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Background Results Discussion and Conclusion

References

1. Glass burn, J., L. Brady,P. Grigsby, Endometrium, in Principles and Practice in Radiation Oncology. 2nd ed, ed. P.a. Brady. 1997: Lippincott-Raven. 1835-52.2 Smith-Bindman, R., E. Weiss, and V. Feldstein, Ultrasound in Obstetrics and Gynaecology. 2004. 24(5): p. 558-565. 3 M. Gambacciani et al, Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women ,Maturitas 48 (2004) 421–424,4. Pe´rez-Medina T, Bajo J, Huertas MA, Rubio A. Predicting atypia inside endometrial polyps. J Ultrasound Med 2002 21:125–8.5 DeWaay DJ, Syrop CH, Nygaard IE, DavisWA, Van Voorhis BJ. Natural history of uterine polyps and leiomyomata. Obstet Gynecol2002;100:3-76.Goldstein SR, Monteagudo A, Popiolek D,Mayberry P, Timor-Tritsch I. Evaluation of endometrial polyps. Am J Obstet Gynecol 2002;186:669-74.7Orovieto R, Bar-Hava I, Dicker D, Bar J,Ben-Rafael Z, Neri A. Endometrial polyps during menopause: characterization and significance.Acta Obstet Gynecol Scand 1999;78;883-6.8 Ben-Arie A, Goldchmit C, Laviv Y, et al. The malignant potential of endometrial polyps. Eur J Obstet Gynecol 2004;115:206-10.9.Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort, Ian Jacobs, Aleksandra Gentry-Maharaj,et al The Lancet Oncology 1 January 2011 (Volume 12 Issue 1 Pages 38-48 DOI: 10.1016/S1470-2045(10)70268-0)

Discussion: To diagnose 2 focal atypical hyperplasia, we performed 114 interventions in our study. We had no cases of endometrial cancer.The 2011 UKCTOCS[4] report shows the EC risk to be 5.9% among asymptomatic postmenopausal women found incidentally to have ET of ≥10 mm. This finding concurs with the earlier Smith Bindman(2004) statistical hypothesis that EC risk would be 6.7 % at an ET of ≥10 mm in asymptomatic postmenopausal women. The numbers needed to treat (NNT) would be 47.7 asymptomatic postmenopausal women for an ET of ≥5 mm ,whereas it would be 17 women when the ET cut off ≥10 mm is used to trigger interventions. Moreover there are no studies to support improved mortality from EC due to earlier interventions in asymptomatic postmenopausal women.

Conclusion: ET of ≥ 10 mm may be used as a cut off value to trigger invasive investigations in asymptomatic postmenopausal women. The screening burden can be further reduced by limiting interventions to women at increased risk of endometrial cancer.

Methods and Results

128 histology samples were analysed 70 endometrial and 58 polyp samples. These numbers do not match with the number of interventions since in some both endometrial and polyp samples were obtained at one intervention.

Among the two women with focal atypical, one woman had a personal history of breast cancer and use od aramidex. The other had a family history of breast cancer. Both women have used hormone replacement therapy for less than 2 years.

2) Asymptomatic postmenopausal women both with and without HRT/Tamoxifen use were included

Main outcome measure: Diagnosis of endometrial cancer or complex atypical hyperplasia among these women.

ResultsDemographics of our study cohort are shown below.

Data was not available for all on risk factors for endometrial cancer such as age at menarche, body mass index, diabetes, hypertension, oral contraceptive use, hormone replacement use and breast cancer. The Median ET was 11, mean 11.2, and the range,1.6-27.6 mm.

26 women were managed conservatively.114 invasive interventions were performed and the outcomes are demonstrated below.

87%

6% 5%

2%

Histopathology of polyp samples,n=58

Benign end polyp

fibroid polyp

tam polyp

focal atypia

87%

5%5% 2% 1%

Histopathology of endometrial samples,n=70

atrophic

endo polyp

fibroid polyp

simpl.hyper

focal atypia

Expectant Management of incidental thickened endometrium, is it negligence?Nirmala Murthy, Registrar, Obstetrics and Gynaecology, Liverpool Women’s Hospital , Laura Moncreiffe , Foundation Doctor, UHSM

Mourad W Seif ,Senior Lecturer and Consultant Gynaecologist, University of Manchester /St Mary’s Hospital, Manchester

United Kingdom (UK)

Exclusion criteria:313 women were excluded due to missing data, ET<10mm and those with PMB.

Range Median

Age at presentation (Yrs)

52-78 65

Parity 0-7 2

Age at menopause (Yrs) 37-65 51

Outcomes of interventions

0

20

40

60

80

100

120

Pipelle OPH IPH

Interventions

SuccessfulFailed

OPHIPH

OPH+IPHLaparoscope

Outcomes (%)

Endometrial cancer (EC) presents early as postmenopausal bleeding[1].Incidental findings of thickened endometrium and endometrial polyp are increasing due to extensive use of imaging across all specialties. Current UK practice is to offer investigations to both symptomatic and asymptomatic postmenopausal women when the endometrial thickness is 4 mm or more and or endometrial polyp. The cost effectiveness and clinical benefit of such investigations are uncertain[2] Smith Bindman[3] calculated the statistical probability of EC to be 6.7 % for an endometrial thickness (ET) of ≥10 mm in asymptomatic postmenopausal women. This is similar to the 7.2% risk of EC for an ET of ≥5 mm among women with postmenopausal bleeding. Similarly the risk of EC in polyps reportedly ranges from 0-4%[4-9]. However these studies included both symptomatic and asymptomatic postmenopausal women.

ObjectiveTo identify the endometrial thickness cut off level for invasive interventions in asymptomatic postmenopausal women.

Methods Design: Retrospective clinical audit.

Study limitations include the retrospective nature, small sample size and single centre experience.

453 healthy postmenopausal UKCTOCS volunteers were referred with endometrial abnormalities to St. Mary’s Hospital, Manchester, 2002-2010.

Inclusion criteria: 1)140 asymptomatic healthy postmenopausal women with incidental ET ≥10 mm, endometrial polyp and or abnormal endometrium were included.