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Diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies and appropriateness of performed hysteroscopies among asymptomatic postmenopausal women.

Eur J Obstet Gynecol Reprod Biol. 2014 Jun;177:29-33. doi: 10.1016/j.ejogrb.2014.03.025. Epub 2014 Apr 12.

Giannella L1, Mfuta K2, Setti T2, Boselli F3, Bergamini E2, Cerami LB2.
1Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy. Electronic address: lucazeta1976@libero.it.2Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynaecology, Cesare Magati Hospital, Scandiano, Italy.3Mother-Infant Department, Institute of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, Modena, Italy.
Eur J Obstet Gynecol Reprod Biol
ABSTRACT
OBJECTIVE: To measure the diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies among asymptomatic postmenopausal women, and to test the diagnostic accuracy and appropriateness of performed hysteroscopies.STUDY DESIGN: Prospective study of 268 asymptomatic postmenopausal women with endometrial thickness =4mm referred to diagnostic hysteroscopy. The diagnostic accuracy of various endometrial thickness cut-off values was tested. Histological and hysteroscopic results were compared to measure the diagnostic accuracy of outpatient hysteroscopies.RESULTS: No endometrial thickness cut-off values had optimal diagnostic accuracy [positive likelihood ratio (LR+) >10 and negative likelihood ratio (LR-) <0.1]. The best endometrial thickness cut-off value for the detection of all intra-uterine pathologies was =8mm (LR+ 10.05 and LR- 0.22). An endometrial thickness cut-off value =10mm did not miss any cases of endometrial cancer. The success rate of diagnostic hysteroscopy was 89%, but 97% of these revealed a benign intra-uterine pathology. The diagnostic accuracy of hysteroscopy was optimal for all intra-uterine pathologies, except endometrial hyperplasia (LR- 0.52).CONCLUSION: Using an endometrial thickness cut-off value =4mm, only 3% of performed hysteroscopies were useful for the detection of pre-malignant or malignant lesions. Despite the finding that endometrial thickness did not show optimal diagnostic accuracy, using the best cut-off value (=8mm) may be helpful to decrease the number of false-positive results. No cases of endometrial cancer were diagnosed in asymptomatic postmenopausal women with endometrial thickness <10mm.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:24766900 | http://www.ncbi.nlm.nih.gov/pubmed/24766900

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