Alteration of sonographic texture of the endometrium in post-menopausal bleeding a guide to further management

Abstract

Background. The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling. Methods. Two hundred and seven consecutive cases of postmenopausal bleeding were evaluated by transvaginal ultrasound. Endometrial thickness was measured as the maximum anteroposterior thickness of the endometrium including both the anterior and posterior layers, in the sagittal long axis view. The morphology of the endometrium was studied and categorized as homogeneous, focally increased echogenecity, diffusely increased echogenecity or diffusely inhomogeneous. Patients were followed up for clinical course and endometrial histopathology. Results. Textural inhomogeneity was observed in all the three cases of endometrial cancers with endometrial thickness of less than 6 mm, and, in ten out of 11 cases of a more than 6 mm thick endometrium. On the other hand the endometrial texture was homogeneous in all cases of endometrial atrophy/tissue inadequate for diagnosis, with thickness of less than 6 mm.Conclusion. This study adds the dimension of abnormal echogenecity of the endometrium to the currently followed criterion of endometrial thickness with a view to enhance accuracy, both for a better prediction of atrophy and a higher prediction for endometrial cancer. Expectant management can be offered to patients with a homogeneous endometrium which is 6 mm thick or less. Aggressive evaluation for a malignancy must be made if there is a focal increased echogenecity or a diffuse increased echogenecity even in a thin endometrium.

Monodisperse Magnetic Single‐Crystal Ferrite Microspheres

“…Endometrial polyps, fibroids and endometrial cancer may manifest characteristic gray‐scale ultrasound morphology both at conventional ultrasound examination4–7 and at saline infusion sonography8, 9, but some research teams have found overlapping ultrasound morphology between benign and malignant endometrial lesions10, 11. Others concluded that the accuracy of transvaginal sonography in detecting endometrial cancer increases if assessment of endometrial morphology and endometrial border appearance is used in combination with endometrial thickness measurements12, 13.…”

Endometrial volume as predictor of malignancy in women with postmenopausal bleeding

“…Studies examining screening methods for endometrial carcinoma in asymptomatic postmenopausal women have accepted ultrasound‐determined endometrial thickness as an indication of risk. The thickest anteroposterior diameter of the endometrium is measured during 2D ultrasound, and a cutoff value of 4 to 5 mm is considered predictive of pathologic changes [4–7]. Many trials were introduced to enhance the predictive usefulness of ultrasound for endometrial malignancy, and Sheikh et al [5] added abnormal focal echogenicity—the sign of a nonhomogenous endometrium—as a predictor of malignancy.…”

“…Endometrial thickness has been used as an indicator of risk for endometrial carcinoma in asymptomatic menopausal and postmenopausal women. In 2‐dimensional (2D) ultrasound, the thickest anteroposterior diameter of the endometrium is measured using the 2 endometrial layers, and a cutoff value of 4 to 5 mm has been found to be predictive of pathologic changes [4–7]. However, the same thickness does not express the same endometrial volume in different endometria because uterine lengths may be different and endometrial irregularities may exist.…”

Diabetes Revealed: Multisystem Danger

“…The morphology of the endometrium on transvaginal ultrasound is also useful in the assessment of patients with abnormal bleeding. Adding morphologic characteristics to the assessment and categorizing the endometrium as homogeneous with focally increased echogenicity, diffusely increased echogenicity, or diffusely inhomogeneous increased the specificity and negative predictive value of sonography [91].…”