Clinical And Pathological Analysis Of Asymptomatic Endometrial Thickening In Postmenopausal Women

Objective: This study retrospectively analyzed the clinical and pathological characteristics of postmenopausal patients with endometrial thickening,to explore whether there is clinical intervention for postmenopausal patients with asymptomatic endometrial thickening,whether there is an appropriate endometrial thickness cut-off value,and to evaluate the efficacy of cut-off value in detecting endometrial malignant lesions in this population,so as to screen endometrial malignant lesions accurately,and provide theoretical basis and reference for clinical treatment of this population.Methods: From January 2015 to December 2020,182 patients with postmenopausal asymptomatic endometrial thickening(transvaginal ultrasound endometrial thickness ≥ 4mm)underwent diagnostic curettage in Yijishan Hospital of Wannan Medical College.The data of 482 postmenopausal women with endometrial thickening were collected.SPSS26.0 software package was used for statistical analysis.T-test or nonparametric tests was used for measurement data,chi square test was used for counting data,and statistical analysis was made to see whether the differences among groups were statistically significant.The risk factors of univariate analysis were included in Logistic regression analysis.In the asymptomatic group,the sensitivity and specificity were calculated with different endometrial thickness,and the ROC curve was drawn to calculate the endometrial thickness cut-off value of clinical intervention.The efficacy of endometrial thickness as a predictor of endometrial malignant lesions was evaluated.Results: 1.664 cases of postmenopausal patients with endometrial thickening,pathological type and ultrasound imaging features,whether combined with mass(P=0.000)there was significant difference.2.There was no significant difference between asymptomatic group and symptomatic group when the echo was uniform(P=0.505);There was significant difference between the two groups(P=0.027).There was no significant difference between asymptomatic group(except ultrasound imaging features and mass)and symptomatic group in menopause age(P=0.401)and endometrial thickness(P=0.791);There were significant differences in age(P=0.009),menopausal years(P=0.016)and pathological type(P=0.002).3.The ultrasound imaging features with mass were excluded in the asymptomatic patients,and the pathological types of the 155 patients were proliferative endometrium in 63 cases(40.65%)and endometrial polyp in55 cases(35.48%).4.There were no significant differences in age(P=0.118),menopausal age(P=0.948)and menopausal years(P=0.195)between the malignant intima group and the benign intima group,except for the ultrasound imaging features of the asymptomatic patients with mass.There were significant differences in intimal thickness(P=0.037).Logistic regression analysis showed that endometrial thickness(OR 1.688,95% CI 1.070～ 2.663 P=0.024)was an independent risk factor for endometrial malignant lesions in asymptomatic patients(except for ultrasound imaging features with mass).5.The ultrasound imaging features of asymptomatic patients with mass were excluded,The sensitivity was 100% and the specificity was 57.24% with 10 mm as the cut-off value.The sensitivity and specificity of 11 mm were 66.67% and 69.74%,respectively.Therefore,10 mm has higher efficiency.The area under the ROC curve(AUC)of asymptomatic patients with different endometrial thickness in the diagnosis of endometrial malignant lesions was 0.947,and P=0.03,the difference was statistically significant,13.5 mm is the best cut-off value.Conclusion: 1.In postmenopausal patients with asymptomatic endometrial thickening,when the ultrasound imaging features endometrial thickening and mass,the risk of malignant lesions is increased.2.Postmenopausal patients with endometrial thickening symptoms than asymptomatic patients,ultrasound imaging features of uneven echo and the probability of combined mass increased.3.The pathological types of postmenopausal patients with asymptomatic endometrial thickening(except for ultrasound imaging features combined with mass)are mainly proliferative endometrium and endometrial polyps,and the incidence of malignant lesions is low.4.Endometrial thickness is an independent risk factor for endometrial malignancy in postmenopausal patients with asymptomatic endometrial thickening(except for ultrasound imaging features combined with mass).5.In postmenopausal patients with asymptomatic endometrial thickening(except for ultrasound imaging features combined with mass),when the endometrial thickness is less than 10 mm,the probability of endometrial cancer and precancerous lesions is low.