title: Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Measurement of endometrial thickness is an important tool in the assessment of women with postmenopausal bleeding, but the role of endometrial thickness measurement by ultrasound in asymptomatic women is unclear. The aims of this study were to determine: (1) the normal endometrial thickness measured by ultrasonography, (2) the prevalence of serious endometrial pathology and (3) the sensitivity and specificity of endometrial thickness measurement by transvaginal ultrasonography (TVS) for diagnosing premalignant and malignant endometrial disease in asymptomatic postmenopausal women.
  
  
  METHODS
  A MEDLINE and EMBASE search (from inception to January 2011) was performed. Articles reporting on endometrial thickness measurement in the diagnosis of endometrial carcinoma and atypical hyperplasia in asymptomatic postmenopausal women not using hormone replacement therapy (HRT) were selected. Endometrial thickness and the prevalence of endometrial (pre)malignancies were recorded. If possible, 2 × 2 tables were extracted.
  
  
  RESULTS
  Thirty-two studies reporting on 11100 women were included. The estimated mean endometrial thickness was 2.9 mm (95% CI, 2.6-3.3 mm). The pooled estimated prevalences of endometrial carcinoma and atypical endometrial hyperplasia were 0.62% (95% CI, 0.42-0.82%) and 0.59% (95% CI, 0.22-0.96%), respectively. Summary estimates for sensitivity and specificity of TVS endometrial thickness measurement in the prediction of endometrial carcinoma were 0.83 (95% CI, 0.19-1.00) and 0.72 (95% CI, 0.23-0.95) for a 5-mm cut-off and 0.33 (95% CI, 0.04-0.85) and 0.94 (95% CI, 0.92-0.96) for a 6-mm cut-off.
  
  
  CONCLUSIONS
  The results from this systematic review do not justify the use of endometrial thickness as a screening test for endometrial carcinoma and atypical endometrial hyperplasia in asymptomatic postmenopausal women not using HRT.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. m.c.breijer@amc.uva.nl
authors.forename: M C
authors.initials: MC
authors.lastname: Breijer
authors.forename: J A H
authors.initials: JA
authors.lastname: Peeters
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: T J
authors.initials: TJ
authors.lastname: Clark
authors.forename: R H M
authors.initials: RH
authors.lastname: Verheijen
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: A
authors.initials: A
authors.lastname: Timmermans
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D017698:Postmenopause; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity; D014463:Ultrasonography