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Results: 50 patients were enrolled and underwent TVUS; 41 SYS were performed. At TVUS the agreement in the description of endometrial echogenicity was poor (32%, weighted kappa 0.163). The agreement in the description of endometrial midline was moderate (70%, weighted kappa 0.42). The agreement in the description of endo-myometrial junction was poor (66%, weighted kappa 0.035). At SYS, the agreement in the assessment of symmetry of endometrial layers was poor (59%, kappa 0.177) and the agreement in the description of the outline of endometrial background was moderate (59%, weighted kappa 0.435). Conclusions: Despite the great effort in standardising terminology to describe endometrial appearance at ultrasound, in our series the assessment of endometrial features remains heterogeneous, partially subjective and not well reproducible. OC13.03 Differences between proximal and distal endometrial echo thickness in postmenopausal women undergoing saline infusion sonohysterography [SIS]O. Rotenberg, G. Doulaveris, J. Gebb, M. Renz, P. Dar Department of Obstetrics and Gynecology, AECOM, Berkeley Heights, NJ, USAObjectives: To investigate the endometrial echo (EE) measurements in postmenopausal women undergoing SIS. Methods: Retrospective study of a cohort of 598 women older than 50 years old with postmenopausal bleeding or thickened endometrium, who SIS for the evaluation of their endometrium.Measurements of anterior, posterior and total EE with and without focal lesions were obtained. The data was further analyzed for differences between proximal and distal endometrial echo to correct for anteverted (AV) vs retroverted (RV) uteri. Results were compared between groups using two-tailed Student's t test for normally distributed data and Fisher's exact test for categorical variables. p < 0.05 was considered significant. Results: The mean anterior EE for all uteri was 1.88 ± 0.06 mm and the mean posterior EE was 2.14 ± 0.06 mm (p = 0.003) [ figure 2]. 477 (79.8%) women had an anteverted, 84 (14.1%) had a retroverted and 37 (6.1%) had a mid-position uterus. Among the AV uteri, 68.1% of the times the distal EE (posterior) was measuring thicker and when looking at the RV uteri, 70.2% of the times the distal EE (anterior) was thicker (p = 0.79).The distal to proximal EE ratio was 1.35 ± 0.03 in AV and 1.26 ± 0.04 in RV uteri (p = 0.23). 214 of the 562 AV and RV uteri had a total EE >4 mm which is consider ''thickened''. In 41 (19.1%) of them the proximal EE that was measuring less than 2 mm. Conclusions: The distal endometrium is read significantly thicker than the proximal in SIS of postmenopausal women regardless of the uterus position. Enhancement artefact is the most plausible reason for the uneven reading. Since 1 out of 5 women with ''thick endometrium'' had a normal proximal EE, it is likely that the total thickness is an overestimate which might lead to unnecessary invasive procedures.

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