THICKENED ENDOMETRIAL STRIPE AND OR ENDOMETRIAL FLUID AS A MARKER OF PATHOLOGY - FACT OR FANCY/

Objective: To evaluate the implication of a thickened endometrial stri pe (ES) and endometrial fluid (EF) in postmenopausal women. Methods: B etween 1991 and 1995, 897 consecutive postmenopausal patients underwen t pelvic ultrasound at our institution. Clinical and ultrasound data w ere reviewed for the 624 patients in whom a comprehensive evaluation o f the uterus and adnexae was performed. Of this study group, 495 had n ormal ES thickness. Nine patients with a thickened ES were excluded du e to immediate hysterectomy or history of cervical cancer. This result ed in 120 subjects comprising the group with EF, or a thickened ES [gr eater than or equal to 5 mm for patients not on hormone replacement th erapy (HR-) and greater than or equal to 8 mm in patients receiving ho rmone replacement therapy (HR+)]. Symptoms were defined as bleeding. S tatistical analysis was performed by use of Fisher's exact test. Resul ts: 184/495 patients with normal ES thickness underwent biopsy. In thi s group, 7 cases of simple hyperplasia, 4 cases of atypical hyperplasi a (AH), and 4 cases of endometrial cancer (CA) were detected. All of t hese subjects who were found to have either AH or CA were symptomatic. Of the subjects with a thickened ES, 54 had symptoms and 66 were asym ptomatic with 51/54 and 52/66 undergoing endometrial sampling, respect ively. Initial sampling in the symptomatic group with thickened ES rev ealed 7 cases of simple hyperplasia and 2 cases of AH. There were 6 ca ses of simple hyperplasia in the asymptomatic group (P = NS). Initial biopsy results were either negative or nondiagnostic in 42 symptomatic patients and 46 asymptomatic patients with 40/42 and 19/46 undergoing repeat sampling, respectively. Repeat sampling further identified 9 c ases of endometrial hyperplasia or cancer in the symptomatic group whi le in the asymptomatic group, 2 cases of simple hyperplasia were detec ted. For symptomatic and asymptomatic patients, analysis of combined i nitial and second biopsies performed within 1 year was undertaken. Thi s combined analysis revealed a significantly greater rate of detection of endometrial hyperplasia or carcinoma in the symptomatic group vs t he asymptomatic group (P = 0.0229, Fishers exact test, [Mantel-Haensze l odds ratio 3.094, confidence interval 0.4799-25.7]). Indeed, the obs erved detection of hyperplasia or cancer doubled in the symptomatic gr oup, increasing from 9 to 18%, but did not increase significantly in t he asymptomatic group. A subpopulation of 21 patients with a thickened ES were HRC and underwent biopsy, while 72 patients with a thickened ES who were HR- underwent biopsy. 43% of HR+ patients manifested endom etrial hyperplasia vs 8% in the HR- group (P = 0.0022). Endometrial fl uid was present in 23 patients. The one patient with EF who was determ ined to have endometrial hyperplasia also had a thickened ES, was symp tomatic and HR+. Conclusions: In the absence of symptoms, repeat sampl ing is not warranted in patients with a thickened ES and negative find ings at initial abnormal biopsy. The presence of symptoms with a thick ened ES warrants further diagnostic evaluation to determine an etiolog y. There was an association with hyperplasia in patients with a thicke ned ES who were HR+. (C) 1996 Academic Press, Inc.