Clinical Significance of Endometrial Abnormalities: an Observational Study on 1020 Women Undergoing Hysteroscopic Surgery

Overview

Journal BMC Womens Health

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2022 Apr 8

PMID 35392892

Authors

Lodovico Patrizi

Carlo Ticconi

Barbara Borelli

Susanna Finocchiaro

Carlo Chiaramonte

Francesco Sesti

Alessandro Mauriello

Caterina Exacoustos

Luisa Casadei

Affiliations

Soon will be listed here.

Abstract

Background: The overall clinical significance of the finding of endometrial abnormalities in predicting premalignant/malignant endometrial lesions is still incompletely determined. For this reason the management, surgical or expectant, of women in which an endometrial abnormality has been detected is debated.

Methods: This retrospective study was carried out on 1020 consecutive women, 403 premenopausal and 617 postmenopausal, who underwent operative hysteroscopy in a University Hospital for suspected endometrial abnormalities, which were detected by transvaginal ultrasound (TVS) and/or office hysteroscopy. In these women, the clinical characteristics and findings at TVS and hysteroscopy were evaluated in relation to the presence/absence of premalignant/malignant endometrial lesions at pathology report.

Results: The clinical characteristics considered were significantly different when the study women were compared according to their menopausal status. Premalignant/malignant lesions were found in 34/1020 (3.33%) women. Complex hyperplasia with atypia and endometrial cancer were detected in 22 (2.15%) and 12 (1.17%) cases, respectively. The postmenopausal women had a significantly higher risk of premalignant/malignant lesions than premenopausal women (O.R. = 5.098 [95% C.I.: 1.782-14.582], P < 0.005). This risk was even higher when abnormal uterine bleeding (AUB) was present (O.R. = 5.20 [95% C.I.: 2.38-11.35], P < 0.0001). The most significant associations with premalignant/malignant endometrial lesions were BMI, AUB in postmenopause, overall polyp size, atypical aspect of endometrial polyps at hysteroscopy, postmenopausal status, diabetes mellitus and patient age.

Conclusions: The results of the present study suggest that the proper, aggressive or expectant, management of endometrial abnormalities should take into account both ultrasonographic and hysteroscopic findings together with the specific clinical characteristics of the patients.

Citing Articles

Comparison of Endometrial Polyp Characteristics in Transvaginal Sonography and Hysteroscopy in Predicting Endometrial Malignancies in Premenopausal and Postmenopausal Women.

Rouholamin S, Irannezhad P, Hashemi M Adv Biomed Res. 2024; 13:27.

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Analysis of ultrasonic imaging changes and factors related to malignant transformation in postmenopausal patients with endometrial polyps.

Meng Q, Ge N, Fan Y, Li L Am J Transl Res. 2024; 16(7):3055-3063.

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References

Ianieri M, Staniscia T, Pontrelli G, Di Spiezio Sardo A, Manzi F, Recchi M . A New Hysteroscopic Risk Scoring System for Diagnosing Endometrial Hyperplasia and Adenocarcinoma. J Minim Invasive Gynecol. 2016; 23(5):712-8. DOI: 10.1016/j.jmig.2016.02.017. View

. Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial. Facts Views Vis Obgyn. 2019; 11(2):127-134. PMC: 6897516. View

. ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018; 131(5):e124-e129. DOI: 10.1097/AOG.0000000000002631. View

Leone F, Timmerman D, Bourne T, Valentin L, Epstein E, Goldstein S . Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol. 2009; 35(1):103-12. DOI: 10.1002/uog.7487. View

Ricci E, Moroni S, Parazzini F, Surace M, Benzi G, Salerio B . Risk factors for endometrial hyperplasia: results from a case-control study. Int J Gynecol Cancer. 2002; 12(3):257-60. DOI: 10.1046/j.1525-1438.2002.01105.x. View

Njoku K, Abiola J, Russell J, Crosbie E . Endometrial cancer prevention in high-risk women. Best Pract Res Clin Obstet Gynaecol. 2020; 65:66-78. DOI: 10.1016/j.bpobgyn.2019.12.005. View

de Azevedo J, de Azevedo L, Freitas F, Wender M . Endometrial polyps: when to resect?. Arch Gynecol Obstet. 2015; 293(3):639-43. DOI: 10.1007/s00404-015-3854-3. View

Wethington S, Herzog T, Burke W, Sun X, Lerner J, Lewin S . Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol. 2011; 18(13):3819-23. DOI: 10.1245/s10434-011-1815-z. View

. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2011; 19(1):3-10. DOI: 10.1016/j.jmig.2011.09.003. View

10.

Munro M, Critchley H, Broder M, Fraser I . FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011; 113(1):3-13. DOI: 10.1016/j.ijgo.2010.11.011. View

11.

Levy-Zauberman Y, Pourcelot A, Capmas P, Fernandez H . Update on the management of abnormal uterine bleeding. J Gynecol Obstet Hum Reprod. 2017; 46(8):613-622. DOI: 10.1016/j.jogoh.2017.07.005. View

12.

Aggarwal A, Hatti A, Tirumuru S, Nair S . Management of Asymptomatic Postmenopausal Women Referred to Outpatient Hysteroscopy Service with Incidental Finding of Thickened Endometrium - A UK District General Hospital Experience. J Minim Invasive Gynecol. 2021; 28(10):1725-1729. DOI: 10.1016/j.jmig.2021.02.012. View

13.

Ghoubara A, Sundar S, Ewies A . Predictors of malignancy in endometrial polyps: study of 421 women with postmenopausal bleeding. Climacteric. 2017; 21(1):82-87. DOI: 10.1080/13697137.2017.1410783. View

14.

Singh S, Best C, Dunn S, Leyland N, Wolfman W . No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can. 2018; 40(5):e391-e415. DOI: 10.1016/j.jogc.2018.03.007. View

15.

Ghoubara A, Emovon E, Sundar S, Ewies A . Thickened endometrium in asymptomatic postmenopausal women - determining an optimum threshold for prediction of atypical hyperplasia and cancer. J Obstet Gynaecol. 2018; 38(8):1146-1149. DOI: 10.1080/01443615.2018.1458081. View

16.

Alcazar J, Bonilla L, Marucco J, Padilla A, Chacon E, Manzour N . Risk of endometrial cancer and endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness ≥11 mm: A systematic review and meta-analysis. J Clin Ultrasound. 2018; 46(9):565-570. DOI: 10.1002/jcu.22631. View

17.

Ferrazzi E, Zupi E, Leone F, Savelli L, Omodei U, Moscarini M . How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol. 2008; 200(3):235.e1-6. DOI: 10.1016/j.ajog.2008.09.876. View

18.

Leslie K, Thiel K, Goodheart M, De Geest K, Jia Y, Yang S . Endometrial cancer. Obstet Gynecol Clin North Am. 2012; 39(2):255-68. PMC: 3518445. DOI: 10.1016/j.ogc.2012.04.001. View

19.

Jiang T, Yuan Q, Zhou Q, Zhu Y, Lv S, Cao Y . Do endometrial lesions require removal? A retrospective study. BMC Womens Health. 2019; 19(1):61. PMC: 6501327. DOI: 10.1186/s12905-019-0756-8. View

20.

Park Y, Lee S, Kim Y, Bae I, Kim H, Choe J . Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women. Obstet Gynecol Sci. 2019; 62(6):445-453. PMC: 6856473. DOI: 10.5468/ogs.2019.62.6.445. View