Role of transvaginal ultrasonography in determining endometrium cancer risk in asymptomatic postmenopausal women with thickened endometrium

The aim of this study is to determine the cut-off value for the histopathological evaluation of premalignant-malignant endometrial pathologies from benign pathologies in postmenopausal asymptomatic patients with increased endometrial thickness. This cross-sectional study included a population that included asymptomatic 481 postmenopausal women with an endometrial thickness of more than 5mm in TVU who underwent diagnostic/ operative hysteroscopy and full curettage between January 2015 and January 2018. Demographic characteristics TVU, hysteroscopy findings of patients were recorded. As a result, in the histopathological outcome, 154(3%) women were evaluated as having normal endometrium, 189(39.3%) women as having endometrial polyps, 93(19.3%) women as having endometrial atrophy, and 23(4.6%) women as having endometrial simple hyperplasia, 5(1%) women as having endometrial simple hyperplasia, 17(3.5%) women as having endometrial atrophy and only one (0.1%) woman as having fibroids. In the 187 postmenopausal women with normal diagnostic hysteroscopic evaluation, histopathological findings were: 13(7%) endometrial hyperplasia, 2(1.1%) atypical endometrial hyperplasia, 27(14.4%) endometrial polyps, 4 2.1%) endometrial atrophy, and 2(1.1%) endometrial carcinoma. The endometrial thickness was analyzed with the ROC curve for cutoff value differentiating atypical endometrial hypreplasia/endometrial carcinoma from benign lesions and 10.5 mm was found with 90% sensitivity and 63% specificity. In conclusion, hysteroscopy is highly effective for identifying the endometrium and focal intracavitary pathologies such as polyps, myomas and foreign bodies in women with abnormal uterine bleeding. However, for the diagnosis of endometrial hyperplasia and cancer, hysteroscopic-guided biopsy with uterine curettage seems to be the best method.