Association of endometrial thickness assessed at trans-vaginal ultrasonography to endometrial cancer in postmenopausal women asymptomatic or with abnormal uterine bleeding.
OBJECTIVE
To define the normal cut off of endometrial thickness as measured at transvaginal ultrasonography (TVUS) in order to define postmenopausal women without symptoms or with abnormal uterine bleeding (AUB) at risk of endometrial carcinoma (EC).


METHODS
3460 postmenopausal women (2240 asymptomatic, 1220 with AUB) undergoing TVUS. These series was linked with the Tuscany Cancer Registry archives in order to identify subjects who developed EC subsequent (within two years) to TVUS.


RESULTS
Thickness (half layer) was significantly reduced in 2234 subjects not developing EC (1.68 mm; range = 0-20, SD 3.14) as compared to 6 subjects developing EC (4.67 mm, range = 0-10, SD 3.67) (p=0.02). A 4 mm cut off was associated with a sensitivity of 66.7%, a specificity of 92.1%, a positive predictive value of 2.2% and a negative predictive value of 99.9%. Similarly, in subjects with AUB, thickness (half layer) was significantly smaller in the 1175 subjects not developing EC (2.46 mm, range 0-20, SD 3.59) as compared to 45 subjects developing EC (8.0 mm, range 0-44, SD 6.76) (p<0.001). The best cut off for clinical purposes was 4 mm, with a sensitivity of 91.1%, a specificity of 79.8%, a positive predictive value of 14.8% and a negative predictive value of 99.6%.


CONCLUSIONS
The study confirms the usefulness of measuring endometrial thickness (half layer cut off = 4 mm) with TVUS in asymptomatic postmenopausal women, both in asymptomatic subjects to indicate further special surveillance and in subjects with AUB to indicate immediate invasive assessment.
Ciatto
Stefano
S
Centro per lo Studio e la Prevenzione Oncologica, Ferrara, Italy. s.ciatto@cspo.it
Cecchini
Silvia
S
Gervasi
Ginetta
G
Landini
Antonella
A
Zappa
Marco
M
Crocetti
Emanuele
E
D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D004717:Endometrium / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000150:complications*