title: Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study.
abstract: OBJECTIVE
  To estimate the accuracy of transvaginal ultrasound (TVS) measurement of endometrial thickness (ET) in diagnosing endometrial cancer in postmenopausal women with vaginal bleeding (PMB).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  One-stop PMB clinic in a Hong Kong teaching hospital.
  
  
  METHODS
  A cohort of 4383 women with PMB.
  
  
  METHODS
  Transvaginal ultrasonic measurement of ET and endometrial biopsies were obtained in women presenting with PMB between 2002 and 2013. Endometrial histology was used as the reference standard to calculate accuracy estimates.
  
  
  METHODS
  Accuracy data for TVS ET presented as sensitivity, specificity, and area under the receiver operator characteristic (ROC) curve.
  
  
  RESULTS
  Endometrial cancer was diagnosed in 3.8% of women. The median ET in those with endometrial cancer was significantly higher than those with benign conditions (15.7 versus 3.2 mm, P < 0.001). The area under the ROC curve was 0.92 (95% CI 0.89-0.94). The sensitivity for the detection of endometrial cancer at 3-, 4-, and 5-mm cut-offs were 97.0% (95% CI 94.5-99.6%), 94.1% (95% CI 90.5-97.6%), and 93.5% (95% CI 89.7-97.2%), respectively. The corresponding estimates of specificity at these thresholds were 45.3% (95% CI 43.8-46.8%), 66.8% (65.4-68.2%), and 74.0% (72.7-75.4%).
  
  
  CONCLUSIONS
  Transvaginal ultrasound using a 3-mm cut-off has high sensitivity for detecting endometrial cancer and can identify women with PMB who are highly unlikely to have endometrial cancer, thereby avoiding more invasive endometrial biopsy.
authors: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong.
authors: A S-W
authors: AS
authors: Wong
authors: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong.
authors: T T-H
authors: TT
authors: Lao
authors: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong.
authors: C W
authors: CW
authors: Cheung
authors: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong.
authors: S W
authors: SW
authors: Yeung
authors: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong.
authors: H L
authors: HL
authors: Fan
authors: Department of Obstetrics and Gynaecology, Union Hospital, Hong Kong City, Hong Kong.
authors: P S
authors: PS
authors: Ng
authors: Department of Obstetrics and Gynaecology, Hong Kong Sanatorium & Hospital, Hong Kong City, Hong Kong.
authors: P M
authors: PM
authors: Yuen
authors: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong.
authors: D S
authors: DS
authors: Sahota
mesh_terms: D001706:Biopsy; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D012189:Retrospective Studies; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology*
keywords: Endometrial cancer; endometrial thickness; transvaginal ultrasound