The association between endometrial cystic spaces in women with abnormal bleeding and endometrial hyperplasia and endometrial cancer.

Abstract

Introduction/Background Early identification and management of endometrial hyperplasia can prevent progression to endometrial cancer. A thickened endometrium on ultrasound is a well-known predictor of endometrial hyperplasia or endometrial cancer, the significance of endometrial cysts found on ultrasound however is not well established. This study aimed to determine the association between endometrial cystic spaces on ultrasound and endometrial hyperplasia with or without atypia and endometrial cancer in women with abnormal uterine bleeding and to determine the prevalence of endometrial cystic spaces in women with abnormal uterine bleeding. Methodology Women aged 30 years-old and above referred with abnormal uterine bleeding (AUB) and waitlisted for a hysteroscopy dilatation and curettage (HDC) or endometrial biopsy were eligible for recruitment. They undertook a transvaginal ultrasound the week of their surgery to assess for endometrial cysts and answered a short health questionnaire. The histopathology results, ultrasound results and health questionnaire answers were collated and analysed. Results Of the 232 women recruited, 97 were excluded. Mean age was 42 years-old. Nine (6.7%) had endometrial cysts. Of women with endometrial cysts, four had endometrial hyperplasia without atypia (OR=5.1, 95% CI [0.5-55.0], p=0.18), three had endometrial intraepithelial hyperplasia (EIN) (OR=62.5, 95% CI [5.6-693.7], p<0.001) and four had endometrial carcinoma (OR=5.1, 95% CI [0.5-55.0], p=0.18). Postmenopausal women with endometrial cysts were more likely to have endometrial hyperplasia without atypia, EIN or endometrial cancer (OR=26.0, 95% CI [0.1-604.5], p=0.04). Increased age and BMI were associated with higher prevalence of endometrial cysts in women with AUB. Conclusion The significance of endometrial cysts on ultrasound is not well established. Our results indicate a possible association with endometrial cysts and EIN. However this study was unfortunately stopped early due to recruitment issues and is therefore underpowered to draw clinically significant conclusions. Disclosures There are no conflicts of interest to declare.Copyright © 2024