Obstet Gynecol Sci.  2019 Nov;62(6):445-453. 10.5468/ogs.2019.62.6.445.

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

• Park YR
• Lee SW
• Kim Y
• Bae IY
• Kim HK
• Choe J
• Kim YM

• KMID: 2462123
• DOI: http://doi.org/10.5468/ogs.2019.62.6.445

Abstract

OBJECTIVE
To assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+).
METHODS
This 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.
RESULTS
Of 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%).
CONCLUSION
TVS 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.

Keyword

Diagnosis; Endometrium; Endometrial hyperplasia; Endometrial neoplasms

MeSH Terms

Biopsy
Chungcheongnam-do
Cohort Studies
Diagnosis
Endometrial Hyperplasia
Endometrial Neoplasms
Endometrium
Female
Humans
Hyperplasia
Incidental Findings
Lost to Follow-Up
Mass Screening*
Myoma
Pathology*
Polyps
Retrospective Studies
Sensitivity and Specificity
Ultrasonography*

Figure

• 

  Fig. 1 Flow diagram of cohort selection for assessing the diagnostic accuracy of endometrial thickness. EH+, endometrial hyperplasia or cancer.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve of endometrial thickness measurements for the detection of endometrial hyperplasia or cancer. AUC, area under the curve; CI, confidence interval.

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