Factors influencing the detection of uterine cancer by suction curettage and endometrial brushing

OBJECTIVE: To analyze the factors that influence the detection of uterine cancers by Pipelle and Tao Brush endometrial sampling devices. STUDY DESIGN: Seventy-nine Pipelle currettages were followed by Tao Brush sampling. The curettage specimens were fixed in formalin for histology and reported by surgical pathology, whereas the Tao Brush specimens were fixed in CytoRich Red for histology and cytology and reported by cytopathology. Uterine size and features of residual tumors were obtained from hysterectomy reports. Follow-up for clinically benign cases ranged from 16 to 52 months (mean, 33.7; median, 34). RESULTS: There were 10 uterine cancers and 9 hysterectomies. Five cases of centrally located adenocarcinoma, ranging from 0.4 to 3 cm, were detected by both samplers. Additionally, a Tao Brush sampled an adenocarcinoma located near the cornu. An endometrial stromal sarcoma found with a Tao Brush was reported as necrotic tissue by Pipelle. Both samplers missed a microscopic focus of adenocarcinoma, an in situ adenocarcinoma in a polyp and a large leiomyosarcoma. CONCLUSION: The size and type of tumor and its location within the uterine cavity, the mechanism of sampling and preparation method influence the detection of uterine cancer by the Pipelle and Tao Brush.     

Diagnosis of endometrial cancer by hysteroscopy does not increase the risk for microscopic extrauterine spread in early-stage disease

The purpose of this study was to determine whether women with endometrial cancer have a higher incidence of microscopic extrauterine spread in early-stage disease when diagnosed by hysteroscopy compared with being diagnosed by dilatation and curettage (D&C) or endometrial biopsy (Pipelle). We retrospectively reviewed the medical records of 110 patients who had undergone surgical staging for endometrial cancer from January 1997 to December 2003. They all had a preoperative histological diagnosis of endometrial carcinoma without evidence of extrauterine disease. Diagnosis was made by hysteroscopy in 64 patients (58.2%), by D&C in 17 (15.5%), and by endometrial biopsy using a Pipelle device in 29 (26.3%). The groups were compared for known prognostic factors for microscopic extrauterine spread, including age, grade, stage, and vascular space involvement, and did not differ in these parameters. Microscopic intraperitoneal disease and positive peritoneal cytology were considered the primary endpoints of this analysis. Peritoneal cytology was positive in three of 110 (2.7%) patients. The presence of positive peritoneal cytology was not associated with hysteroscopy as the diagnostic procedure. We conclude that diagnosis of endometrial cancer by hysteroscopy does not increase the risk of microscopic intraperitoneal spread compared with diagnosis by D&C or endometrial biopsy (Pipelle).     

The role of Pipelle Mark II sampling in endometrial disease diagnosis

OBJECTIVE: To evaluate the feasibility and accuracy of Pipelle Mark II sampling (designed for combined cytology and histology testing) in the diagnosis of endometrial disease. MATERIALS AND METHODS: A 97 women with abnormal uterine bleeding or intrauterine lesions on ultrasound examination underwent Pipelle Mark II endometrial sampling, followed by diagnostic hysteroscopy. The adequacy of endometrial samples obtained for cytological and histological analysis was assessed. A correlation was established between endometrial cytology, histology and diagnostic hysteroscopy results. Where discrepancies were found, they were compared with the histological results obtained from operative hysteroscopy. RESULTS: The tissue samples obtained for cytological and histological diagnoses were insufficient in 14.4% and 11.3% of patients, respectively. The opposite was found in the group of postmenopausal women (N=52): the tissue samples for cytological and histological diagnoses were insufficient in only 3.8% and 15.4% of cases, respectively. The cytological results corroborated diagnostic hysteroscopy findings and histological results in all cases but 3 (3.6%). Only two cases of endometrial carcinoma were reported in this group of patients, and they were both detected by all three methods. The rate of false positives with endometrial cytological sampling was 3.6%. There were no false negatives. CONCLUSION: Pipelle Mark II endometrial sampling is feasible. It provides adequate samples for histological and/or cytological analysis and reliable results. It reduces the rate of false negative results for endometrial cancer. Pipelle Mark II sampling is particularly useful in postmenopausal women and in women with endometrial atrophy. Other larger studies are necessary to evaluate the efficiency of Pipelle Mark II.     

Management of early endometrial carcinoma

Management of early endometrial carcinoma is controversial in regard to timing and indication of adjunctive radiation therapy. Two hundred eighty patients with stage I carcinoma of the endometrium are analyzed: 135 patients were treated with surgery only and 61 patients underwent preoperative and 83 patients postoperative radiation therapy. The overall survival was 94%. Recurrence rates in all three treatment arms were equal. Tumor grade was found to change from the diagnostic D&C specimen to the definite surgical specimen in 31% of all cases and in 50% of all grade 3 lesions. As only 39% of all patients required postoperative radiation therapy with equal survival, a primary surgical approach spares the majority of patient unnecessary treatment and preserves prognostically important histology.     

Comparison of D&;C and hysterectomy pathologic findings in endometrial cancer patients

Objective The objective of this study is to compare the accuracy of tumor grade in endometrial cancer between fractional dilatation and curettage (D&C) and postoperative hysterectomy specimen findings.Methods From January 2000 to November 2002, 52 women with abnormal vaginal bleeding and diagnosed or suspected endometrial cancer were treated in the Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Second Medical University. The comparison of tumor grades was performed on both D&C and hysterectomy specimens, the relationship between the concordance rate of grade, and the depth of tumor invasion into the myometrium. The expression of estrogen receptor (ER), progesterone receptor (PR), p53, Bcl2, and proliferation cell nuclear antigen (PCNA) in tumor samples were analyzed.Results The concordance rates were 20% in grade 1, 61.5% in grade 2, and 77.8% in grade 3. The concordance rates for grade 2 and grade 3 were higher than grade 1 significantly (grade 2 ~ grade 1, P=0.010; grade 3 ~ grade 1, P=0.005). Fourteen out of 52 (26.9%) patients diagnosed with atypical endometrial hyperplasia by D&C had their diagnosis changed to endometrial cancer after being ascertained by hysterectomy specimen. The accuracy of tumor grade diagnosis by D&C was 50%, and 48% of patients were downgraded after comparison of postoperative specimens. The concordance rate of tumor invasion into the outer half of myometrium was higher than in tumors localized in the endometrium (P= 0.030). No association between high concordance rate and the expression of ER, PR, p53, Bcl-2 and PCNA was found.Conclusion We concluded that D&C had a high accuracy in the diagnosis of endometrial cancer in grade 3 tumors (77.8%) and tumor invasion into the outer half of the myometrium (75%). Overall, 48% of endometrial cancer patients tumor grades seemed to be decreased by D&C evaluation; thus, the diagnosis of endometrial disorders by D&C should not be overlooked.     

Transvaginal ultrasound measurement of endometrial thickness and endometrial pipelle sampling as an alternative diagnostic procedure to hysteroscopy and dilatation and curettage in the management of post-menopausal bleeding.

In order to evaluate pipelle endometrial sampling combined with ultrasound measurement of endometrial thickness as an initial diagnostic procedure in the assessment of endometrial pathology in patients presenting with postmenopausal bleeding, 50 consecutive patients were studied prospectively. In each patient measurement of endometrial thickness and pipelle endometrial biopsy were performed as an out-patient procedure before hysteroscopy and dilatation and curettage (D&C). The diagnostic sensitivity with pipelle endometrial sampling alone in detecting endometrial pathology was 25% with a specificity of 100%. The measurement of endometrial thickness had a sensitivity of 62% with a specificity of 87.8%. Pipelle sampling combined with endometrial thickness increased the sensitivity to 87.5% with a specificity of 87.8%. Therefore, we suggest that pipelle sampling combined with sonographic measurement of endometrial thickness is an acceptable, less invasive alternative to hysteroscopy and D&C as a first-line investigation in the management of post-menopausal bleeding.     

Endometrial adenocarcinoma: therapeutic impact of preoperative histopathologic examination of endometrial tissue

Adenocarcinoma of the endometrium is diagnosed by the histologic evaluation of endometrial tissue. In stage I disease, five-year survival depends upon a number of prognostic factors. Histologic grade and type of carcinoma are most important. The need for pelvic and para-aortic lymphadenectomy is often based on the preoperative histologic grade and type of tumor. The purpose of this study was: 1) to compare preoperative histology of endometrial carcinoma to that found at hysterectomy, 2) to determine if preoperative histology can accurately predict depth of myometrial invasion or extra-uterine spread, 3) to determine whether para-aortic lymphadenectomy could be deleted based only on the preoperative finding of well differentiated carcinoma. In 19 (28%) of the 68 patients studied, the histologic grade or pattern at hysterectomy was different from that found preoperatively. In seven (13%) of the 52 "good prognosis" patients with grades 1 and 2 preoperative histology, hysterectomy revealed a more serious histologic type. Three of the seven (43%) had extrauterine spread. In the 16 "poor prognosis" patients with preoperative grade 3 or papillary serous/clear cell carcinoma, 14 (88%) had a similar histologic pattern at hysterectomy. Three of these patients had metastatic disease. Depth of myometrial invasion could not be predicted by preoperative histology even though the data suggested that extrauterine spread could. Clinical stage I endometrial carcinoma, grade 1 or 2, should not be treated without para-aortic nodal sampling based only on a supposedly favorable preoperative histologic pattern. Confirmed para-aortic nodal disease will alter the fields of post-operative radiation therapy should that become necessary. In these patients, however, pelvic lymphadenectomy is not justified.2 +     

Endometrial hyperplasia and carcinoma in endometrial polyps: clinicopathologic and follow-up findings.

The objectives of this study were: 1) to evaluate findings in follow-up hysterectomy specimens after a diagnosis of complex atypical hyperplasia or carcinoma in endometrial polyps (EMPs) for possible significance in management strategies; and 2)to identify features in these polyps, that are predictive of the presence of endometrial hyperplasia or carcinoma in subsequent hysterectomy. Records of all cases of EMPs with endometrial hyperplasia were retrieved from the files of New York University Medical Center from 1993 to 2005. Those cases with follow-up hysterectomy were selected for the study. Of the 29 patients with complex atypical hyperplasia within the polyp, 19 out of 29 (66%) patients had hyperplasia of the non-polyp endometrium, and adenocarcinoma was observed in 9 out of 29 (31%) patients on follow-up hysterectomy. The percentage of polyp area involved by the hyperplasia was predictive of finding endometrial disorder in subsequent hysterectomy (P = 0.005). Of the 8 patients with adenocarcinoma in situ (AIS) within the polyp 3 (38%) had myoinvasive adenocarcinoma. In contrast, in cases without AIS, 4 out of 21 (19%) had myoinvasive adenocarcinoma in follow-up hysterectomy. Eight of the nine cases with carcinoma in endometrial polyp had endometrial pathology on hysterectomy. Approximately two thirds of the patients with hyperplasia and 90% of patients with adenocarcinoma in endometrial polyps show endometrial pathology on subsequent hysterectomy. The above findings reinforce the need for hysterectomy especially in postmenopausal women with atypical complex hyperplasia or carcinoma in endometrial polyps even if these changes appear confined to the polyp in initial sampling.     

Incidence of endometrial carcinoma in patients with endometrial hyperplasia

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.     

Value of endocervical curettage in the staging of endometrial carcinoma

The prognosis for women with endometrial cancer correlates with stage of disease. Spread to the cervix distinguishes Stage II from Stage I disease. To assess the accuracy of endocervical curettage (ECC) in predicting cervical involvement by endometrial adenocarcinoma, we examined and assigned to one of four groups the ECC from 147 women treated between 1980 and 1985. Ultimate determination of spread to the cervix was based on examination of subsequent hysterectomy specimens. In the hysterectomy specimen 19 of 147 women (13%) had cervical involvement demonstrated. Five women had tumor clearly within the endocervical tissue of the ECC (Group I), and three of these five (60%) had spread of tumor to the cervix in the hysterectomy specimen. At hysterectomy, 13 of 41 women (32%) with tumor present but not contiguous with endocervical tissue within the ECC (Group II) had cervical involvement. Of the 80 women without tumor in the curettage (Group III), one (1.2%) had cervical involvement by tumor at hysterectomy. Two of the 21 women (9.5%) with curettings considered insufficient for diagnosis (Group IV) had spread of adenocarcinoma to the cervix within the hysterectomy specimen. We also compared the results of ECC performed at our institution with those performed at referring hospitals and found a significant difference between them in ability to obtain definitive results. We conclude that (a) the absence of carcinoma in ECC is highly predictive of absence of cervical involvement by endometrial carcinoma; (b) ECC having tumor within endocervical tissue is a good predictor of cervical involvement by tumor.(ABSTRACT TRUNCATED AT 250 WORDS)     

A randomized clinical trial comparing Pipelle and Tis-u-trap for endometrial biopsy

Recent publications have suggested that use of the Pipelle endometrial suction curette is a safe and effective method by which to obtain samples of endometrial tissue. To address this issue, we performed a randomized clinical trial comparing the Pipelle to the Tis-u-trap in 156 patients. The Pipelle was as effective as the Tis-u-trap in obtaining endometrial samples in both the adequacy of the specimen (Pipelle 88%, Tis-u-trap 84%) and the quality of the specimen (P = .26). This trial confirms the favorable observational reports on the use of the Pipelle for endometrial biopsy.     

Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women

Purpose

The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology, in comparison with histology.

Methods

1987 patients scheduled for hysteroscopy were enrolled in this study. All patients proceeded sequentially through endometrial cytology, hysteroscopy and then dilatation and curettage (D&C). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnosis was correlated with the D&C histological diagnosis.

Results

Cyto-histological correlations were possible in 1672 (89.3%) patients: in 254 (12.8%) patients the D&C was inadequate, in 75 (3.8%) patients the cytology was inadequate, and in 14 (0.7%) patients both were inadequate. In postmenopausal women, 758 of 790 cytologies (96.0%) were adequate, while 586 of 790 histologies (74.2%) were adequate. SAP-1 provided more sufficient materials for cytology than D&C for histology (P < 0.001). Taking atypical hyperplasia or worse as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 86.1%, sensitivity was estimated at 70.3%, specificity at 88.5%, positive predictive value at 48.0% and negative predictive value at 95.2%. Taking endometrial carcinoma as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 94.4%; sensitivity was estimated at 53.2%, specificity at 98.6%, positive predictive value at 79.8% and negative predictive value at 95.3%.

Conclusions

Liquid-based endometrial cytology can be considered a useful method for detecting of endometrial pathology as a first-line approach.

     

Successful in vitro fertilization pregnancy after conservative management of endometrial cancer

OBJECTIVE: To report a successful IVF pregnancy in an infertile couple after conservative treatment of endometrial cancer. DESIGN: Case report and literature review. SETTING: University teaching hospital. PATIENT(S): A 29-year-old infertile white woman. MAIN OUTCOME MEASURE(S): Successful pregnancy after conservative management of endometrial cancer. INTERVENTION(S): Grade 1 endometrial adenocarcinoma diagnosed at hysteroscopy, followed by dilatation and curettage (D&C). On follow-up D&C, pathologic examination was normal after high-dose progesterone therapy. The patient subsequently underwent an IVF cycle with transfer of three blastocysts. RESULT(S): The patient delivered triplets by cesarean section. Laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy was then done. No residual endometrial cancer was evident in the hysterectomy specimen, but a 1.1-cm cystic mixed endometrioid and clear cell-type adenocarcinoma was discovered in the left ovary. The patient is doing well after 3 cycles of chemotherapy; her CA-125 level is normal. The triplets are also doing well. CONCLUSION(S): In carefully chosen situations, deferring surgery in infertile patients with endometrial cancer may be a viable option permitting subsequent successful pregnancy.     

Hysteroscopic view in atypical endometrial hyperplasias: A correlation with pathologic findings on hysterectomy specimens

STUDY OBJECTIVE: To evaluate whether hysteroscopic imaging can contribute to decrease the rate of undetected endometrial carcinomas concurrent with atypical hyperplasia diagnosed by endometrial biopsy. DESIGN: Retrospective study. DESIGN CLASSIFICATION: Canadian Task Force Classification II-3. SETTING: Public hospital. PATIENTS: Hysteroscopic reports of 25 menopausal patients undergoing endometrial biopsy yielding a diagnosis of atypical hyperplasia were reviewed. On the basis of this diagnosis, all patients were treated by hysterectomy, and the pathologic findings on the uterine specimen were correlated with the diagnoses obtained by hysteroscopic view. INTERVENTIONS: Hysteroscopy was video-assisted and carried out with normal saline solution used as liquid distension medium; a 5-mm sheathed hysteroscope, with a working channel, was used for each examination. After hysteroscopic inspection, an endometrial sampling targeted under vision was performed by mechanical or electrosurgical instrumentation. When extensive features of hyperplastic or neoplastic growth were observed, we combined a blind sampling procedure with Vabra-curettage. We calculated the sensitivity, specificity, and negative and positive predictive values of hysteroscopic inspection to foresee the diagnosis of endometrial cancer incidentally detected on hysterectomy specimen. MEASUREMENTS AND MAIN RESULTS: On the basis of histopathologic study of uterine specimens, non atypical hyperplasias were detected in 3 patients, the diagnosis of complex atypical hyperplasia was confirmed in 11 patients, whereas a concurrent infiltrating endometrial adenocarcinoma was detected in 11 patients (44.0%). In the 14 patients with diagnosis of endometrial hyperplasia, no feature suggesting endometrial malignancy was reported by hysteroscopic inspection. In the 11 cases showing infiltrating carcinomas, hysteroscopic view was consistent with endometrial malignancy in 9 patients and with endometrial hyperplasia in 2 patients. An intramucous endometrial carcinoma without evidence of myometrial invasion was found on hysterectomy specimens of these two latter patients. From these figures, sensitivity, specificity, and negative and positive predictive values of hysteroscopy to foresee a diagnosis of infiltrating carcinoma were 84.6%, 100%, 87.5%, and 100%, respectively. CONCLUSIONS: Hysteroscopic view is a sensitive and specific method to identify among patients with a diagnosis of atypical hyperplasia on endometrial biopsy those with a coexisting infiltrating carcinoma.     

The Pipelle endometrial suction curette: how useful is it in clinical practice?

The Pipelle endometrial sampler is gaining popularity as an alternative to formal dilatation and curettage (D&C). This study demonstrates that the Pipelle reduces the number of D&Cs required to assess the endometrium by 65%. This has significant benefits in terms of patient safety and cost. If an inadequate sample is obtained, which occurs most commonly in the postmenopausal patient, there may be a temptation to ascribe this to the presence of an atrophic endometrium. This study, however, finds a significant chance of an underlying carcinoma in these cases. Thus whereas the Pipelle sampler has clinical usefulness when a sample sufficient for histological analysis is obtained, an equivocal result must lead to further investigation.     

Significance of atypical endometrial cells detected by cervical cytology

A retrospective study was conducted to assess the histologic significance of atypical endometrial cells identified on routine cervical cytology. One hundred seventy-seven women had Papanicolaou smears demonstrating atypical endometrial cells. The histology of the endometrium was available from endometrial sampling and/or hysterectomy in 134 of the patients within 12 months of their abnormal cytologic evaluation. Fifty-six women (42%) had endometrial disease, including 14 cases (10%) of endometrial polyp, 15 cases (11%) of endometrial hyperplasia, and 27 cases (20%) of adenocarcinoma. The frequency and nature of the endometrial changes depended on the age of the patient (P less than .001) and the degree of cytologic atypia (P less than .05). In 21 women over 59 years who had atypical endometrial cells suspicious for adenocarcinoma, 12 (57%) had adenocarcinoma. Using this information, we have estimated the risk of adenocarcinoma in various groups of women with atypical endometrial cells.     

Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review

OBJECTIVE: We reviewed reported cases of grade 1 endometrial adenocarcinoma that were conservatively managed with hormonal therapy in an effort to identify the most effective treatment regimen. METHODS: We searched MEDLINE and other databases for English-language articles describing patients with grade 1 endometrial adenocarcinoma who were treated with hormonal therapy. The search included articles published between January 1966 and December 2003. The following key words were used: endometrial cancer, uterine cancer, adenocarcinoma, hormones, progesterone, medroxyprogesterone acetate, megestrol acetate, conservative therapy, fertility, and female. A total of 79 articles were found. Studies were excluded for the following reasons: advanced stage, metastatic or recurrent disease, progestin use after radiation, chemotherapy, or surgery, concurrent with radiation therapy or chemotherapy, administration of progestin other than orally or intramuscularly, tumor confined to a polyp, grade 2 or 3 disease, undocumented grade, nonendometrioid histology, progestin use in conjunction with ovarian wedge resection or other hormones, and hyperplasia. Our study ultimately included 81 patients in 27 articles. RESULTS: Sixty-two patients (76%) responded to treatment. The median time to response was 12 weeks (range, 4-60 weeks). Fifteen patients (24%) who initially responded to treatment recurred. The median time to recurrence was 19 months (range, 6-44 months). Ten (67%) of the patients with recurrence ultimately underwent total abdominal hysterectomy. Residual endometrial carcinoma was found in six patients (60%). Nineteen patients never responded. Twenty patients were able to become pregnant at least once after completing treatment. The median follow-up was 36 weeks (range, 0 weeks-30 years). No patients died of their disease. CONCLUSION: The majority of patients reported with well-differentiated endometrial adenocarcinoma who undergo conservative treatment with a progestational agent respond to treatment. When an initial response is not achieved or when disease recurs, carcinoma extending beyond the uterus is rare.     

The significance of residual tumor after preoperative pelvic irradiation for stage II endometrial carcinoma

The prognostic significance of residual endometrial carcinoma in the hysterectomy specimen after preoperative radiotherapy is controversial. Sixty-two patients with stage II endometrial carcinoma were treated with a standardized program of preoperative radiotherapy, followed in six weeks by an extrafascial hysterectomy. Twenty patients (32%) had no residual carcinoma in their hysterectomy specimens and 42 (68%) had residual carcinoma. There were no significant clinical, surgical, or pathologic differences between patients with or without residual carcinoma. Patients with no residual carcinoma had a 25% recurrence rate and a 53% actuarial five-year survival rate. Patients with residual carcinoma had a 21% recurrence rate and a 78% actuarial five-year survival rate. The presence of residual endometrial carcinoma in the hysterectomy specimen does not imply a compromised prognosis in patients with stage II endometrial carcinoma treated by the described method.     

The role of vaginal scan in measurement of endometrial thickness in postmenopausal women

Transvaginal ultrasound scanning was performed on 111 postmenopausal women. Of these women, 103 had postmenopausal bleeding, and eight were undergoing hysterectomy. Of the 103 women with bleeding, 93 had dilatation and curettage (D&C) and 10 patients were treated conservatively with a repeat scan in six months. A correlation of ultrasound findings and endometrial histopathology was possible in 94 patients. In 59 of these (63%) the endometrium was atrophic and the ultrasound endometrial thickness was 5 mm or less. In 29 (31%) patients the endometrial histology was abnormal and ultrasound endometrial thickness was greater than 5 mm. In six patients the endometrium was atrophic, but the ultrasonic endometrial thickness was apparently greater than 5 mm due to intracavity fluid. We suggest that an endometrial thickness of 5 mm is an appropriate cut-off level for conservative management of patients with postmenopausal bleeding, or in screening for endometrial carcinoma.     

The role of vaginal scan in measurement of endometrial thickness in postmenopausal women

Summary. Transvaginal ultrasound scanning was performed on 111 postmenopausal women. Of these women, 103 had postmenopausal bleeding, and eight were undergoing hysterectomy. Of the 103 women with bleeding, 93 had dilatation and curettage (D&C) and 10 patients were treated conservatively with a repeat scan in six months. A correlation of ultrasound findings and endometrial histopathology was possible in 94 patients. In 59 of these (63%) the endometrium was atrophic and the ultrasound endometrial thickness was 5 mm or less. In 29 (31%) patients the endometrial histology was abnormal and ultrasound endometrial thickness was greater than 5 mm. In six patients the endometrium was atrophic, but the ultrasonic endometrial thickness was apparently greater than 5 mm due to intracavity fluid. We suggest that an endometrial thickness of 5 mm is an appropriate cut-off level for conservative management of patients with postmenopausal bleeding, or in screening for endometrial carcinoma.