title: Sonographic findings in postmenopausal women with a prior endometrial ablation: interpretation and management of women with endometrial thickening and bleeding.
abstract: OBJECTIVE
  To understand the meaning of endometrial thickening and bleeding in postmenopausal women who had previously undergone endometrial ablation (EA).
  
  
  METHODS
  Retrospective observational study. Canadian Task Force III.
  
  
  METHODS
  Obstetrics and Gynecology Unit, Magna Graecia University, Catanzaro, Italy.
  
  
  METHODS
  Sixty-three postmenopausal women who had previously undergone EA.
  
  
  METHODS
  A retrospective evaluation of clinical charts of postmenopausal women who had a follow-up visit after EA between January 2000 and August 2014.
  
  
  RESULTS
  The rates of endometrial thickening (with or without bleeding), endometrial atrophy, and cancer were determined. Postmenopausal bleeding was reported in 9 patients (14.3%). Endometrial thickening was observed in 51 patients (80.9%; mean ± SD endometrial thickness, 7.7 ± 3.0 mm). A significantly (p < .05) greater number of patients with an endometrial thickness of 5 to 10 mm was observed compared with those with an endometrial thickness of <5 mm or >10 mm. A significant (p = .001) difference in increase in endometrial thickness was observed between patients with and without bleeding. Overall, hysteroscopy plus endometrial biopsy was scheduled in 24 patients. In all bleeding women, a histological diagnosis of endometrial atrophy was demonstrated. Concerning bleeding-free women, in 14 patients with endometrial thickening of >10 mm, mucosal atrophy was detected. The only bleeding-free patient in whom an endometrial echogenic fluid collection was detected had a histological diagnosis of endometrioid endometrial cancer. Thus, patients who underwent hysteroscopy had a 95.8% rate of mucosal atrophy and a 4.2% rate of endometrial cancer. The overall cancer rate in our global population (menopause with previous EA) was 1.6%.
  
  
  CONCLUSIONS
  Postmenopausal bleeding and sonographic detection of endometrial thickening in patients with previous EA are not necessarily related to a malignant disease. Nonetheless, ultrasound visualization of endometrial thickening plus an echogenic endometrial fluid collection in these patients always warrants an invasive diagnostic procedure regardless of whether or not bleeding is reported.
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Morelli
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy. Electronic address: morenarocca@hotmail.it.
authors.forename: Morena Luigia
authors.initials: ML
authors.lastname: Rocca
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Mocciaro
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Di Cello
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Sacchinelli
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: De Trana
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cariati
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Venturella
authors.affiliation: Obstetrics and Gynecology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University and Gynecologic Oncology Unit, Tommaso Campanella Cancer Center of Germaneto, Catanzaro, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zullo
mesh_terms: D001284:Atrophy / Q000453:epidemiology / Q000473:pathology; D001706:Biopsy; D055356:Endometrial Ablation Techniques / Q000009:adverse effects*; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007558:Italy / Q000453:epidemiology; D008796:Metrorrhagia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D017698:Postmenopause; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: Asymptomatic postmenopausal women; Bleeding; Echogenic endometrial fluid collection; Endometrial ablation; Endometrial cancer; Endometrial thickening; Hematometra; Thickened endometrium