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Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding
Author(s) -
Louie Michelle,
Canavan Timothy P.,
Mansuria Suketu
Publication year - 2016
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2015.07.023
Subject(s) - medicine , odds ratio , endometrial biopsy , vaginal bleeding , confidence interval , endometrial hyperplasia , endometrial cancer , gynecology , carcinoma , biopsy , atypical hyperplasia , logistic regression , obstetrics , radiology , cancer , pregnancy , genetics , biology
Objective To provide an optimum threshold for endometrial biopsy sampling among postmenopausal women without vaginal bleeding and an incidentally‐found endometrial lining of above 4 mm. Methods A cohort of postmenopausal women (aged ≥ 50 years) who underwent pelvic ultrasonography at a tertiary US hospital for indications other than vaginal bleeding was retrospectively evaluated. Women were included if they had an endometrial lining of above 4 mm. Logistic regression was performed to determine the probability of endometrial carcinoma and atypical hyperplasia at each increasing millimeter of endometrial thickness from 4 to 20 mm. Results Among 462 women, carcinoma was identified in 9 (1.9%) and atypical hyperplasia in 7 (1.5%). An endometrial thickness of or above 14 mm was significantly associated with atypical hyperplasia (odds ratio 4.29; 95% confidence interval 1.30–14.20; P = 0.02), with a negative predictive value of 98.3%. A thickness of or above 15 mm was associated with carcinoma (odds ratio 4.53; 95% confidence interval 1.20–17.20; P = 0.03), with a negative predictive value of 98.5% and a 0.06% risk of cancer. Conclusion Irrespective of conventional risk factors, an incidentally‐found thickened endometrial lining of less than 15 mm might not warrant endometrial biopsy sampling among postmenopausal women without vaginal bleeding.