Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

• Published in: Australian & New Zealand journal of obstetrics & gynaecology 2022-04, Vol.62 (2), p.190-197
• Main Authors: Li, Jessica X. L., Chan, Felix, Johansson, Cherynne Yuin Mun
• Format: Article
• Language: English
• Subjects: asymptomatic; carcinoma of the endometrium; Endometrial Hyperplasia - complications; Endometrial Hyperplasia - diagnostic imaging; Endometrial Neoplasms - diagnostic imaging; Endometrium - diagnostic imaging; Endometrium - pathology; Female; Humans; Hyperplasia; Postmenopause; systematic review; Ultrasonography; Uterine Hemorrhage - etiology
• ISSN: 0004-8666; 1479-828X
• DOI: 10.1111/ajo.13472

Background Asymptomatic postmenopausal women incidentally found to have thickened endometrium (>4 mm) on transvaginal ultrasound (TVUS) often undergo hysteroscopy and dilatation and curettage despite having a low absolute risk of endometrial cancer. A low threshold for investigation may be unnecessary in these women. Aim This systematic literature review examines whether an increased TVUS endometrial thickness threshold has superior diagnostic accuracy for endometrial malignancies and premalignancies in asymptomatic postmenopausal women than the current threshold of ≥4 mm. Methods Pubmed, EMBASE and Cochrane Database of Systematic Reviews were systematically searched using keywords for publications between 2011 and 2021. Studies were included if they reported TVUS endometrial thickness analysis in asymptomatic postmenopausal women and excluded if they were written in a non‐English language. Quality of evidence in the included articles was evaluated according to recommendations by the Grading of Recommendations Assessment Development and Evaluation Working Group and reported results were tabulated. Results Of seven studies (N = 2986), better evidence identified 12 mm as the optimal diagnostic threshold (area under the curve receiver operating characteristic (AUC ROC) 0.716, 95% CI 0.534–0.897, P = 0.019) for endometrial cancer in asymptomatic postmenopausal women. Two higher quality studies (n = 488 and n = 4751) identified 11 mm as optimal for diagnosing both endometrial carcinoma and atypical hyperplasia (AUC ROC 0.587, 95% CI 0.465–0.708, P = 0.144 and 2.59 relative risk, 95% CI 1.66–4.05, P