DOI: 10.47582/jompac.1998233 ISSN: 2717-7505

Menopause-specific ROC-based cutoff values for endometrial thickness and the role of heterogeneous endometrial morphology in predicting EIN/endometrial carcinoma

Meryem Bekmezci, Ramazan Bülbül, Melike Ordu
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Aims: To evaluate the diagnostic value of transvaginal ultrasonography in differentiating benign and malignant endometrial conditions and to determine menopause-specific endometrial thickness cutoff values.Methods: This retrospective study included 6,333 women with abnormal uterine bleeding who underwent transvaginal ultrasonography followed by histopathological evaluation between January 2020 and December 2025. Demographic characteristics, endometrial thickness and morphology, and histopathological findings were recorded. Diagnostic performance was assessed using ROC analysis, optimal cutoff values were determined using the Youden index, and independent predictors were evaluated by multivariable logistic regression.Results: Endometrial thickness was significantly greater in patients with hyperplasia, endometrial intraepithelial neoplasia (EIN), and endometrial carcinoma than in those with benign histopathology (p12 mm in premenopausal and perimenopausal women and >14.2 mm in postmenopausal women. Increasing age (OR 1.06), endometrial thickness (OR 1.11), postmenopausal status (OR 3.14), and heterogeneous endometrial morphology (OR 10.32) were independent predictors of EIN/endometrial carcinoma.Conclusion: Endometrial thickness is a valuable predictor of EIN/endometrial carcinoma. Combining menopause-specific cutoff values with endometrial morphology and clinical factors may improve diagnostic accuracy and support individualized clinical decision-making.

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