The incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection

  • Zhe Li
  • Lei LiEmail author
Gynecologic Oncology



To investigate the incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection (EFC).


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.


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.


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.


Menopause Endometrial fluid collection Hysteroscopy Malignancy Vaginal bleeding 


Author contributions

LL: protocol/project development, data management, data analysis, and manuscript editing. ZL: data collection, data analysis, and manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest and nothing to disclose.


  1. 1.
    Carlson JA Jr, Arger P, Thompson S, Carlson EJ (1991) Clinical and pathologic correlation of endometrial cavity fluid detected by ultrasound in the postmenopausal patient. Obstet Gynecol 77(1):119–123PubMedGoogle Scholar
  2. 2.
    Gull B, Karlsson B, Wikland M, Milsom I, Granberg S (1998) Factors influencing the presence of uterine cavity fluid in a random sample of asymptomatic postmenopausal women. Acta Obstet Gynecol Scand 77(7):751–757CrossRefPubMedGoogle Scholar
  3. 3.
    Vuento MH, Pirhonen JP, Mäkinen JI, Tyrkkö JE, Laippala PJ, Grönroos M et al (1996) Endometrial fluid accumulation in asymptomatic postmenopausal women. Ultrasound Obstet Gynecol 8(1):37–41CrossRefPubMedGoogle Scholar
  4. 4.
    Epstein E, Ramirez A, Skoog L, Valentin L (2001) Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound Obstet Gynecol 18(2):157–162CrossRefPubMedGoogle Scholar
  5. 5.
    Goldstein SR (1994) Postmenopausal endometrial fluid collections revisited: look at the doughnut rather than the hole. Obstet Gynecol 83(5 Pt 1):738–740PubMedGoogle Scholar
  6. 6.
    Breckenridge JW, Kurtz AB, Ritchie WG, Macht EL Jr (1982) Postmenopausal uterine fluid collection: indicator of carcinoma. AJR Am J Roentgenol 139(3):529–534CrossRefPubMedGoogle Scholar
  7. 7.
    Smith PP, O’Connor S, Gupta J, Clark TJ (2014) Recurrent postmenopausal bleeding: a prospective cohort study. J Minim Invasive Gynecol 21(5):799–803CrossRefPubMedGoogle Scholar
  8. 8.
    Topcu HO, Tasdemir U, Islimye M, Bayramoglu H, Yilmaz N (2015) The clinical significance of endometrial fluid collection in asymptomatic postmenopausal women. Climacteric 18(5):733–736CrossRefPubMedGoogle Scholar
  9. 9.
    Leone FP, Timmerman D, Bourne T, Valentin L, Epstein E, Goldstein SR et al (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35(1):103–112CrossRefPubMedGoogle Scholar
  10. 10.
    Goldstein SR (1997) The presence of endometrial fluid in asymptomatic postmenopausal women is associated with clinically relevant cervical stenosis. J Ultrasound Med 16(3):208CrossRefPubMedGoogle Scholar
  11. 11.
    Takacs P, De Santis T, Nicholas MC, Verma U, Strassberg R, Duthely L (2005) Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease. J Ultrasound Med 24(11):1477–1481CrossRefPubMedGoogle Scholar
  12. 12.
    Bedner R, Rzepka-Gorska I (1998) Diagnostic value of uterine cavity fluid collection in the detection of pre-neoplastic lesions and endometrial carcinoma in the asymptomatic post-menopausal women. Ginekol Pol 69(5):237–240PubMedGoogle Scholar
  13. 13.
    Seckin NC, Sener AB, Gozen A, Kutlay L, Cobanoglu O, Gokmen O (1996) The importance of endometrial fluid collection in postmenopause. Gynecol Obstet Invest 41(4):244–246CrossRefPubMedGoogle Scholar
  14. 14.
    Inceboz U, Uyar Y, Baytur Y, Kandiloglu AR (2009) Endometrial fluid in postmenopausal women. Int J Gynaecol Obstet 107(2):154–155CrossRefPubMedGoogle Scholar
  15. 15.
    Schmidt T, Nawroth F, Breidenbach M, Hoopmann M, Mallmann P, Valter MM (2005) Differential indication for histological evaluation of endometrial fluid in postmenopause. Maturitas 50(3):177–181CrossRefPubMedGoogle Scholar
  16. 16.
    Debby A, Malinger G, Glezerman M, Golan A (2006) Intra-uterine fluid collection in postmenopausal women with cervical stenosis. Maturitas 55(4):334–337CrossRefPubMedGoogle Scholar
  17. 17.
    Epstein E, Valentin L (2006) Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 28(1):89–95CrossRefPubMedGoogle Scholar
  18. 18.
    Zalel Y, Tepper R, Cohen I, Goldberger S, Beyth Y (1996) Clinical significance of endometrial fluid collections in asymptomatic postmenopausal women. J Ultrasound Med 15(7):513–515CrossRefPubMedGoogle Scholar
  19. 19.
    Krissi H, Bar-Hava I, Orvieto R, Levy T, Ben-Rafael Z (1998) Endometrial carcinoma in a post-menopausal woman with atrophic endometrium and intra-cavitary fluid: a case report. Eur J Obstet Gynecol Reprod Biol 77(2):245–247CrossRefPubMedGoogle Scholar
  20. 20.
    Giannella L, Mfuta K, Setti T, Cerami LB, Bergamini E, Boselli F (2014) A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness > 4 mm. Biomed Res Int 2014:130569CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Knific T, Osredkar J, Smrkolj S, Tonin I, Vouk K, Blejec A et al (2017) Novel algorithm including CA-125, HE4 and body mass index in the diagnosis of endometrial cancer. Gynecol Oncol 147(1):126–132CrossRefPubMedGoogle Scholar
  22. 22.
    Savelli L, De Iaco P, Santini D, Rosati F, Ghi T, Pignotti E et al (2003) Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 188(4):927–931CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyPeking Union Medical College HospitalBeijingChina

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