Ultrasound of a 38-year-old woman with postmenopausal bleeding shows endometrial thickness of 14 mm on transvaginal scan (TVS). At what endometrial thickness cut-off in a postmenopausal woman is endometrial biopsy recommended, according to current guidelines?
- A ≥8 mm
- B ≥12 mm
- C ≥5 mm ✓
- D ≥16 mm
Correct answer: C. ≥5 mm
Explanation
In postmenopausal women with bleeding, an endometrial thickness ≥5 mm on TVS is the threshold for further evaluation (biopsy or hysteroscopy) according to established guidelines including RCOG, ACOG, and ESGE. Below 5 mm, the negative predictive value for endometrial carcinoma is >99% and biopsy may be deferred. This patient's endometrium at 14 mm is well above threshold, mandating urgent biopsy to exclude endometrial carcinoma. In asymptomatic postmenopausal women, the threshold is higher (≥11 mm in some guidelines), but for symptomatic patients 5 mm is the standard.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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