title: Asymptomatic thickened endometrium in postmenopausal women: malignancy risk.
abstract: OBJECTIVE
  To assess the diagnostic findings and determine the frequency of malignancy in postmenopausal women evaluated by office hysteroscopy for a thickened endometrium without bleeding.
  
  
  METHODS
  Retrospective cohort (Canadian Task Force classification II-B).
  
  
  METHODS
  Academic medical center in the Midwestern United States.
  
  
  METHODS
  Over 3600 women underwent an office hysteroscopy between January 1, 2007, and October 20, 2011, for abnormal uterine bleeding or an abnormal ultrasound. Of these, 154 postmenopausal women had a thickened endometrium (>4 mm) and no bleeding.
  
  
  METHODS
  Flexible office hysteroscopy using a 3.1-mm scope with saline as the distending media was performed for clinical reasons, and results were captured within a research database.
  
  
  RESULTS
  For the 154 women, the range of endometrial measurements was 4.2 to 28 mm (mean = 10.0 mm). Hysteroscopy diagnoses included 93 patients with polyps, 19 with myomas or uterine synechiae, and 34 with benign-appearing endometrium. Nine hysteroscopies were inadequate because of poor visualization (n = 1), cervical stenosis (n = 6), or patient discomfort (n = 2). Endometrial biopsies (EMBs) were performed in 109 patients, and none were found to have cancer or an atypical endometrium. Six had simple hyperplasia without atypia, and their endometrial measurements were within the range of the patients in our study who had a benign endometrium (5-15 mm, mean = 10.3). Of the women with a polyp, 73 (78.4%) subsequently underwent polypectomy. On final pathology, 1 had cancer (endometrial measurement = 24 mm), and 1 had complex hyperplasia with atypia (endometrial measurement = 17 mm). EMBs performed in the office for these 2 patients showed an insufficient endometrium and inactive endometrium, respectively.
  
  
  CONCLUSIONS
  Cancer and atypia can occur in asymptomatic women. Endometrial thickness was 17 mm or greater in 2 cases, and EMBs performed in the office were inconsistent with the final diagnosis. Hysteroscopy is important when ultrasound and EMB do not agree. Polypectomy may be indicated even in asymptomatic women, but further studies regarding an endometrial measurement threshold or polyp size are warranted.
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Breitkopf
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.affiliation: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Electronic address: laughlintomaso.shannon@mayo.edu.
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Laughlin-Tommaso
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D055088:Early Detection of Cancer; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007889:Leiomyoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D011127:Polyps / Q000473:pathology*; D017698:Postmenopause; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000473:pathology; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
keywords: Endometrial cancer; Endometrial polyp; Office hysteroscopy; Thickened endometrium