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.
Tofiloska et al. (Thu,) studied this question.