension and history of endometrial hyperplasia were associated with the incidence of endometrial cancer in this study. Endometrial cancer was diagnosed in all ranges when the endometrial thickness was ≥5 mm. Endometrial fluid collection, with increased endometrial thickness, was a risk factor associated with endometrial cancer.Conclusionregardless of symptoms and risk factors, endometrial histological confirmation in postmenopausal women should be conducted immediately if endometrial abnormalities such as an endometrial thickness ≥5 mm or endometrial fluid collection are detected by transvaginal ultrasound.

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

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.

Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women.

ObjectiveTo assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+).MethodsThis retrospective cohort study included 29,995 consecutive women who underwent transvaginal ultrasonography (TVS) for an incidental finding of a thickened endometrium at the health screening and promotion center at Asan Medical Center between 2006 and 2010. Among 959 patients with endometrial abnormalities, 92 patients were included in this study. A total of 867 patients were excluded: 416 were lost to follow-up; 263 did not undergo endometrial biopsy; 155 had endometrial polyps; 17 had submucosal myomas; and 16 had insufficient tissue samples. Endometrial histology was the reference standard for calculating accuracy.ResultsOf the 92 patients, 78 (84.8%) had normal pathology, while 14 (15.2%) had endometrial pathology (EH+), including 5 patients (35.7%) with simple hyperplasia without atypia, 3 (21.4%) with complex hyperplasia, and 6 (42.9%) with endometrial carcinoma, all stage Ia. The area under the receiver-operating characteristic curve was 0.75 (95% confidence interval [CI], 0.593–0.906). The cut-off value for ET was 8 mm, indicating that TVS ET had a fair accuracy in diagnosing carcinoma, had a sensitivity of 100% (95% CI, 62.9–100.0%) and a specificity of 24.3% (95% CI, 15.2–36.3%).ConclusionTVS is useful for detecting EH+, with a cut-off value for ET of 8 mm having a high sensitivity for detecting endometrial pathologies and the ability to identify women highly unlikely to have EH+, thereby avoiding more invasive endometrial biopsy.

Ultrasonic and Histopathological Evaluation to Exclude Premalignant and Malignant Lesions in Perimenopausal and Postmenopausal Women Presenting as Abnormal Uterine Bleeding.

Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause. The aim of this study was (1) to identify the different benign, premalignant and malignant conditions as the cause of abnormal uterine bleeding in perimenopausal and postmenopausal women and (2) to find out the different histopathological patterns of endometrium and cervix in these women. This is a prospective study done in gynaecological oncology in 100 cases attending the OPD. Pap smear and cervical biopsy were done following clinical examination and then, the patients were sent for abdominal and pelvic ultrasound examination. Endometrial biopsy was done if endometrial thickness was increased with respect to age. The cut-off value of endometrial thickness in perimenopausal women was 11mm, and for postmenopausal women, it was 4mm, respectively. All the tissue specimens were sent for histopathological examination. A total of 100 women were evaluated in which 50% were in the perimenopausal age group and 50% in the menopausal age group. Cervical pathology was present in 47% of cases, organic cause of uterine body like fibroid and adenomyosis was present in 26% of women, and thickened endometrium was seen in 24% of cases and endometrial polyp in 3 cases only. In this study, the incidence of benign cases was 49%, premalignant 9% and malignant condition42%, respectively. Out of 42 malignant cases, 37 (88.09%) were cervical cancer, 3 (7.14%) endometrial carcinoma, 1 (2.38%) vulval cancer and 1 sarcoma of uterus. With regard to histology of endometrium, 34.48% had simple hyperplasia without atypia, 20.68% hyperplasia with atypia and secretory endometrium, and 10.34% endometrial carcinoma. Histologically, 94.59% of cervical cancer was squamous cell carcinoma and 5.40% was adenocarcinoma. Evaluation of cases of perimenopausal and postmenopausal bleeding differentiated premalignant and malignant lesions of the uterine body, endometrium and cervix. As our centre is a Regional Cancer Centre of Bihar, incidence of malignant lesions is higher in our centre.

Hiperplasia endometrial y criterios ecográficos: reporte de caso y revisión de la literatura

The aim of this article is to review the sonographic criteria of endometrial hyperplasia and define the cutoff value to indicate the completion of the endometrial biopsy due to its relationship with the risk of endometrial carcinoma. We report the case of a woman aged 47 with four years of vaginal bleeding characterized by menorrhagia, metrorrhagia, and hypermenorrhea being treated with oral contraceptives without improvement, and transvaginal ultrasound diagnosis of endometrial hyperplasia. For the diagnosis of endometrial pathology in postmenopausal women with vaginal bleeding, the authors recommend a cutoff value of endometrial thickness by transvaginal ultrasound of 4-5 mm with sensitivity of 98% and negative predictive value of 99% since higher values are closely related to endometrial carcinoma.

P14.08: Focal endometrial pathology, ultrasound, hysteroscopy and histology: what is the correlation between them?

To evaluate the accuracy of gynecological ultrasound for focal endometrial pathology, using data of ultrasound, hysteroscopy and histology. We defined focal pathology on ultrasound as the presence of polyp, myoma or unspecified focal pathology. We studied all women with suspicion of focal endometrial pathology in gynecological ultrasound between January 2013 and December 2014. Of all these women, we went to see how many had hysteroscopy and/or histology results and then we studied the correlation between the findings. There were 804 women with abnormal endometrial findings in ultrasound, of which 352 with focal pathology. The age of women in this last group varied between 20 and 87, with an average of 55.1 years. 179 women were post-menopausal. The endometrial thickness varied between 4 and 48 mm. 164 women were submitted to hysteroscopy. In 2 cases the procedure was abandoned for uterine perforation and in 20 cases there was no focal pathology. There were 4 cases of synechiae, 5 septums, 13 uterine myomas, 119 uterine polyps and 1 case suspected of malignant neoplasia in a polypoid formation. There were 3 confirmed cases of malignancy, all present in polypoid formations. 16 women were directly submitted to hysterectomy. 7 had uterine myoma and the others had no focal pathology. In this sample, we obtained a positive predictive value of ultrasound for focal endometrial pathology of 82.7%. We could not find any cut-off value of endometrial thickness below which there is never a focal pathology and above which there is always pathology. All women with endometrial malignancy had an endometrial thickness above 5 mm. Our women with suspected focal endometrial pathology on gynecological ultrasound had a probability of actually having an abnormal finding of 82.7%. The endometrial thickness value did not allow us to distinguish women with and without focal pathology, however no woman with an endometrium with less than 5 mm had malignant focal pathology.

Relationship of endometrial thickness and endometrial cancer risk in postmenopausal women

Evaluation of the vaginal bleeding of postmenopausal women is crucial to diagnose endometrial lesions. Endometrial thickness measured by transvaginal ultrasonography provides an important reference for diagnosis. Currently, no specific cut-off value of endometrial thickness has been identified to predict the malignant risk for endometrial thickening and postmenopausal women without any symptoms. Most of resected endometrial specimens from postmenopausal women without any symptoms are diagnosed as benign or normal tissues. It seems that postmenopausal women without any symptoms have no need for general screen or intervention of endometrial cancer.

Dynamic monitoring of menopause hormone therapy and defining the cut-off value of endometrial thickness during uterine bleeding.

The aim of this study was to evaluate the effects of low-dose tibolone therapy on ovarian area, uterine volume and endometrial thickness, and define the cut-off value of endometrial thickness for curettage during uterine bleeding. We followed 619 postmenopausal women, aged 40-60 years, for two years. There were 301 subjects in the low-dose tibolone treatment group and 318 subjects in the control group. The ovarian area, uterine volume and endometrial thickness in all participants were measured by transvaginal ultrasound prior to, one and two years post enrollment, respectively. Endometrial specimens were collected from all subjects with abnormal uterine bleeding during the follow-up period. We found that the uterine volume in the treatment group was greater than that in the control group, and the difference was significant (P<0.05), but there were no significant differences in ovarian area and endometrial thickness between the two groups (P>0.05). When the cut-off value for endometrial thickness was 7.35 mm, the sensitivity and specificity were 100% and 79.07%, respectively, and 85.71% and 93.02% when 7.55 mm was set as the cut-off during tibolone therapy. The results indicate that low-dose tibolone therapy may postpone uterine atrophy and the cut-off value of endometrial thickness may be appropriately adjusted for curettage.

Diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies and appropriateness of performed hysteroscopies among asymptomatic postmenopausal women

ObjectiveTo measure the diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies among asymptomatic postmenopausal women, and to test the diagnostic accuracy and appropriateness of performed hysteroscopies. Study designProspective study of 268 asymptomatic postmenopausal women with endometrial thickness ≥4mm referred to diagnostic hysteroscopy. The diagnostic accuracy of various endometrial thickness cut-off values was tested. Histological and hysteroscopic results were compared to measure the diagnostic accuracy of outpatient hysteroscopies. ResultsNo endometrial thickness cut-off values had optimal diagnostic accuracy [positive likelihood ratio (LR+) >10 and negative likelihood ratio (LR−) <0.1]. The best endometrial thickness cut-off value for the detection of all intra-uterine pathologies was ≥8mm (LR+ 10.05 and LR− 0.22). An endometrial thickness cut-off value ≥10mm did not miss any cases of endometrial cancer. The success rate of diagnostic hysteroscopy was 89%, but 97% of these revealed a benign intra-uterine pathology. The diagnostic accuracy of hysteroscopy was optimal for all intra-uterine pathologies, except endometrial hyperplasia (LR− 0.52). ConclusionUsing an endometrial thickness cut-off value ≥4mm, only 3% of performed hysteroscopies were useful for the detection of pre-malignant or malignant lesions. Despite the finding that endometrial thickness did not show optimal diagnostic accuracy, using the best cut-off value (≥8mm) may be helpful to decrease the number of false-positive results. No cases of endometrial cancer were diagnosed in asymptomatic postmenopausal women with endometrial thickness <10mm.

Accuracy of Transvaginal Ultrasonography for Detecting Intrauterine Lesions at a Taiwan Medical Center: A Correlation with Ultrasound and Hysteroscopic Histopathology

Transvaginal ultrasound (TVUS) can detect intrauterine benign focal pathological mass lesions such as polyps and measure endometrial thickness (ET) in patients with or without abnormal uterine bleeding (AUB). Our study assessed TVUS images for evaluating and measuring benign focal intrauterine lesions. This study retrospectively analyzed symptoms, ultrasound findings, and final histopathological reports for 184 women who underwent operative hysteroscopy in 2011 at a single medical center in Taiwan. Patients were chosen if their TVUS images showed benign focal intrauterine pathological masses. Sonographic reports corresponding with hysteroscopic pathologic examinations were reported in 184 patients. There were 36 patients with positive sonographic reports that did not correlate with their pathologic examination results. Another 36 patients, however, had negative sonographic reports but positive pathologic examination results, with a sensitivity of 72.9% and positive predictive value of 72.9%. An ET cut-off value above 9 mm had a poorer sensitivity (74.4%) for detecting focal benign intrauterine lesions and an ET cut-off value above 8 mm had a higher sensitivity of 86.5% for detecting focal benign intrauterine lesions. In the AUB status group, calculated Chi-square test (χ 2 ) results showed that the intrauterine benign focal lesion detection rate did not change statistically even after controlling ET. TVUS had a sensitivity of 72.9% for diagnosing focal lesions. An ET ≥ 8 mm had a lower sensitivity for diagnosing benign intrauterine focal lesions. In our retrospective study group, AUB was not a good predictor for diagnosing focal intrauterine lesions even after treating ET as a fixed variance.

The Predictive Value of Endometrial Thickness in Endometrial Pathologies in Premenopausal Women with Abnormal Uterine Bleeding

Abstract&#x0D; Background: Abnormal uterine bleeding (AUB) is one of the most common complains in women of any age seeking gynecologic health care and needs early diagnosis and proper management due to its impacts on the quality of life. This study was conducted to investigate the cut-off value of endometrial thickness (ET) by trans-vaginal ultra-sonography (TVUS) and evaluate its accuracy in the diagnosis of the endometrial abnormalities in premenopausal women with AUB.&#x0D; Materials and Methods: In this descriptive  study, 64 married women between 35-50 years old were evaluated due to AUB during 2011-2012; TVUS and fractional curettage were done. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the ET were calculated in different cut-off values.&#x0D; Results: The pathological evaluations of the biopsies were normal in 37 (57.8%) patients and were abnormal in 27 (42.2%) patients, 19 endometrial polyps, 6 hyperplastic lesions and 2 endometrial cancers. ET=4 mm had 100% sensitivity, 100% NPV, 10% specificity and 28% PPV in the detection of endometrial abnormalities. ET&lt;10 mm had a proper sensitivity (67%-100%) and NPV (78.6%-100%) but specificity was low (%10-%44). ET=10 mm with sensitivity=63%, specificity=60%, NPV=65.8% and PPV=48.2% was introduced as the cut-off point with the best area under curve (LR+=2.22 LR- =0.77).&#x0D; Conclusion: Although an ET&lt;10 mm was less likely to be associated with an endometrial abnormality, the low PPV of ET and low area under ROC curve shows sonography has high false positivity in premenopausal women. ET≤4 mm was more reliable and could reduce unnecessary biopsies.

Correlation between Endometrial Thickness and IVF Outcome in an African Population

Background: The endometrium undergoes cyclic changes during the menstrual cycle in preparation for implantation. Successful implantation depends on a close interaction between the embryo and the receptive endometrium. The association between endometrial thickness and IVF outcome was investigated in this study. Objective: To study the prognostic effect of endometrial thickness on outcome of In Vitro Fertilization (IVF) cycles Method: A retrospective analysis of 267 IVF/ICSI cycles between 2009 and 2011 at Human reproductive research program of University of Benin Teaching Hospital was conducted. Cycle parameters were compared between pregnant and non-pregnant patients, main outcome measure being clinical pregnancy following IVF cycles. The endometrial thickness was measured on the day of human Chorionic Gonadotrophin (hCG) administration. The clinical pregnancy rates at each millimeter of endometrial thickness was evaluated to determine its predictive role Results: Fifty-four among 267 cycles (20.2%) resulted in clinical pregnancy. The endometrial thickness on day of hCG administration was significantly higher in pregnant group compared to non-pregnant group [10.1 ± 1.7 mm versus 8.9 ± 2.0; p<0.0001). The endometrial thickness cut-off value of at least 7 mm strongly correlated with clinical pregnancy. Conclusion: Amongst other factors a thicker endometrial lining is associated with higher pregnancy rates. Effort should be made to institute protocols that will improve endometrial growth as a means of improving cycle outcome.