Endometrial study in patients with postmenopausal metrorrhagia

Area of Science:

• Gynecology
• Oncology
• Diagnostic Imaging

Background:

• Minimizing invasive diagnostic tests for endometrial pathologies is crucial.
• Accurate diagnosis of adenocarcinoma and atypical hyperplasia is essential for timely treatment.

Purpose of the Study:

• To develop an efficient diagnostic strategy for malignant endometrial pathologies.
• To reduce the number of invasive procedures while maintaining high detection rates.

Main Methods:

• Retrospective study of 779 postmenopausal women with a 1-year follow-up.
• Analysis of clinical histories including hysteroscopy, aspiration biopsy, and curettage.
• Evaluation of transvaginal ultrasound findings and endometrial thickness.

Main Results:

• Malignant pathology detected in 77 women (66 adenocarcinomas, 11 atypical hyperplasias).
• Transvaginal ultrasound sensitivity 98.4% (≥5 mm cutoff); aspiration biopsy sensitivity 89.1%; hysteroscopy 83.9%.
• Biopsy achieved 100% sensitivity and specificity for malignant pathology detection.

Conclusions:

• For postmenopausal women with metrorrhagia, transvaginal ultrasound is the recommended first step.
• Further endometrial study is indicated if ultrasound shows irregular endometrium or thickness ≥5 mm.
• In asymptomatic women, an endometrial thickness cutoff of 10 mm is suggested; ambulatory biopsy is the preferred immediate method.