| Objective:Analyze the clinical data and postoperative pathological reports of postmenopausal patients with endometrial thickening,and explore the relationships between clinical data and pathological reports in these patients.Then provide guidance for invasive surgery.Methods:A total of 190 medical records of asymptomatic postmenopausal women with endometrial thickening(endothelium?4mm)who were diagnosed by physical examination in Tianjin Medical University General Hospital from February 2012 to February 2018 were collected.366 women who had symptoms of PMB and increased vaginal secretions with thickened endometrium were collected in the same period.Clinical data and pathological reports were collected.All analyses were performed by SPSS version 23.0.The independent t-test,Mann-Whitney U test,?~2 test and Fisher's exact test were applied to compare the difference between two groups.A multivariate logistic regression model was applied to evaluate the relationship between clinical characteristics and the occurrence of endometrial cancer.ROC curves were derived to assess the performance of endometrial thickness as a diagnostic test for the detection of endometrial diseases.Result:1.The BMI in the symptomatic group was significantly higher than that in the asymptomatic group(28.32±18.1 vs.25.25±3.14 kg/m~2,P=0.045),and both were high in the two groups;222 cases(60.66%)were with hypertension in the symptomatic group and there were 97 cases(51.05%)in the asymptomatic group,the difference was statistically significant(P=0.03);the endometrium in the symptomatic group was11.80±7.51mm,and in the asymptomatic group was 10.49±4.7mm,the difference was statistically significant(P=0.012).The age,menarche age,serum estradiol levels,age of menopause,menopause period,and diabetes mellitus had no significant differences in the two groups.2.The endometrial cancer and AH in the symptomatic group was significantly higher than that in the asymptomatic group(18.58%vs.0.53%,P<0.001);benign lesions in asymptomatic group were 187 cases(98.42%),significantly higher than260 cases(71.04%)in the symptomatic group(P<0.001);non-organic lesions in symptomatic group were 38 cases(10.38%)significantly higher than the asymptomatic group 2 cases(1.05%),and the difference was statistically significant(P<0.001).3.In all patients,the average endometrium of endometrial cancer and AH group(Group A)was 15.2±8.64 mm,which was significantly thicker than that of benign and non-organic lesions group(Group B)(10.82±6.20 mm)(P<0.001).In Group A,24 patients(34.78%)had diabetes mellitus and more than 111 patients(22.79%)in Group B(P=0.03);68 patients in Group A had a symptom of PMB(98.55%),and 298 cases in Group B(61.19%),there were statistically significant(P=0.009).The risk factors which were selected by independent t-test and?~2 test were included in the multivariate logistic regression analysis.The results suggested that PMB(OR16.249,95%CI 2.167~121.869,P=0.007),diabetes(OR2.544,95%CI1.175~5.506,P=0.018),endometrial thickening(OR1.049,95%CI 1.002~1.099,P=0.04)were independent risk factor for endometrial cancer.The risk of endometrial cancer and AH was significantly higher in women with two high-risk factors than that with one high-risk factor(OR3.452,95%CI 1.977-6.028,P<0.001).4.The sensitivity of diagnosing endometrial cancer and AH with the cutoffs of 4,5,7 and 11 mm were 97.10%,95.70%,87.00%,63.80%,respectively;and the specificities were 3.70%,13.30%,32.20%and 64.70%,respectively.The cutoff of9.5mm had the best diagnostic efficiency.5.The sensitivity of diagnosing endometrial organic lesions with the cutoffs of 4,5,7 and 11mm were 97.50%,90.30%,73.40%and 41.50%respectively;and the specificities were 15.00%,42.50%,70.00%and 92.50%,respectively.The cutoff of7.45mm had the best diagnostic efficiency.6.In the asymptomatic group,the sensitivity for the detection of endometrial cancer and AH with the cutoffs of 4,5,7 and 11mm were all 100%;and the specificities were 0%,2.12%,17.99%and 61.90%,respectively.The positive predictive values for the diagnosis of endometrial cancer and AH at the cutoffs of 4,5,7 and 11mm were 0.53%,0.54%,0.64%and 1.37%respectively.At the cutoffs of 5,7 and 11mm the negative predictive values were all 100%.The cutoff of 11mm had the best diagnostic efficiency.7.In the asymptomatic group,the sensitivity for the detection of organic lesions with the cutoffs of 4,5,7 and 11mm were 100%,97.87%,82.98%and 38.83%,respectively;and the specificities were 0%,0%,100%and 100%,respectively.The positive predictive values for the diagnosis of organic lesions at the cutoffs of 4,5,7and 11mm were 98.95%,98.92%,100%and 100%,respectively.At the cutoffs of 5,7 and 11mm the negative predictive values were 0%,5.88%and 1.71%,respectively.The cutoff of 7mm had the best diagnostic efficiency.Conclusion:1.Endometrial polyps,submucosal fibroids,endometrial cancer and AH,intrauterine adhesions and non-organic diseases such as proliferative endometrium,secretory endometrium and the individual differences of endometrial basal layer can cause postmenopausal endometrial thickening.2.Benign lesions are most common in asymptomatic postmenopausal endometrial thickening,and endometrial polyps are most common in the benign lesions.There is low risk of malignant lesions in asymptomatic postmenopausal endometrial thickening.3.In asymptomatic endometrial thickening after menopause,the probability of endometrial cancer and AH is extremely low when the endometrium thickness is less than 11mm. |
PDF Full Text Request