| Objective:By analyzing the clinical data of endometrial diseases in postmenopausal women and their relationship with pathological types,the risk factors of symptomatic and asymptomatic endometrial atypical hyperplasia and endometrial cancer after menopause were clarified,and the optimal endometrial thickness was selected as the limit value for pathological examination of asymptomatic endometrial thickening after menopause,providing reference for the clinical diagnosis and treatment of such patients.Methods:The clinical data of 610 postmenopausal patients with endometrial lesions diagnosed and treated in the Second Affiliated Hospital of Dalian Medical University from January 2019 to October 2018 were retrospectively analyzed.Endometrial thickness > 5mm was considered as endometrial thickening.They were divided into symptomatic group and asymptomatic group according to the presence of clinical symptoms,and benign group,endometrial atypical hyperplasia and endometrial cancer(AH/EC)group combined with pathological diagnosis.The general clinical data and pathological diagnosis results of the patients were collected,including the patient’s age,symptoms,menopause age,menopause years,pregnancy times,childbirth times,BMI,history of hypertension,history of diabetes,history of sex hormone-dependent diseases,previous uterine operations,endometrial thickness,family history of malignant tumors,etc.Pathological diagnosis results included polyps,inflammation,atypical hyperplasia,submucosal myoma,endometrial cancer,etc.,among which the AH/EC group included endometrial atypical hyperplasia and endometrial cancer,and the other pathological types were benign group.SPSS 26.0 software was used for data analysis.Measurement data were represented by median,and rank sum test was performed.Count data were represented by percentage(%),and Chi-square test(c2)or Fisher exact probability test were performed.Univariate analysis identified the risk factors of AH/EC in symptomatic and asymptomatic groups,and multivariate Logistic regression analysis was performed to obtain the independent risk factors of AH/EC in symptomatic and asymptomatic groups.According to sensitivity,specificity and Yoden index,the best truncation value of endometrial thickness was selected to diagnose AH/EC.ROC curve was drawn and AUC was calculated.P < 0.05 indicated statistically significant difference.Results:1.Among 610 postmenopausal patients with endometrial lesions,405(66.39%)were in the benign group and 205(33.61%)were in the AH/EC group.Polyps were the most common pathological type,accounting for 319(52.30%).There were 398 cases in the symptomatic group and 212 cases in the asymptomatic group.Polyps accounted for a high proportion in both groups,and there were statistically significant differences in polyps,submucosal myoma,inflammation,atypical hyperplasia and endometrial cancer between the two groups(P < 0.05).There were no statistically significant differences in the non-atypical hyperplasia and other pathological types between the two groups.2.In the symptomatic group,univariate analysis showed that age,menopause years,combined with estrogen-dependent disease,combined with endometrial thickening,combined with uterine space occupation were the risk factors for AH/EC in postmenopausal symptomatic women(P < 0.05).Meaningful risk factors from univariate analysis were included in multivariate Logistic regression analysis,and the results showed that combined sex hormone-dependent disease,combined endometrial thickness and combined uterine mass were independent risk factors for post-menopausal symptoms of AH/EC(P < 0.05).3.In the asymptomatic group,univariate analysis showed that menopause age combined with endometrial thickening were risk factors for AH/EC in asymptomatic postmenopausal women(P < 0.05).Significant risk factors from univariate analysis were included in multivariate Logistic regression analysis,and the results showed that endometrial thickening was an independent risk factor for asymptomatic postmenopausal AH/EC(P < 0.05).4.In the risk assessment of the endometrial thickness on AH/EC,the AUC of the symptomatic group was 0.77.When the endometrial thickness was ≥5mm,the sensitivity was 88%,the specificity was 59%,and the 95%CI was 0.70-0.84.At this time,the Yoden index was the highest(0.47),which had the highest diagnostic value.The AUC of the asymptomatic group was 0.8.When the endometrial thickness was ≥11mm,the sensitivity was 100%,the specificity was 56%,and the 95%CI was 0.50-1.10.At this time,the Yoden index was the highest(0.56),which had the highest diagnostic value.Conclusion:1.The pathology of postmenopausal patients with endometrial lesions was mostly benign and mainly polyps,and the distribution ratio of each pathological type was different between the symptomatic group and the asymptomatic group.2.For postmenopausal patients with endometrial disease,if the endometrial thickness is greater than 5mm,endometrial pathology examination should be performed in time;If the endometrial thickness is less than 5mm,and complicated with advanced age,long menopause years,estrogen-dependent diseases,uterine occupation or persistence,recurrent vaginal bleeding,etc.,adequate attention should also be paid to endometrial biopsy.3.Postmenopausal asymptomatic patients with simple endometrial thickening should not blindly perform invasive operations,but when they are combined with advanced age,late menopause,long menopause years,fewer pregnancy times,obesity,hypertension,diabetes,family history and other high risk factors of endometrial cancer,endometrial biopsy should be performed to guard against endometrial cancer or precancerous lesions and prevent delayed diagnosis and treatment.4.The endometrial thickness limit of asymptomatic AH/EC was assessed to be 11 mm,with a sensitivity of 100%.When the endometrial thickness of asymptomatic postmenopausal women was greater than 11 mm,endometrial biopsy should be actively performed to confirm the diagnosis. |
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