Objective: To investigate the incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection (EFC).
Methods: All patients with EFC diagnosed by transvaginal sonography (TVS) were retrospectively reviewed if they had undergone biopsy of the endometrium from January 2008 to January 2016 in a tertiary teaching hospital. Follow-up ended in June 2017. The incidence of gynecologic malignancies was described, and predictive factors were determined by comparing the epidemiological and clinico-pathological characteristics of the patients.
Results: During the study period, 273 women with EFC (3.4%) were enrolled. Biopsy pathology and the following hysterectomy revealed 29 (10.6%) cases of gynecological cancer. In the multivariable analysis, patient-reported genital symptoms [odds ratio (OR) 16.2, 95% confidence interval (CI) 1.9-139.3], abnormal serum CA125 (OR 14.5, 95% CI 4.5-46.5), lesions in the uterine cavity (OR 18.8, 95% CI 6.0-59.1) and endometrial thickness (OR 1.1, 95% CI 1.0-1.2) determined by TVS were independent factors associated with malignancy. Only 1.1% (1/90) of the asymptomatic patients had gynecologic cancer. During the follow-up, gynecologic cancer was diagnosed in nine patients, six of whom had vaginal bleeding at the time of initial enrollment. The prognosis of patients with cancer was worse than that of patients with benign results.
Conclusion: The risk of gynecologic malignancies in postmenopausal patients with EFC is related to genital symptoms, TVS findings and CA 125 levels. Asymptomatic EFC is associated with an extremely low risk of malignancy.
Keywords: Endometrial fluid collection; Hysteroscopy; Malignancy; Menopause; Vaginal bleeding.