Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding

Abstract

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.

Investigation des métrorragies de la post-ménopause (MPM)

“…Des myomes sous-muqueux sont trouvés chez 6 à 7 % des patientes avec MPM [29,31] L'échographie transvaginale et la mesure de l'épaisseur endométriale permettent dans environ 50 % des cas (12 à 83,7 %) de renoncer à une investigation histologique et de réduire ainsi les coûts engendrés [7, 8, 12, 13, 22, 25, 36 -39] L'analyse de la littérature permet donc de conclure que l'utilisation isolée de la mesure de l'épaisseur de l'endomètre ne permettra pas le diagnostic de pathologies de l'endomètre dans 1,3 % des cas si la valeur seuil est fixée à 4 mm et dans 2,4 % des cas si la limite est fixée à 5 mm.…”

Investigation des métrorragies de la post-ménopause (MPM).

“…Si l'utérus est agrandi à la palpation bimanuelle, il faut penser aux myomes sous-muqueux [21][22][23][24] ou plus rarement aux sarcomes [1,10,17] comme causes de MPM.…”

“…Des myomes sous-muqueux sont trouvés chez 6 à 7 % des patientes avec MPM [22,24], leur incidence en pourcentage est massivement élevée chez les auteurs pratiquant le traitement des MPM par hystéro-scopie opératoire: 35 -48 % [21,23].…”

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

“…[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.…”

“…[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. [11][12][13][14][15][16][17] Despite numerous publications advocating the use of TVS and TVHS in evaluating women with postmenopausal bleeding, many physicians still consider endometrial biopsy (EMB) to be the standard of care when screening for endometrial diseases.…”