Diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies and appropriateness of performed hysteroscopies among asymptomatic postmenopausal women.
OBJECTIVE
To measure the diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies among asymptomatic postmenopausal women, and to test the diagnostic accuracy and appropriateness of performed hysteroscopies.


METHODS
Prospective study of 268 asymptomatic postmenopausal women with endometrial thickness ≥4 mm referred to diagnostic hysteroscopy. The diagnostic accuracy of various endometrial thickness cut-off values was tested. Histological and hysteroscopic results were compared to measure the diagnostic accuracy of outpatient hysteroscopies.


RESULTS
No endometrial thickness cut-off values had optimal diagnostic accuracy [positive likelihood ratio (LR+) >10 and negative likelihood ratio (LR-) <0.1]. The best endometrial thickness cut-off value for the detection of all intra-uterine pathologies was ≥8 mm (LR+ 10.05 and LR- 0.22). An endometrial thickness cut-off value ≥10 mm did not miss any cases of endometrial cancer. The success rate of diagnostic hysteroscopy was 89%, but 97% of these revealed a benign intra-uterine pathology. The diagnostic accuracy of hysteroscopy was optimal for all intra-uterine pathologies, except endometrial hyperplasia (LR- 0.52).


CONCLUSIONS
Using an endometrial thickness cut-off value ≥4 mm, only 3% of performed hysteroscopies were useful for the detection of pre-malignant or malignant lesions. Despite the finding that endometrial thickness did not show optimal diagnostic accuracy, using the best cut-off value (≥8 mm) may be helpful to decrease the number of false-positive results. No cases of endometrial cancer were diagnosed in asymptomatic postmenopausal women with endometrial thickness <10mm.
Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy. Electronic address: lucazeta1976@libero.it.
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Giannella
Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy.
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Mfuta
Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy.
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Setti
Mother-Infant Department, Institute of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, Modena, Italy.
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Boselli
Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy.
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Bergamini
Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy.
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Cerami
D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D058070:Asymptomatic Diseases; D001284:Atrophy / Q000175:diagnosis; D004714:Endometrial Hyperplasia / Q000175:diagnosis; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000592:standards / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000175:diagnosis*; D008875:Middle Aged; D009929:Organ Size; D011127:Polyps / Q000175:diagnosis*; D017698:Postmenopause; D011446:Prospective Studies; D014463:Ultrasonography; D019564:Unnecessary Procedures; D014594:Uterine Neoplasms / Q000175:diagnosis*
Appropriateness; Asymptomatic postmenopausal women; Diagnostic accuracy; Endometrial thickness; Hysteroscopy; Intra-uterine pathology