Journal of minimally invasive gynecology · 2025
Hysteroscopy in Asymptomatic Postmenopausal Women With Thickened Endometrium: Analyzing Clinical Characteristics and Pathology With an Emphasis on SERM History.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Liang Ze, Gu Xiangyu, Dong Yifan, Li Wenbo, Lv Changshuai, Li Ling, Tong Jiali
Аннотация
OBJECTIVE: To optimize cut-off values of endometrial thickness for referral to hysteroscopy among asymptomatic postmenopausal women with thickened endometrium.
DESIGN: A retrospective observational analysis.
SETTING: A teaching hospital.
PATIENTS: 415 asymptomatic postmenopausal cases who underwent hysteroscopy with thickened endometrium between January 2014 to January 2023.
INTERVENTIONS: Patients with endometrium thicker than 5mm underwent hysteroscopy for endometrial pathological examination.
MEASUREMENTS: Transvaginal sonography (TVS) reports of 37732 patients who had ET ≥ 5mm were reviewed. Among them, 415 patients were postmenopausal and asymptomatic. Their clinical characteristics were analyzed retrospectively, including demographic data, TVS reports, hysteroscopy surgery records, and pathology results.
RESULTS: Endometrial thickness significantly differed between patients whose samples were pathologically benign and those who turned out premalignant or malignant (χ2 = 70.7, P < .001). The observed endometrial morphology during hysteroscopy varied notably between these groups (χ2 = 33.3, p < .001). Logistic regression revealed significant associations between treatment by Selective Estrogen Receptor Modulator (SERM; OR = 3.2, p = .04), increased endometrial thickness (OR = 3.7, p < .001), and abnormal endometrial morphology (OR = 3.4, p < .001) with non-benign outcomes. To differentiate for non-benign pathology, the optimal endometrial thickness cut-offs were 10.5mm for all asymptomatic patients with thickened endometrium, 10.5mm for those with concurrent intrauterine lesions, and 19.5mm for those with a history of SERM treatment.
CONCLUSIONS: Increasing the endometrial thickness cut-off value in asymptomatic postmenopausal women, especially for those with a history of SERM treatment, would improve patient management.
DESIGN: A retrospective observational analysis.
SETTING: A teaching hospital.
PATIENTS: 415 asymptomatic postmenopausal cases who underwent hysteroscopy with thickened endometrium between January 2014 to January 2023.
INTERVENTIONS: Patients with endometrium thicker than 5mm underwent hysteroscopy for endometrial pathological examination.
MEASUREMENTS: Transvaginal sonography (TVS) reports of 37732 patients who had ET ≥ 5mm were reviewed. Among them, 415 patients were postmenopausal and asymptomatic. Their clinical characteristics were analyzed retrospectively, including demographic data, TVS reports, hysteroscopy surgery records, and pathology results.
RESULTS: Endometrial thickness significantly differed between patients whose samples were pathologically benign and those who turned out premalignant or malignant (χ2 = 70.7, P < .001). The observed endometrial morphology during hysteroscopy varied notably between these groups (χ2 = 33.3, p < .001). Logistic regression revealed significant associations between treatment by Selective Estrogen Receptor Modulator (SERM; OR = 3.2, p = .04), increased endometrial thickness (OR = 3.7, p < .001), and abnormal endometrial morphology (OR = 3.4, p < .001) with non-benign outcomes. To differentiate for non-benign pathology, the optimal endometrial thickness cut-offs were 10.5mm for all asymptomatic patients with thickened endometrium, 10.5mm for those with concurrent intrauterine lesions, and 19.5mm for those with a history of SERM treatment.
CONCLUSIONS: Increasing the endometrial thickness cut-off value in asymptomatic postmenopausal women, especially for those with a history of SERM treatment, would improve patient management.