Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography.
OBJECTIVE
To evaluate endometrial thickness and uterine arterial flow measurement as predictors of endometrial cancer.


METHODS
Prospective study among a cohort of women invited to age-adjusted, population-based breast cancer screening by mammography.


METHODS
City of Turku, Finland.


METHODS
1074 postmenopausal women aged 57-61 years (mean 59 years).


METHODS
Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was > or = 4.0 mm, if the uterine artery pulsatility index was < or = 1.0 or if there was a fluid accumulation in the endometrial cavity.


METHODS
Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models.


RESULTS
An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result.


CONCLUSIONS
Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is > or = 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.
Vuento
M H
MH
Department of Obstetrics and Gynaecology, University of Turku, Finland.
Pirhonen
J P
JP
Mäkinen
J I
JI
Tyrkkö
J E
JE
Laippala
P J
PJ
Grönroos
M
M
Salmi
T A
TA
D001706:Biopsy; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D015914:Estrogen Replacement Therapy; D005260:Female; D005387:Finland; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D011673:Pulsatile Flow; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D014599:Uterus / Q000098:blood supply / Q000473:pathology