Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausal bleeding

Fistonić, Ivan; Hodek, Branko; Klarić, Petar; Jokanović, Ljubomir; Grubišić, Goran; Ivičević-Bakulić, Tomislav

doi:10.1002/(sici)1097-0096(199710)25:8<431::aid-jcu4>3.0.co;2-k

Cited by 22 publications

(24 citation statements)

References 20 publications

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“…It was absent or difficult to assess in the 3 cases (1.5%) that were diagnosed as endometrial cancer. Fistonic et al 18 assessed the various features of malignancy and found 100% sensitivity for an irregular myometrial‐endometrial interface in predicting endometrial carcinoma. Using the interface as one of the criteria, none of the cases with a benign diagnosis were misdiagnosed in this study.…”

Section: Discussionmentioning

confidence: 99%

Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids

Bhaduri

Tomlinson

Glanc

2014

J of Ultrasound Medicine

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Objectives The purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids. Methods This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial‐myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings. Results The LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial‐myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial‐myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity. Conclusions A combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.

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Section: Discussionmentioning

confidence: 99%

Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids

Bhaduri

Tomlinson

Glanc

2014

J of Ultrasound Medicine

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“…Am häufigsten wurden die cut-off-Level 4 mm und 5 mm untersucht, wobei unterhalb dieser Werte (£ 4 mm bzw. £ 5 mm) mit großer Sicherheit ein Endometriumkarzinom auszuschließen ist, aber darüber eine große Zahl falsch positiver Befunde zu finden ist [6, 30,40,56,70,79]. Neben den angeführten Arbeiten existieren 3 Metaanalysen, die dieses Resultat bestäti-gen [12,42,78]: Gupta et al (57 Studien,9 031 Patientinnen) folgerten, dass bei einem negativen Ergebnis, unter Anwendung eines cut-off-Level von £ 5 mm, eine endometriale Pathologie (Endometriumhyperplasie oder ein Karzinom) mit großer Sicherheit ausgeschlossen werden kann, da hiermit die Wahrscheinlichkeit einer endometrialen Erkrankung von 26 auf 2,7 % und eines Karzinoms von 14 auf 2,5 % vermindert wurde [42].…”

Section: Introductionunclassified

“…Die Ergebnisse zeigen, dass die Messung der Endometriumdicke bei PMB eine hohe Sensitivität für die Erkennung des Endometriumkarzinoms aufweist, aber eine geringe Spezifität [12,30,49]. Neben dem Karzinom können sich Polypen und Hyperplasien hinter einem verbreiterten Endometrium verbergen [12].…”

Section: Introductionunclassified

Diagnostik und präoperatives Staging des Endometriumkarzinoms mittels transvaginaler Sonographie - eine Übersicht

Nk¹,

Rehn²,

Thanner³

et al. 2006

Zentralbl Gynakol

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Endometrial carcinoma is the most common malignant tumor of the female genital tract. The major non-invasive diagnostic method is ultrasound. Endometrial thickness (double layer) is measured by transvaginal sonography. The cut-off value in patients with postmenopausal bleeding is still controversial, although in patients with endometrial thickness below 4 mm (or 5 mm respectively), malignancy can be excluded with high probability. If the endometrium measures more than 4 mm (or more than 5 mm respectively) or the patient presents with continuous bleeding, hysteroscopy and curettage should be performed in order to obtain histologic diagnosis. Sonographic findings like structure and demarcation of the endometrium increase diagnostic specificity only when combined with the measurement of endometrial thickness. Measuring the fluid within the uterine cavity does not seem to be useful in differentiating malignant from benign disorders. The extent of surgery depends on the preoperative estimation of the tumor stage which is particularly important for elder patients with increased morbidity. Transvaginal sonography has not been widely accepted to predict the depth of myometrial invasion or cervical infiltration. Although promising studies exist, additional examinations have to be done in order to determine the role of transvaginal sonography beside other methods (CT, MRT). This article on transvaginal ultrasound reviews current data on the method's capacity to identify endometrial cancer and to diagnose the depth of invasion.

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“…In 1995, Weigel and colleagues 29 suggested that adding assessment of the endometrium for homogeneity, presence of a central echo, and echogenicity would be most useful in diagnosing cancers in women whose endometrial thickness is in the ''gray area'' of 4-10 mm. Another prospective trial 30 found a 100% sensitivity for irregular myometrial-endometrial interface in predicting endometrial carcinoma. When intrauterine fluid is present, the measurement of endometrial thickness includes only 2 fine walls of the endometrium and excludes the fluid.…”

Section: Endometrial-myometrial Interfacementioning

confidence: 99%

Value of sonography in the diagnosis of abnormal vaginal bleeding

Dubinsky

2004

J of Clinical Ultrasound

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Abnormal vaginal bleeding is one of the most common presenting complaints in women of any age seeking gynecologic health care. Two of the most frequently used diagnostic tests to investigate the cause of the bleeding are endometrial biopsy and transvaginal sonography. The most worrisome cause of abnormal bleeding is endometrial carcinoma, yet benign etiologies are far more prevalent, including fibroids, polyps, and endometrial atrophy. Endometrial biopsy and transvaginal sonography have equal sensitivities for carcinoma, but sonography is far more effective in diagnosing benign disease. This article reviews the state-of-the-art in the diagnostic evaluation of abnormal vaginal bleeding and analyzes the data, with emphasis on the prevalence of benign and malignant disease as the basis for determining whether sonography or biopsy is more cost-effective in evaluating women with abnormal vaginal bleeding.

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Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausal bleeding

Cited by 22 publications

References 20 publications

Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids

Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids

Diagnostik und präoperatives Staging des Endometriumkarzinoms mittels transvaginaler Sonographie - eine Übersicht

Value of sonography in the diagnosis of abnormal vaginal bleeding

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