Exploring risk factors and management strategies for endometrial premalignant/malignant lesions in women with abnormal uterine bleeding: A retrospective cohort study

Background/Aim: Abnormal uterine bleeding (AUB) in women can often be attributed to a range of underlying factors, including endometrial premalignant and malignant lesions. However, despite the prevalence and potential severity of these lesions, the specific risk factors contributing to their development have not been fully explained. This study aims to explore the risk factors linked to these lesions and to elucidate the corresponding management strategies, filling a crucial gap in our understanding of the underlying causes of AUB. Methods: This retrospective cohort study was conducted among women presenting with AUB and undergoing endometrial biopsy at a gynecology clinic between July 2018 and January 2022. We recorded patients' demographic and clinical characteristics, ultrasonographic findings, and histopathological results of endometrial biopsies. Excluded from the study were patients under 30 years old, pregnant women, those with biopsy results from another center, individuals diagnosed with cancers other than endometrial cancer, cases of insufficient endometrial biopsies, and patients with missing data. The included patients were categorized into two groups: benign and premalignant/malignant, based on histopathological results, and subsequently compared using clinicodemographic findings. Logistic regression analysis was conducted to identify significant risk factors for premalignant/malignant endometrial lesions. We assessed the predictive capacity of endometrial thickness (ET) for premalignant/malignant lesions through receiver operating characteristic (ROC) analysis. Results: A total of 391 patients were analyzed, with a mean age of 50.9 (7.7) years. Among these patients, 89.3% (n=349) were classified as benign, while 10.7% (n=42) exhibited premalignant/malignant lesions. The premalignant/malignant group displayed higher age and BMI compared to the benign group (55.83 [10.55] vs 50.3 [7.6], P<0.001 and 29.17 [3.40] vs 27.73 [3.67], P=0.018, respectively). Logistic regression analysis identified age, BMI, and ET as significant risk factors associated with premalignant/malignant endometrial lesions. ROC analysis for predicting premalignant/malignant lesions using ET yielded cut-off values of 10.5 mm for premenopausal women (sensitivity 62.5%, specificity 58.7%, AUC [95% CI]: 0.688 [0.56-0.80], P =0.012) and 8.5 mm for postmenopausal women (sensitivity 88.5%, specificity 70.2%, AUC [95% CI]: 0.854 [0.78-0.92]; P<0.001). Conclusion: In summary, our findings shed light on the pivotal role of age, BMI, ET, and menopausal status in tailoring management strategies for patients with AUB, underscoring the importance of individualized approaches in enhancing patient care. However, definitive conclusions warrant multi-center prospective investigations to validate these findings in a larger population.