Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography.

Hulka, Carol A.; Hall, D A; McCarthy, Kathleen A.; Simeone, JF

doi:10.1148/radiology.191.3.8184058

Cited by 103 publications

(50 citation statements)

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“…Dilatation and curettage does not require an expensive apparatus and is a method available to most gynecologists, but it carries many risks, costs and limitations, such as the impossibili ty to obtain selected tissue samples, which leads to poor sensitivity as compared to hysteroscopy [11,12], Transvaginal sonography has been extensively used to evaluate postmenopausal bleeding [13,14] and the finding of cys tic spaces seeems to be predictive of endometrial polyps [15]. Although this is a useful tool for the presumptive diagnosis of endometrial lesions, it is not as accurate as hysteroscopy and the final diagnosis can only be made by biopsy [16].…”

Section: Discussionmentioning

confidence: 99%

Cervical Polyp as Risk Factor for Hysteroscopically Diagnosed Endometrial Polyps

Vilodre

Bertat

Petters

et al. 1997

Gynecol Obstet Invest

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A case-control study was conducted searching through 590 diagnostic hysteroscopies in order to identify potential risk factors for endometrial polyps. Case (hysteroscopically positive for endometrial polyps) and control groups were compared for age, parity, cervical polyp, menopausal status, smoking and current use of contraceptive pills. A higher prevalence of endometrial polyps was found among women with a cervical polyp (26.9%) compared to those without a cervical polyp (7.1 %, Χ² = 27.52, p < 0.001). Increased risk of endometrial polyp was found to be associated with age (odds ratio =1.75 every 10 years, p < 0.001), cervical polyp (odds ratio = 4.83, 95% CI = 2.43–9.52), and menopause (odds ratio = 2.03, 95% CI = 1.12–3.69). After multivariate analysis, only age (adjusted odds ratio = 1.90, p = 0.001) and cervical polyp (adjusted odds ratio = 5.42, p < 0.001) were independent variables still associated with increased risk of endometrial polyps. We conclude that age and cervical polyp are strong, independent risk factors for endometrial polyps.

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Section: Discussionmentioning

confidence: 99%

Cervical Polyp as Risk Factor for Hysteroscopically Diagnosed Endometrial Polyps

Vilodre

Bertat

Petters

et al. 1997

Gynecol Obstet Invest

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“…They are then supposed to be the cause of the abnormal bleeding, even though this is not necessarily the case [15]. The typical ultrasound appearance of a benign endometrial polyp is thick hyperechogenic endometrium with or without regular small cysts (cysts are common in atrophic polyps where the glands are cystically dilated [16]) and the presence of a "bright edge" [17,18] (Figure 6). The bright edge is explained by the interface between the polyp (or any other focal lesion in the uterine cavity) and the endometrium [1,18].…”

Section: Benign Endometrial Polypsmentioning

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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“…Other abnormalities, such as endometrial polyps and submucous fibroids, are difficult to diagnose by D&C. 22 In addition, many patients with PMB whose initial endometrial biopsy or D&C results reveal benign or insufficient tissue may eventually be diagnosed as having endometrial cancer or complex endometrial hyperplasia. 23 Numerous recent investigations [5][6][7][8][9][10][11] indicate that TVS is an effective procedure to exclude endometrial and intrauterine abnormalities, and advocate its use as a routine first-step procedure in patients with abnormal uterine bleeding. The prevalence of endometrial carcinoma is higher in women in whom the endometrium is thicker than 5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10] In these women, a thickening of the endometrium exceeding 5 mm indicates the presence of pathologic endometrial lesions (a sensitivity of 97% for detecting a carcinoma). [5][6][7][8][9][10] Biopsies of endometria of less than 5 mm thick are nearly always negative or result in tissue insufficient for diagnosis, 11 however, endometrial thickening is a nonspecific finding that can be due to hyperplasia, polyps, fibroids (intraluminal or submucosal), and carcinoma. 11 Several recent reports have indicated that transvaginal hysterosonography (TVHS) can improve the specificity of transvaginal sonography (TVS) in differentiating endoluminal masses from more diffuse endometrial thickening.…”

mentioning

confidence: 99%

Comparative Study of Transvaginal Hysterosonography and Biopsy for the Evaluation of Post-Menopausal Bleeding

1999

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Background:The aim of this prospective study was to evaluate transvaginal hysterosonography (TVHS) in postmenopausal bleeding (PMB) as an alternative to endometrial biopsy. The study was conducted at the Zarka Military Hospital, Amman, Jordan, over a one-year period from 1996 to 1997. Patients and Methods:The study comprised 98 women presenting with post-menopausal bleeding who had been listed for diagnostic dilatation and curettage. Transvaginal sonography (TVS) and transvaginal hysterosonography were performed one week before operation. The mean age of the women was 57 years, and all of them had had their menopause for at least six months. Results: Sixty-one women (62%) demonstrated endometrial thickness of more than 5 mm by transvaginal sonography. All the women had transvaginal hysterosonography, except seven on whom hysterosonography could not be performed for technical reasons and who had to be excluded from the study, leaving a total of 54 women. TVS confirmed the presence of endoluminal mass in 30 of 54 women (60%). Twenty-two of the 30 endoluminal mass cases were pedunculated while eight were sessile. Sixteen of the pedunculated cases were endometrial polyps while the remaining six were fibroid polyps. Five of the sessile cases were fibroid, two were endometrial hyperplasia, and the last one endometrial carcinoma. The other 44 out of the 98 patients also underwent transvaginal hysterosonography. No pathology could be detected in these patients, but they were noted to have atrophic endometrium after dilatation and curettage. Conclusion: The combination of transvaginal sonography and transvaginal hysterosonography is both sensitive and specific with regard to detecting and excluding endoluminal masses as the cause of post-menopausal bleeding. Diagnostic dilatation and curettage fails to detect a large percentage of some lesions, so TVS in combination with TVHS should be considered as the initial examination in the evaluation of all women with post-menopausal bleeding.

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Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography.

Abstract: Endovaginal sonography may be useful for differentiation of endometrial polyps, hyperplasia, and carcinoma.

Cited by 103 publications

References 0 publications

Cervical Polyp as Risk Factor for Hysteroscopically Diagnosed Endometrial Polyps

Cervical Polyp as Risk Factor for Hysteroscopically Diagnosed Endometrial Polyps

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

Comparative Study of Transvaginal Hysterosonography and Biopsy for the Evaluation of Post-Menopausal Bleeding

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