Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography

Objective To evaluate endometrial thickness and uterine arterial now measurement as predictors of endometrial cancer. Design Prospective study among a cohort of women invited to age-adjusted, population-based breast cancer screening by mammography. Setting City of Turku, Finland. Population 1074 postmenopausal women aged 57-61 years (mean 59 years). Methods Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was greater than or equal to 4.0 mm, if the uterine artery pulsatility index was less than or equal to 1.0 or if there was a fluid accumulation in the endometrial cavity. Main outcome measures Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models. Results An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result. Conclusion Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is greater than or equal to 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.