Role of transvaginal ultrasound in finding endometrial cancer in postmenopausal women with or without bleeding

Purpose of Investigation: To determine the endometrial thickness (ET) threshold to predict high risk of endometrial cancer (EC) in symptomatic and asymptomatic postmenopausal patients. It is also assessed whether additional ultrasonic findings (vascularisation, myometrial invasion, and inhomogeneity) improves diagnostic accuracy. Materials and Methods: In a prospective study the authors included 447 postmenopausal patients, treated for endometrial pathology. Ultrasound assessment was followed by endometrial sampling and histopathological examination. Results were compared according to presence of symptoms and histopathological findings (benign and malignant). Results: Eighty-six percent (385) patients were symptomatic and 14% (62) were asymptomatic. In the symptomatic patients with ET >= 5 mm, 17.5% had EC (CI: 13.5 -22); there was no patient with EC and ET less than 5 mm (CI: 0-15). All asymptomatic patients with ET >= 11 mm had benign findings. Three asymptomatic patients with malignancy were discovered because of other suspicious findings than ultrasound. Additional ultrasonic assessment showed statistically relevant results in symptomatic group (p < 0.05). Conclusions: In symptomatic women, less than 5 mm ET threshold rules out patients with EC with good certainty. In asymptomatic patients, ET measurement played no role in discovering EC.