| Objective: The purpose of this study was to investigate the correlation between asymptomatic endometrial thickening and the risk of endometrial lesions in postmenopausal women,to systematically analyse the value of using endometrial thickness in the diagnosis and screening of endometrial lesions,to try to find a reasonable threshold value of endometrial thickness to predict the need for further clinical intervention in postmenopausal women with asymptomatic endometrial thickening,and to further screen for the need for more active management in postmenopausal asymptomatic women with endometrial thickening in combination with possible high-risk factors.Methods: A personal computer was used to conduct a comprehensive search in Chinese and English databases such as Pubmed,The Cochrane Library,EMBASE,Web of Science,CBM,CNKI,VIP and Wanfang Database.The search was limited to all literature since the establishment of the database until October 2022,and literature screening and data extraction were performed according to inclusion and exclusion criteria.The methodological quality of the included studies was evaluated using the QUADAS-2 and the NOS scale.Sensitivity,specificity,positive likelihood ratios,negative likelihood ratios and diagnostic ratio ratios for the combined effect measures,plotting of the summary subject operating characteristic curve(SROC)and calculation of the area under the curve(AUC)for the SROC were performed using Stata 15.0 software.Results: 1.The predictive value of endometrial thickness for the diagnosis of endometrial lesions can be used for the initial screening of disease.2.The overall sensitivity of asymptomatic endometrial thickness for the diagnosis of malignant endometrial lesions in postmenopausal women was 0.72(95% CI:0.60-0.82)for the final combination;specificity was 0.59(95% CI:0.51-0.65),PLR was 1.74(95% CI:1.40-2.17),NLR was 0.48(95% CI:0.32-0.71),DOR 3.67(95% CI: 2.01-6.67),SROC curves were plotted and the combined AUC was =0.69(95% CI: 0.65-0.73)The overall sensitivity of endometrial thickness for the diagnosis of endometrial polyps in the combined studies was 0.51(95% CI: 0.38-0.63);specificity was 0.75(95% CI: 0.65-0.83),PLR 2.02(95% CI: 1.44-2.85),NLR 0.66(95% CI: 0.52-0.83),DOR 3.08(95% CI: 1.81-5.24),and SROC curve with a combined AUC = 0.68(95% CI: 0.64-0.72).The overall sensitivity for the inclusion of endometrial thickness for the diagnosis of fibroids was 0.32(95% CI: 0.07-0.73);specificity was 0.67(95% CI: 0.53-0.78),PLR was 0.96(95% CI: 0.39-2.35),NLR was 1.02(95% CI: 0.68-1.53),DOR was 0.94(95% CI: 0.26-3.46)and the SROC curve was plotted with a combined AUC of =0.60(95% CI: 0.56-0.64).No publication bias was found for either.3.In this study,subgroup analyses were also performed using endometrial thicknesses of 5 mm,8 mm,10 mm,11 mm and 12 mm,respectively.By comparing the combined effect sizes of each threshold value,the results suggested that using 8 mm as the threshold value for endometrial thickness is more beneficial for screening patients with asymptomatic endometrial thickening in postmenopausal women.4.Based on the content of the included literature and extractable literature information,postmenopausal women with asymptomatic endometrial thickening were selected for analysis for five possible risk factors,including age ≥ 60 years,BMI ≥ 25 kg / m2,hypertension,diabetes mellitus,and reproductive history.The results showed that BMI ≥25 kg / m2 was considered a risk factor for malignant endometrial lesions in postmenopausal women [OR=2.62,95% CI(1.58,4.35),P=0.0002].Conclusion: 1.The predictive value of endometrial thickness for the diagnosis of endometrial lesions can be used for the initial screening of disease.2.In this study,endometrial thickness of 5mm,8mm,10 mm,11mm and 12 mm were used as the threshold values for analysis and the results suggest that an endometrial thickness of 8mm is more effective as a threshold value for early screening in postmenopausal women without clinical symptoms of endometrial thickening.3.Patients with asymptomatic endometrial thickness in postmenopausal women should not use endometrial thickness alone as a basis for exclusion or prediction of endometrial pathology,but should be actively managed in postmenopausal asymptomatic women with endometrial thickening combined with a BMI ≥25 kg/m~2. |
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