Question
A 58-year-old woman on combined estrogen and progesterone hormone replacement has postmenopausal bleeding. You obtain a pelvic ultrasound that shows an endometrial stripe thickness of 12 mm. Which of the following is most correct?
| A. |
If the endometrial stripe thickness had been less than 5 mm, you would have told the patient that no further evaluation was needed.
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| B. |
An endometrial stripe thickness of 5 to 10 mm confers no risk of endometrial cancer.
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| C. |
She has a greater than 50% risk of having adenocarcinoma of the endometrium.
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| D. |
Hysterectomy should be performed.
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Show Answer
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Correct Answer » A
Explanation
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- Postmenopausal bleeding (PMB) is considered endometrial carcinoma until proven otherwise.
- Transvaginal ultrasound is the first-line investigation to measure endometrial thickness.
- An endometrial thickness of 12 mm is abnormal and requires further evaluation (endometrial biopsy).
- Endometrial thickness less than or equal to 4–5 mm has a very high negative predictive value (>99%) for endometrial cancer.
- In such cases, no further invasive testing is usually required.
- Therefore, statement A is correct.
Explanation of Incorrect Options
Option B
- Incorrect because risk is not zero between 5–10 mm.
- Any thickness greater than 5 mm in PMB requires endometrial sampling.
Option C
- Incorrect because risk of endometrial cancer is not greater than 50%.
- Actual risk is approximately 10–20% depending on patient factors.
Option D
- Incorrect because hysterectomy is not the first step.
- Diagnosis must be confirmed with endometrial biopsy before definitive management.
