Risk of endometrial cancer in postmenopausal women undergoing diagnostic hysteroscopy: role of AUB and endometrial thickness

Aims to investigate the predictive value of endometrial thickness on the risk of endometrial cancer in postmenopausal women according to the presence or absence of AUB history. Secondly, to estimate the weight of BMI, hormone replacement therapy, hypertension and diabetes mellitus on the risk of cancer. Method We conducted a prospective, observational study from June 2012 to June 2014 on a cohort of postmenopausal patients undergoing diagnostic hysteroscopy with endometrial biopsy. Patients were included if a recent endometrial thickness measurement was available. For each patient we collected general features and history. Results 435 patients were included in the study: 329 asymptomatic with endometrial thickness ≥ 4 mm (ET_Group), 106 with AUB (AUB_Group), of which 58 with endometrial thickness ≥ 4 mm (AUB_Subgroup1) and 48 with ET < 4 mm (AUB_Subgroup2). We found higher prevalence of cancer in AUB_Group in comparison to ET_Group (15,2% vs 3,7%; p<0,001) and in AUB_Subgroup1 than AUB_Subgroup2 (20,7% vs 8,5%; p<0,001). Sensitivity and specificity of endometrial thickness for cancer detection in AUB patients resulted 75% and 48,3%. In ET_Group we found a correlation between endometrial thickness and BMI with cancer risk. The best cut-off of endometrial thickness for cancer diagnosis was 11 mm (100% sensitivity and 80% specificity). Conclusion In asymptomatic women hysteroscopy should be indicated exclusively when endometrial thickness is ≥ 11 mm, especially in case of overweight. In women with AUB the risk of cancer is considerably high even if endometrial thickness is < 4 mm, therefore diagnostic hysteroscopy is always recommanded in these patients.