title: Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium.
abstract: Endometrial carcinoma is the most common genital cancer in women. While patients usually present with vaginal bleeding, in 10-20% this characteristic symptom is absent. Endometrial thickness (double layer) is measured by transvaginal sonography and thickening indicates an increased risk of malignancy or other pathology (hyperplasia or polyps).
  
  
  OBJECTIVE
  We sought to correlate hysteroscopic and pathological findings in asymptomatic postmenopausal women with sonographically thickened endometrium (>6mm).
  
  
  METHODS
  A prospective observational study in a university hospital of 304 postmenopausal women referred between 1996 and 2006 because of a sonographically thickened endometrium in the absence of abnormal bleeding, who underwent continuous flow hysteroscopy (4.5mm Storz hysteroscope) and fractionated curettage of the uterine cervix and corpus (D & C) in addition to vaginal sonography (5MHz probe).
  
  
  RESULTS
  The mean age of the women was 64.8 (range 57.7-71.9) years. Average endometrial thickness measured by ultrasound was 12mm+/-6.7mm. Hysteroscopy suggested the presence of endometrial polyps in 226 women (74.3%), simple endometrial hyperplasia in 34 (11.2%), atrophic endometrium in 18 (5.9%), complex endometrial hyperplasia in 2 (0.7%), atypical hyperplasia in 3 (1%) and leiomyoma in 9 (3.0%). In 12 women (3.9%), the hysteroscopic appearance suggested malignancy and histology revealed endometrial adenocarcinoma. All hysteroscopic results were confirmed by histological examination.
  
  
  CONCLUSIONS
  Hysteroscopy represents an easy, safe and effective method for the investigation of asymptomatic women with a thickened endometrium found with transvaginal ultrasound. The commonest pathology was endometrial polyps.
authors.affiliation: Department of Gynecology and Obstetrics, University of Cologne Medical Center, Cologne, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Schmidt
authors.forename: Martina
authors.initials: M
authors.lastname: Breidenbach
authors.forename: Frank
authors.initials: F
authors.lastname: Nawroth
authors.forename: Peter
authors.initials: P
authors.lastname: Mallmann
authors.forename: Ines M
authors.initials: IM
authors.lastname: Beyer
authors.forename: Markus C
authors.initials: MC
authors.lastname: Fleisch
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Rein
mesh_terms: D000368:Aged; D001284:Atrophy / Q000175:diagnosis; D004714:Endometrial Hyperplasia / Q000175:diagnosis* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007889:Leiomyoma / Q000175:diagnosis; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis; D017698:Postmenopause; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014591:Uterine Diseases / Q000175:diagnosis; D014594:Uterine Neoplasms / Q000175:diagnosis*