Clinical Study Of Endometrial Lesions In Postmenopausal Patients With Endometrial Thickening

Objective:1.To analyze the endometrial pathological results of postmenopausal patients with endometrial thickening,and to explore the threshold of endometrial thickness for predicting atypical hyperplasia and endometrial cancer in postmenopausal patients with endometrial thickening.2.To analyze the risk factors of endometrial atypical hyperplasia and endometrial carcinoma in postmenopausal patients with endometrial thickening.Methods:The corresponding clinical data of the patients were obtained by querying the patient’s medical records,communicating with the patient directly or contacting the patient by telephone during the revisit.According to certain inclusion criteria,we selected 500 postmenopausal patients whose endometrial thickness was revealed by ultrasonography in Shenyang Women and Infants Hospital from March 2019 to January2022,and obtained endometrial pathological tissue and endometrial pathological results by hysteroscopy or diagnostic curettage in outpatient or hospitalized patients.The pathological results of endometrium were analyzed and divided into AH/EC group and benign disease group(all pathological types except AH/EC)according to the pathological results.The relevant clinical data of the two groups were compared to explore the risk factors of AH/EC in patients with postmenopausal endometrial thickening.At the same time,according to the symptoms of vaginal bleeding after menopause,patients were divided into PMB group and non-PMB group.The endometrial lesions of the two groups were analyzed,the differences of endometrial lesions between the two groups were compared,the risk factors of AH/EC in the two groups were analyzed,and ROC curves were drawn to explore the threshold of endometrial thickness to predict the risk of AH/EC in the two groups of postmenopausal patients with endometrial thickening.The results were statistically analyzed by SPSS26.0,and the counting data were analyzed by chi-square test;the measurement data were expressed by mean ±standard deviation((?)±S)by t-test,and the significant variables in the results of univariate analysis were further analyzed by binary Logistic regression analysis.The area under the curve(AUC)was calculated by ROC curve to explore the threshold of intimal thickness for predicting AH/EC in patients with and without vaginal bleeding.Results:1.Among the 500 cases of postmenopausal endometrial thickening,422 cases(84.40%)were benign lesions,including 18 cases of atrophic endometrium(3.60%),15 cases of endometritis(3.00%),279 cases of endometrial polyps(55.80%),37 cases of submucosal myoma(7.40%)and 73 cases of endometrial hyperplasia without atypical hyperplasia(14.60%).Cases of AH/EC78(15.60%),including 28 cases of AH(5.60%)and 50 cases of EC(10.00%).2.Univariate analysis showed that AH/EC occurred in 500 patients with postmenopausal endometrial thickening:Age,presence of vaginal bleeding symptoms,endometrial thickness,and body mass index were risk factors for the development of AH/EC in postmenopausal patients with endometrial thickening(P<0.05).Multifactorial analysis showed that having symptoms of vaginal bleeding(OR:6.147,95%CI:2.975-12.702,P=0.000),and endometrial thickness(OR:6.340,95%CI:3.506-11.466,P=0.000)were independent risk factors for the development of AH/EC in postmenopausal patients with endometrial thickening(P< 0.05).3.There were 257 cases of endometrial thickening in PMB group and 243 cases in non-PMB group.AH/EC68 in PMB group(26.46%)was significantly higher than that in AH/EC10 group without PMB(4.12%).Endometrial polyps in non-PMB group(76.13%)was significantly higher than that in PMB group(36.58%).56 cases of endometrial hyperplasia without atypical hyperplasia in PMB group(21.79%)were significantly higher than 17 cases in non-PMB group(6.70%),and the difference was statistically significant(P < 0.05).The most common pathological type in PMB group and non-PMB group was endometrial polyps.4.Univariate analysis of the occurrence of AH/EC in patients in the PMB group and in patients in the no-PMB group showed that age,years of menopause,endometrial thickness,and body mass index were risk factors for the occurrence of AH/EC in patients in the PMB group(P<0.05).Endometrial thickness was a risk factor for the development of AH/EC in the patients without PMB group.Multifactorial analysis showed that age(OR:1.096,95% CI:1.006-1.193,P=0.036),endometrial thickness(OR:5.461,95% CI:2.884-10.338,P=0.000)were independent risk factors for the development of AH/EC in patients in the PMB group(P<0.05).5.The threshold of endothelial thickness predicted for AH/EC in the PMB group was 12.5 mm with an AUC of 0.762,sensitivity 56.7%,and specificity 85.3%;the threshold of endothelial thickness predicted for AH/EC in the no-PMB group was 9.5mm with an AUC of 0.903,sensitivity 100.0%,and specificity 73.8%.Conclusions:1.Vaginal bleeding and endometrial thickness are independent risk factors for AH/EC in postmenopausal women with endometrial thickening.2.The risk of AH/EC in postmenopausal women with endometrial thickening and vaginal bleeding is high.Therefore,clinical pathological examination should be actively carried out for such patients to screen out endometrial atypical hyperplasia and endometrial cancer as soon as possible.3.For postmenopausal patients with endometrial thickening without vaginal bleeding,the risk of endometrial malignant transformation is relatively low,but when the endometrial thickness is ≥9.5mm,we should be alert to AH/EC and actively carry out endometrial pathological examination in clinic.