title: Diagnostic value of sonography for detecting endometrial pathologies in postmenopausal women with and without bleeding.
abstract: OBJECTIVE
  To investigate the diagnostic value of endometrial thickness measurement on sonography in predicting endometrial pathologies in postmenopausal women with vaginal bleeding and in those with asymptomatic thickened endometrium.
  
  
  METHODS
  Six hundred two postmenopausal women with vaginal bleeding or asymptomatic thickened endometrium were evaluated in this study. Two hundred seventy-four women with postmenopausal bleeding regardless of endometrial thickness (group 1: symptomatic) and 328 women with an incidental finding of thickened endometrium (≥5 mm) without bleeding (group 2: asymptomatic) underwent endometrial biopsy for histopathologic examination. The receiver operating characteristics curves of endometrial thickness measurement for prediction of endometrial pathologies were analyzed.
  
  
  RESULTS
  Endometrial carcinoma was detected in eight women (2.9%) in group 1 and in three (0.9%) in group 2. The best cutoff point for endometrial thickness in predicting endometrial carcinoma in group 1 was 8.2 mm, which provided 75% sensitivity (95% confidence interval [CI], 40.9-92.9%) and 74% specificity (95% CI, 68-78.5%); area under the receiver operating characteristics curve (AUC), 0.88; 95% CI, 0.76-1.00%; p = 0.0001. In group 2, the AUC was 0.76 (95% CI, 0.46-1.00; p = 0.114); the evidence was inconclusive as to the relationship between endometrial thickness and malignancy. For the prediction of polyps, the AUCs of endometrial thickness were 0.77 for group 1 (95% CI, 0.71-0.83%; p = 0.0001) and 0.61 for group 2 (95% CI, 0.54-0.67%; p = 0.002).
  
  
  CONCLUSIONS
  Sonographically determined endometrial thickness measurement shows high diagnostic performance for detection of endometrial cancer in symptomatic postmenopausal women at the optimal cutoff thickness of approximately 8 mm, although the evidence supporting the use of sonography for predicting malignancy in asymptomatic women is inconclusive. For polyp detection, this technique shows moderate diagnostic ability in symptomatic women, but its predictive value is low in asymptomatic women. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:339-346, 2016.
authors: Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
authors: Berna
authors: B
authors: Seckin
authors: Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
authors: Mahmut Nedim
authors: MN
authors: Cicek
authors: Department of Public Health, Gazi University, Ankara, Turkey.
authors: Asiye Ugras
authors: AU
authors: Dikmen
authors: Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
authors: Esra Isci
authors: EI
authors: Bostancı
authors: Department of Pathology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
authors: Kamil Hakan
authors: KH
authors: Muftuoglu
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional 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; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014421:Turkey; D014463:Ultrasonography / Q000379:methods*; D014592:Uterine Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: endometrial biopsy; endometrium; postmenopause; ultrasonography; uterus