Objective:

To assess the long-term incidence risk of gynecologic malignancy in postmenopausal women presenting with vaginal bleeding and pathologically confirmed benign endometrial lesions, and to identify clinical independent risk factors for risk stratification and follow-up management.

Approach:

• Study Design: Retrospective cohort study of 696 postmenopausal women presenting with vaginal bleeding who underwent diagnostic endometrial curettage.
• Data Collection: Histopathological evaluation established initial diagnosis; patients with benign findings underwent short-term re-evaluation and long-term follow-up.
• Statistical Analysis: Univariate and multivariate Cox regression analyses were performed to identify independent predictors of gynecologic malignancy.

Key Findings:

• Initial diagnosis rates of endometrial malignancy and precancerous lesions were 15.1% and 2.9%, respectively.
• 5.1% of patients with initially benign pathology were diagnosed with malignancy within 3 months.
• 7.6% of patients with initially benign pathology were diagnosed with precancerous lesions within 3 months.
• During long-term follow-up, 16 incident malignancies and 8 incident precancerous lesions were identified.
• High-grade serous carcinoma was more prevalent in follow-up diagnoses compared to initial diagnoses (43.8% vs. 6.5%).
• Baseline red blood cell distribution width and endometrial thickness were identified as independent predictors of gynecologic malignancy.

Interpretation:

Postmenopausal women with vaginal bleeding and initially benign endometrial lesions have a higher long-term risk of gynecologic malignancy, necessitating standardized screening and long-term surveillance.

Limitations:

• 25.4% of patients were lost to follow-up.
• The study's retrospective nature may limit the generalizability of findings.

Conclusion:

The study highlights the long-term risk of gynecologic malignancy in postmenopausal women with benign endometrial findings.