Endometrial cancer risk factors in patients with endometrial echogenicity: a logistic regression analysis

This study aimed to investigate the factors associated with the risk of detecting endometrial cancer in women with endometrial echogenicity suggested by ultrasound diagnosis, using the results of hysteroscopic pathology and histology as the “gold standard”. The study enrolled 160 hospitalized patients from January 2020 to January 2023, all exhibiting uneven endometrial echogenicity based on ultrasound findings. Following this, hysteroscopy was conducted on all patients, and the hysteroscopy pathological examination results were considered as the reference standard. Data on clinical and ultrasound examinations of the patients were gathered, and logistic regression analysis was employed to investigate the factors impacting the identification of endometrial cancer. Of the 160 patients whose ultrasound indicated uneven endometrial echogenicity, 119 (74.38%) were diagnosed with benign lesions, while 41 (25.63%) were found to have malignant lesions according to the hysteroscopy pathological examination. Results showed that compared to patients with benign lesions, patients with malignant endometrial lesions had higher ages, were more likely to be menopausal, had irregular vaginal bleeding, had endometrial thickening, and had real-time blood flow grading of the endometrium and adjacent myometrium graded II–III. These differences were statistically significant (p < 0.05). The endometrium and surrounding myometrium’s real-time blood flow grading, which are ranked II–III (Odds Ratio (OR) = 3.473, 95% Confidence Interval (CI) 1.540–7.833), are independent variables. In conclusion, doctors should be aware that endometrial cancer may be present in postmenopausal women who have irregular vaginal bleeding, watch for strong real-time blood flow signals between the endometrium and surrounding muscle layers, and use transvaginal ultrasound (TVUS) to detect endometrial thickening.

Endometrial cancer; Ultrasound; Uneven endometrial echogenicity; Hysteroscopy; Pathological histology examination results; Logistic regression model

[1] Alcázar JL, Vara J, Usandizaga C, Ajossa S, Pascual MA, Guerriero S. Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: a systematic review and head-to-head meta-analysis. International Journal of Gynecology & Obstetrics. 2023; 161: 397–405.

[2] Bausic A, Coroleuca C, Coroleuca C, Comandasu D, Matasariu R, Manu A, et al. Transvaginal ultrasound vs. magnetic resonance imaging (MRI) value in endometriosis diagnosis. Diagnostics. 2022; 12: 1767.

[3] Ferré LB, Alvarez-Gallardo H, Romo S, Fresno C, Stroud T, Stroud B, et al. Transvaginal ultrasound-guided oocyte retrieval in cattle: state-of-the-art and its impact on the in vitro fertilization embryo production outcome. Reproduction in Domestic Animals. 2023; 58: 363–378.

[4] Jauniaux E, Hussein AM, Thabet MM, Elbarmelgy RM, Elbarmelgy RA, Jurkovic D. The role of transvaginal ultrasound in the third-trimester evaluation of patients at high risk of placenta accreta spectrum at birth. American Journal of Obstetrics and Gynecology. 2023; 229: 445.e1–445.e11.

[5] Green RW, Fischerová D, Testa AC, Franchi D, Fruehauf F, Lindqvist PG, et al. Sonographic, demographic, and clinical characteristics of pre- and postmenopausal women with endometrial cancer; results from a post hoc analysis of the IETA4 (International Endometrial Tumor Analysis) multicenter cohort. Diagnostics. 2024; 14: 1.

[6] Heremans R, van den Bosch T, Valentin L, Wynants L, Pascual MA, Fruscio R, et al. Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3). Ultrasound in Obstetrics & Gynecology. 2022; 60: 243–255.

[7] Marín-Jiménez JA, García-Mulero S, Matías-Guiu X, Piulats JM. Facts and hopes in immunotherapy of endometrial cancer. Clinical Cancer Research. 2022; 28: 4849–4860.

[8] Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, et al. Endometrial hyperplasia as a risk factor of endometrial cancer. Archives of Gynecology and Obstetrics. 2022; 306: 407–421.

[9] Jamieson A, McAlpine JN. Molecular profiling of endometrial cancer from TCGA to clinical practice. Journal of the National Comprehensive Cancer Network. 2023; 21: 210–216.

[10] Wang L, Quan SM, Bai E, Yang XF. Analysis of clinical data of different endometrial pathological types in perimenopausal women with abnormal uterine bleeding. Frontiers in Oncology. 2024; 14: 1370681.

[11] Liang L, Mei LB, Shi YY, Huang LL, Su ZY, Zeng Y, et al. Turner syndrome with Xp deletions and rare endometrial abnormalities: a case report. Medicine. 2021; 100: e27571.

[12] Moro F, Albanese M, Boldrini L, Chiappa V, Lenkowicz J, Bertolina F, et al. Developing and validating ultrasound-based radiomics models for predicting high-risk endometrial cancer. Ultrasound in Obstetrics & Gynecology. 2022; 60: 256–268.

[13] Vitale SG, Riemma G, Haimovich S, Carugno J, Alonso Pacheco L, Perez-Medina T, et al. Risk of endometrial cancer in asymptomatic postmenopausal women in relation to ultrasonographic endometrial thickness: systematic review and diagnostic test accuracy meta-analysis. American Journal of Obstetrics and Gynecology. 2023; 228: 22–35.e2.

[14] He GY, Zhou X, Shi Y, Wang D, Yu J, Qiao HY, et al. The clinical effect and imaging features of accordion maneuver in promoting bone healing at the docking site after tibial transport under ultrasonic monitoring. Chinese Journal of Surgery. 2021; 59: 477–483. (In Chinese)

[15] Capozzi VA, Rosati A, Rumolo V, Ferrari F, Gullo G, Karaman E, et al. Novelties of ultrasound imaging for endometrial cancer preoperative workup. Minerva Medica. 2021; 112: 3–11.

[16] Xydias EM, Kalantzi S, Tsakos E, Ntanika A, Beis N, Prior M, et al. Comparison of 3D ultrasound, 2D ultrasound and 3D Doppler in the diagnosis of endometrial carcinoma in patients with uterine bleeding: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2022; 277: 42–52.

[17] Goodman A. The challenges of screening large populations: transvaginal ultrasound and endometrial screening for endometrial cancer. Menopause. 2022; 29: 127–128.

[18] Papakonstantinou E, Adonakis G. Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: when to perform endometrial sampling? International Journal of Gynecology & Obstetrics. 2022; 158: 252–259.

[19] Lin DM, Wang H, Liu L, Zhao L, Chen J, Tian HY, et al. IETA ultrasonic features combined with GI-RADS classification system and tumor biomarkers for surveillance of endometrial carcinoma: an innovative study. Cancers. 2022; 14: 5631.

[20] Tong XZ, Wu XF, Zhang QH. Value of preoperative staging of endometrial carcinoma with contrast-enhanced ultrasonography: a PRISMA compliant meta-analysis. Medicine. 2021; 100: e25434.

[21] Lin WH, Chang CL. Ultrasonic presentation variation of patients with pathological evidence of endometrial atrophy. Taiwanese Journal of Obstetrics and Gynecology. 2023; 62: 719–723.

[22] Iwasaki M, Ishihara S, Shimomura M, Inoue M. Endoscopic surgery using ultrasonic energy device for tracheal metastatic tumor. The Annals of Thoracic Surgery. 2022; 114: e189–e191.

[23] Wang XM, Zhang HY, Xu J, Qu PP. The typical polypoid adenomyoma is a special form of endometrial polyp: a case-controlled study with a large sample size. European Journal of Medical Research. 2023; 28: 308.

[24] Zhao HX, Du YY, Guo YJ, Zhou JH, Sun CQ, Wen XD, et al. Application value of real-time shear wave elastography in diagnosing the depth of infiltrating muscular layer of endometrial cancer. Journal of Ultrasound in Medicine. 2021; 40: 1851–1861.

[25] Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of endometrial cancer risk with postmenopausal bleeding in Women: a systematic review and meta-analysis. JAMA Internal Medicine. 2018; 178: 1210-1222.

[26] Hazelwood E, Sanderson E, Tan VY, Ruth KS, Frayling TM, Dimou N, et al. Identifying molecular mediators of the relationship between body mass index and endometrial cancer risk: a Mendelian randomization analysis. BMC Medicine. 2022; 20: 125.