title: Investigating vaginal bleeding in postmenopausal women found to have an endometrial thickness of equal to or greater than 10 mm on ultrasonography.
abstract: OBJECTIVE
  This aim of this study is to determine the risk of endometrial cancer in symptomatic postmenopausal women, when endometrial thickness on transvaginal ultrasonography is equal to or greater than 10 mm, and subsequent office-based endometrial sampling histology is negative.
  
  
  METHODS
  This is a prospective cross-sectional study, performed in a gynaecological oncology centre in the United Kingdom between February 2008 and July 2012. All postmenopausal women presenting with vaginal bleeding were investigated using transvaginal ultrasonography. Women with endometrial thickness measurements equal to or greater than 10 mm and negative office-based endometrial biopsy underwent hysteroscopy and endometrial biopsies.
  
  
  RESULTS
  Over a 52-month period, 4148 women were investigated for postmenopausal vaginal bleeding. 588 (14.2%) women were found to have endometrial thickness measurements of equal to or greater than 10 mm on transvaginal ultrasonography. 170 (28.9%) cases of endometrial cancer were diagnosed in this group: 149 (87.6%) of the cancer cases were diagnosed in the outpatient setting with a Pipelle®endometrial sampler, whilst 21 (12.4%) had a negative Pipelle®sample and were diagnosed with hysteroscopy. The group diagnosed with hysteroscopy had lower BMI (32.7 kg/m2versus 39.7 kg/m2, p < 0.001) whilst the group diagnosed with Pipelle was more likely to have a history of hypertension and diabetes mellitus (p = 0.019 for both). The sensitivity of Pipelle was 87.65%.
  
  
  CONCLUSIONS
  For women presenting with postmenopausal bleeding and where the endometrial thickness is equal to or greater than 10 mm and Pipelle sampling is negative, hysteroscopic evaluation with directed biopsy is strongly recommended.
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. Hilary.turnbull@nnuh.nhs.uk.
authors.forename: Hilary L
authors.identifier: http://orcid.org/0000-0002-6669-571X
authors.initials: HL
authors.lastname: Turnbull
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Akrivos
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Simpson
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Duncan
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Joaquin J
authors.initials: JJ
authors.lastname: Nieto
authors.affiliation: Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Burbos
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D016889:Endometrial Neoplasms / Q000209:etiology* / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000473:pathology*
keywords: Endometrial Cancer; Endometrial thickness; Hysteroscopy; Postmenopausal vaginal bleeding