To explore the clinical significance of hysteroscopy in the diagnosis and treatment of postmenopausal women with asymptomatic endometrial thickening.

A total of 126 postmenopausal women with asymptomatic endometrial thickening, who underwent hysteroscopic and/or surgical treatment at Capital Medical University Fuxing Hospital from January 1, 2019 to December 31, 2021, were retrospectively analyzed. The Fisher's exact test was used to compare the consistency between the hysteroscopic diagnosis and postoperative pathological results to explore the accuracy of hysteroscopy in the clinical diagnosis of postmenopausal patients with asymptomatic endometrial thickening. Receiver operating characteristic (ROC) curve analysis was performed to explore the value of endometrial thickness measured by ultrasound in predicting endometrial malignant disease.

Hysteroscopy showed that among the 126 patients, 78 (61.9%) had endometrial polyps, 12 (9.5%) had uterine mucosal submucosal fibroids, 15 (11.9%) had atrophic endometrium, 12 (9.5%) had uterine endometrial hyperplasia, 4 (3.3%) had atypical endometrial hyperplasia, and 5 (3.9%) had endometrial carcinoma. The pathological results of the submitted specimens from 126 patients showed 73 (57.9%) cases of middle endometrial polyps, 12 (9.5%) cases of uterine mucosal submucosal fibroids, 15 (11.9%) cases of atrophic endometrium, 17 (13.5%) cases of intrauterine membrane hyperplasia, 3 (2.4%) cases of atypical endometrial hyperplasia, and 6 (4.8%) cases of endometrial carcinoma. The overall consistency rate between hysteroscopy and pathological diagnosis was 95.2%, and the two were significantly correlated (P＜0.05). ROC curve analysis showed that the area under the curve of endometrial thickness for predicting endometrial malignancy (including atypical hyperplasia and endometrial cancer) was 0.752. When the endometrial thickness cut-off value was 11.5 mm, the sensitivity and specificity were 66.7% and 75.2%, respectively.

Postmenopausal patients with asymptomatic endometrial thickening can undergo hysteroscopy and/or hysteroscopic surgery for accurate diagnosis and effective treatment; patients with endometrial thickness＞11.5 mm are more likely to suffer from intrauterine disease.