Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer

Gull, Berit; Karlsson, Bengt; Milsom, Ian; Granberg, S.

doi:10.1067/mob.2003.154

Cited by 229 publications

(166 citation statements)

References 17 publications

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“…In a study of patients having postmenopausal bleeding, using a cutoff of 4 mm, it was found that transvaginal ultrasound had 100% sensitivity and 60% specificity. 7 In women without vaginal bleeding, the sensitivity of the endometrial thickness measurement was 17% for a threshold of 6 mm and 33% for a threshold of 5 mm. 8 To date, imaging techniques have a role on presurgery stratification rather than on diagnosis.…”

Section: Early Detection and Diagnosismentioning

confidence: 95%

“…10 and EPS8L2 in representative examples of endometrial carcinoma (upper panels). Specific staining at tumor glands (T) in contrast to faint labeling in normal glands (n) and stroma (st) in different histological types including endometrioid (1,3,4,5,6,7,8), serous (2) and clear cell (9) carcinomas. Western blot analysis of P4HB in paired samples including tumor tissue (T) and adjacent normal endometrium (N) from four different patients.…”

Section: Early Detection and Diagnosismentioning

confidence: 99%

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Molecular markers of endometrial carcinoma detected in uterine aspirates

Colás¹,

Pérez

Cabrera

et al. 2011

Intl Journal of Cancer

111

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Endometrial cancer (EC) is the most frequent of the invasive tumors of the female genital tract. Although usually detected in its initial stages, a 20% of the patients present with advanced disease. To date, no characterized molecular marker has been validated for the diagnosis of EC. In addition, new methods for prognosis and classification of EC are needed to combat this deadly disease. We thus aimed to identify new molecular markers of EC and to evaluate their validity on endometrial aspirates. Gene expression screening on 52 carcinoma samples and series of real‐time quantitative PCR validation on 19 paired carcinomas and normal tissue samples and on 50 carcinoma and noncarcinoma uterine aspirates were performed to identify and validate potential biomarkers of EC. Candidate markers were further confirmed at the protein level by immunohistochemistry and Western blot. We identified ACAA1, AP1M2, CGN, DDR1, EPS8L2, FASTKD1, GMIP, IKBKE, P2RX4, P4HB, PHKG2, PPFIBP2, PPP1R16A, RASSF7, RNF183, SIRT6, TJP3, EFEMP2, SOCS2 and DCN as differentially expressed in ECs. Furthermore, the differential expression of these biomarkers in primary endometrial tumors is correlated to their expression level in corresponding uterine fluid samples. Finally, these biomarkers significantly identified EC with area under the receiver‐operating‐characteristic values ranging from 0.74 to 0.95 in uterine aspirates. Interestingly, analogous values were found among initial stages. We present the discovery of molecular biomarkers of EC and describe their utility in uterine aspirates. These findings represent the basis for the development of a highly sensitive and specific minimally invasive method for screening ECs.

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Section: Early Detection and Diagnosismentioning

confidence: 95%

Section: Early Detection and Diagnosismentioning

confidence: 99%

Molecular markers of endometrial carcinoma detected in uterine aspirates

Colás¹,

Pérez

Cabrera

et al. 2011

Intl Journal of Cancer

111

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“…In a meta-analysis including almost 6000 women with postmenopausal bleeding this risk was estimated to be about 1 in 100 in women not using hormone replacement therapy and about 1 in 1000 in women using hormone 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 5 replacement therapy [2]. It is considered safe to refrain from endometrial sampling to obtain a histological diagnosis in women with postmenopausal bleeding and endometrial thickness < 4 mm [2,3,4]. This endometrial thickness cutoff is applicable both in users and non-users of hormone replacement therapy [2].…”

Section: A Imaging Techniques In the Management Of Postmenopausal Blmentioning

confidence: 99%

Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Valentin

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

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Transvaginal ultrasound plays a pivotal role in the management of non-pregnant women with abnormal vaginal bleeding. No other imaging technique has a role in the triage of these women. In women with postmenopausal bleeding ultrasound is used to categorize women as being at low or high risk of endometrial cancer, the result of the ultrasound examination being the basis for further management. In women with abnormal vaginal bleeding before menopause the role of ultrasound is less clear, because some common causes of abnormal vaginal bleeding before menopause cannot be diagnosed with ultrasound, e.g. infection, dysfunctional bleeding or problems with intrauterine contraceptive devices or contraceptive pills. Nonetheless, transvaginal ultrasound may sometimes be helpful also in women with abnormal vaginal bleeding before menopause. In this chapter ultrasound findings in women with endometrial cancer, endometrial polyps, endometrial hyperplasia, adenomyosis, uterine myomas including submucuous myomas, and leiomyosarcoma will be presented and ultrasound based triage of women with postmenopusal bleeding described. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractTransvaginal ultrasound plays a pivotal role in the management of non-pregnant women with abnormal vaginal bleeding. No other imaging technique has a role in the triage of these women. In women with postmenopausal bleeding ultrasound is used to categorize women as being at low or high risk of endometrial cancer, the result of the ultrasound examination being the basis for further management. In women with abnormal vaginal bleeding before menopause the role of ultrasound is less clear, because some common causes of abnormal vaginal bleeding before menopause cannot be diagnosed with ultrasound, e.g. infection, dysfunctional bleeding or problems with intrauterine contraceptive devices or contraceptive pills. Nonetheless, transvaginal ultrasound may sometimes be helpful also in women with abnormal vaginal bleeding before menopause. In this chapter ultrasound findings in women with endometrial cancer, endometrial polyps, endometrial hyperplasia, adenomyosis, uterine myomas including submucuous myomas, and leiomyosarcoma will be presented and ultrasound based triage of women with postmenopusal bleeding described.

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“…Postmenopausal bleeding had a 64-fold increase in risk for endometrial cancer. There was no increased risk of endometrial cancer or atypia in women who did not have recurrent Discussion bleeding, whereas women with recurrent bleeding have a high-risk 12 . Dilatation and curettage ( D&C) is an inadequate diagnostic tool for uterine focal lesions, but the accuracy of D&C in the detection of endometrial hyperplasia and carcinoma is relatively high being 92.1% 13,14 .…”

Section: Figurementioning

confidence: 79%

Assessment of three methods of curetting orientation for women with excessive uterine bleeding

Alrawi¹,

Rasul²

2013

ZJMS

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Background and objective: Dilation and curettage (D&C) is commonly performed for the diagnosis of gynecological conditions leading to excessive uterine bleeding. The aim of this study was to evaluate different methods of curetting orientation to optimise the diagnosis of common pathological lesions associated with excessive uterine bleeding. Methods: Data and cases retrieved from women presented with excessive uterine bleeding and underwent D&C, at a private histopathology laboratory in Erbil city, Kurdistan region, from December 2010 to January 2012. Three methods of curetting orientation were carried out on 275 patients. Light microscopical study was done to asses the cause of excessive uterine bleeding. Results: A total of 274 out of 275 cases were found to have optimal tissue processing, embedding and histological examination. When the tissue specimens attached to filter paper and gauze, two out of 275 cases were found to have endometrial adenocarcinoma. Moreover, out of 275 cases, 198 were found to have dysfunctional uterine bleeding (hormonal imbalance) and 25 cases were found to have endometrial hyperplasia. Conclusion: Optimal tissue processing, embedding and histological orientation can be attained by using filter paper and/or gauze. Dilation and curettage is an adequate diagnostic tool for endometrial hyperplasia and carcinoma.

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Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer

Cited by 229 publications

References 17 publications

Molecular markers of endometrial carcinoma detected in uterine aspirates

Molecular markers of endometrial carcinoma detected in uterine aspirates

Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Assessment of three methods of curetting orientation for women with excessive uterine bleeding

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