Association between endometrial heterogeneity and endometrial cancer risk stratification in postmenopausal women
Journal
Srpski arhiv za celokupno lekarstvo
Date Issued
2026
Author(s)
DOI
10.2298/SARH260218036M
Abstract
SUMMARY
Introduction/Objective The normal postmenopausal endometrium typically appears thin, homogeneous, and echogenic on transvaginal ultrasonography. In contrast, endometrial carcinoma is often
associated with increased thickness, heterogeneous echogenicity, irregular endometrial–myometrial
interface, and enhanced Doppler vascularization. The objective of this study was to evaluate the association between heterogeneous endometrial echogenicity and the risk of endometrial malignancy
in postmenopausal women.
Methods This prospective clinical study included 120 postmenopausal women treated at the University
Clinic for Gynecology and Obstetrics in Skopje. Participants were divided into a control group (n = 40)
and an examined group (n = 80). The examined group was further stratified according to uterine bleeding status and endometrial thickness (5–8 mm, > 8–11 mm, and > 11 mm). Endometrial echogenicity
was assessed by transvaginal ultrasonography and classified as homogeneous or heterogeneous. Binary
logistic regression analysis was performed to determine independent predictors of malignancy.
Results Heterogeneous endometrial echogenicity was significantly more frequent in the examined
group compared with controls (p < 0.001). It was identified as an independent predictor of endometrial malignancy (OR = 4.938; 95% CI: 1.24–19.62; p = 0.023). No statistically significant association was
observed between echogenicity and endometrial thickness subgroups (p = 0.49) or uterine bleeding
status (p = 0.82).
Conclusion Heterogeneous endometrial echogenicity represents a significant independent sonographic
predictor of endometrial malignancy in postmenopausal women and should be incorporated into routine
ultrasound risk assessment.
Introduction/Objective The normal postmenopausal endometrium typically appears thin, homogeneous, and echogenic on transvaginal ultrasonography. In contrast, endometrial carcinoma is often
associated with increased thickness, heterogeneous echogenicity, irregular endometrial–myometrial
interface, and enhanced Doppler vascularization. The objective of this study was to evaluate the association between heterogeneous endometrial echogenicity and the risk of endometrial malignancy
in postmenopausal women.
Methods This prospective clinical study included 120 postmenopausal women treated at the University
Clinic for Gynecology and Obstetrics in Skopje. Participants were divided into a control group (n = 40)
and an examined group (n = 80). The examined group was further stratified according to uterine bleeding status and endometrial thickness (5–8 mm, > 8–11 mm, and > 11 mm). Endometrial echogenicity
was assessed by transvaginal ultrasonography and classified as homogeneous or heterogeneous. Binary
logistic regression analysis was performed to determine independent predictors of malignancy.
Results Heterogeneous endometrial echogenicity was significantly more frequent in the examined
group compared with controls (p < 0.001). It was identified as an independent predictor of endometrial malignancy (OR = 4.938; 95% CI: 1.24–19.62; p = 0.023). No statistically significant association was
observed between echogenicity and endometrial thickness subgroups (p = 0.49) or uterine bleeding
status (p = 0.82).
Conclusion Heterogeneous endometrial echogenicity represents a significant independent sonographic
predictor of endometrial malignancy in postmenopausal women and should be incorporated into routine
ultrasound risk assessment.