Endometrial study in patients with postmenopausal metrorrhagia.

Serna Torrijos, María C.; de Merlo, Gaspar González; González Mirasol, Esteban; Gómez García, María Teresa; Ángel Parra, Carmen; Goy, Enrique Iglesias; Torrijos, María C Serna; Mirasol, Esteban González; García, María Teresa Gómez; Parra, Carmen Ángel

<bold>Introduction: </bold>The aim of the study was to devise a strategy to diagnose malign endometrial pathologies (adenocarcinoma or atypical hyperplasia) that minimizes the number of invasive tests done (hysteroscopy, aspiration biopsy or curettage) with no loss of its detection efficiency.<bold>Material and Methods: </bold>We retrospectively studied the clinical histories of 779 postmenopausal women at the University Hospital Complex of Albacete, for whom an endometrial study had been done (hysteroscopy, aspiration biopsy or curettage) with a 1-year follow-up between 1 March 2006 and 31 March 2008.<bold>Results: </bold>There were 77 cases of a malignant pathology (66 adenocarcinomas and 11 hyperplasias with atypia); 96.1% had metrorrhagia, and there were only 3 cases of asymptomatic patients (all 3 presented endometrial thickness of > 5 mm: 10, 12 and 15 mm). The sensitivity and specificity of the transvaginal ultrasound, with a 5 mm cut-off point to diagnose a malignant pathology, were 98.4% and 30.1%, respectively; 89.1% and 99.6%, respectively, for aspiration biopsy; 83.9% and 99.1%, respectively, for hysteroscopy without biopsy; and both were 100% for biopsy. Statistical significance was considered at p < 0.05 and confidence intervals were calculated at 95%.<bold>Conclusions: </bold>In postmenopausal women with metrorrhagia, the first action to take is to do a transvaginal ultrasound, followed by en endometrial study, but only if the endometrium is irregular or endometrial thickness is ≥ 5 mm; in asymptomatic women, the cut-off point should be set at 10 mm. The immediate method of choice is an ambulatory biopsy.

METRORRHAGIA; POSTMENOPAUSE; ENDOMETRIAL diseases; DISEASE progression; ENDOMETRIAL biopsy

Archives of Medical Science, 2016, Vol 12, Issue 3, p597

1734-1922

Academic Journal

10.5114/aoms.2016.59934