Risk Factors Analysis And Prediction Of Endometrial Atypical Hyperplasia And Malignancy In Postmenopausal Women With Endometrial Thickening

Research purposes:Whether postmenopausal women with thickened endometrium without vaginal bleeding,vaginal discharge,and lower abdominal pain should be actively tested remains controversial.The purpose of this paper is to explore the cut-off value of endometrial thickness in the symptomatic group and asymptomatic group with postmenopausal irregular vaginal bleeding,vaginal discharge,abdominal pain,etc.,to provide reference for clinical diagnosis and screening.Outcomes after follow-up in patients with benign postmenopausal endometrial thickening.research method:Through a retrospective analysis of women with natural menopause（women over 40 years old,except for other pathological or physiological reasons,amenorrhea for 12 consecutive months）who were admitted to the Second Hospital of Jilin University from January 2019 to December 2021,their menopause Vaginal color Doppler ultrasound showed endometrial thickening（≥ 2mm）,and they were divided into symptomatic group and asymptomatic group according to the presence or absence of symptoms（irregular vaginal bleeding after menopause,vaginal discharge;abdominal pain）.Record its clinical data,including whether the patient has irregular vaginal bleeding after menopause;age,age at menarche,time of menopause,distribution of menopause time,age at menopause,age at menopause;pregnancy,parity,number of miscarriages;Whether there is a family history（direct line or second-generation collateral line: endometrial cancer,colorectal cancer）;height,weight,BMI;blood sugar;signal exception).The pathological results were collected and counted.According to the inclusion and exclusion criteria,among all postmenopausal patients with endometrial thickening,a total of 864 cases met the study criteria,and all of them had endometrial pathology results.According to the presence or absence of postmenopausal vaginal bleeding,discharge or abdominal pain,the patients were divided into groups with symptoms of vaginal bleeding,discharge or abdominal pain（283 cases）（hereinafter referred to as symptomatic group）and those without vaginal bleeding,discharge or abdominal pain Symptom group（hereinafter referred to as asymptomatic group）（581 cases）.The clinical and pathological data of the two groups of patients were analyzed,and the SPSS software package of version25.0 was used for statistical analysis.The measurement data results conforming to the normal distribution were expressed as（x±s）,the differences between groups were analyzed by independent samples t test,and P < 0.05 was considered significant difference.The results of enumeration data were expressed by the number of cases or percentages,and the difference between groups was analyzed by the x2 test,and P <0.05 was considered significant difference.If the application conditions of the chisquare test are not met,Fisher’s exact probability method is used.Statistically significant variables were then included in binary logistic regression analysis,the odds ratio（OR）and its 95% confidence interval（95% confidence interval,95% CI）were calculated,and a forest plot was drawn.Using the histopathological results of the endometrium as the gold standard for diagnosing endometrial abnormalities,and using the endometrial thickness as an independent variable,the ROC curve was drawn and the AUC was calculated.The maximum Youden index was calculated as the cut off value to obtain a threshold for endometrial thickness.The two groups of patients with benign pathological results were followed up for half a year to 1 year.The gynecological vaginal color Doppler ultrasound in the outpatient department of our hospital found that the endometrium was still thickened,and the endometrial pathological examination was performed again to study the benign and malignant endometrial pathology.’s return.Research results:（1）Postmenopausal endometrial thickening and asymptomatic group had 252 benign endometrial lesions and 31 malignant group;229 had benign endometrial lesions in symptomatic group;352 had malignant group;the malignant rate in symptomatic group Significantly higher than the asymptomatic group;the benign rate of the asymptomatic group was significantly higher than the symptomatic group;the difference was statistically significant（p=0.000<0.05）.（2）Endometrial thickness>5mm,history of diabetes,endometrial cancer in immediate relatives,age at menopause,menopause time 2 to 10 years,and vaginal color Doppler ultrasound with blood flow signals were independent risk factors for the symptomatic group after menopause（p<0.05）.（3）Endometrial thickness and fasting blood glucose were independent risk factors in the postmenopausal asymptomatic group（p<0.05）.（4）Symptomatic postmenopausal women with endometrial thickening were more likely to develop atypical hyperplasia/endometrial cancer when the endometrial thickness threshold was 4.5mm,and further treatment was better at this time,which was in line with the benefit ratio（P <0.05）.（5）Asymptomatic postmenopausal women with endometrial thickening were more likely to develop endometrial atypical hyperplasia/endometrial cancer when the endometrial thickness threshold was 11.5mm and the fasting blood glucose threshold was 5.985mmol/L,and further diagnosis and treatment was better,in line with the benefit ratio（P <0.05）.（6）The postmenopausal asymptomatic group was pathologically benign,and the median follow-up period after surgical treatment was 7.5 months（3-12 months）.About 2.8% of the patients had endometrial re-thickening and atypical hyperplasia/endometrial cancer（P <0.05）.Research conclusions:（1）Symptomatic postmenopausal women with endometrial thickening should actively exclude the risk of endometrial lesions.The patients with endometrial thickness >4.5mm,diabetes history,endometrial cancer in their immediate family,the later menopause age,2 ～ 10 years of menopause,vaginal color doppler ultrasonography with blood flow signal should be actively treated to exclude the risk of endometrial lesions.（2）The vast majority of asymptomatic postmenopausal women with endometrial thickening have benign pathological changes,and it is inappropriate to use symptomatic postmenopausal women for this group.Asymptomatic postmenopausal women with endometrial thickness <11.5mm had a lower cancer rate（5.05%（10/198））.The risk of endometrial lesions should be actively excluded when endometrial thickness >11.5mm and fasting blood glucose >5.98mmol/ L are combined in this group.（3）Asymptomatic postmenopausal women with endometrial thickening had benign endometrial lesions and were followed up after surgical treatment（median follow-up was 7.5 months）with re-thickening and a low risk of atypical hyperplasia and endometrial cancer（2.8% in this study）.Long-term close follow-up is recommended for this group.