Ultrasound assessment of endometrial morphology and vascularity to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm

Abstract

Objectives

The use of new and old ultrasound techniques in the assessment of women with postmenopausal bleeding

“…The interobserver agreement between two experienced examiners was excellent for ET measurement in our own study with a Kappa value of 0.8 30 . Opolskiene and co‐workers found that the inter‐observer agreement between two experienced examiner for endometrial morphology assessment was generally moderate to good, with a kappa value of 0.49–0.78 21 . Assessment of vascular morphology showed a similar reproducibility as previously reported for endometrial thickness measurements 21 , 30 .…”

“…There are, however, several studies showing that endometrial morphology assessment can be useful in the prediction of endometrial cancer 20 – 23 . Endometrial echogenicity and border in combination with ET has been shown to be a better predictor of endometrial cancer than ET measurement alone 21 – 23 . The best predictor of cancer at SIS is the finding of an irregular surface focal lesion (sensitivity 89% specificity 67%), Fig.…”

“…2, 20 . Assessment of vascular morphology of endometrial vessels can also be used to estimate the risk of endometrial cancer 20 , 21 , 24 . The presence of multiple vessels has a sensitivity of around 80% for the detection of cancer at a specificity of 54–100%, Fig.…”

“…3, 21 , 24 . Irregular vascular branching and areas of densely packed vessels might also be useful in the prediction of malignancy since these phenomena are very uncommon in benign cases 21 .…”

Three‐dimensional ultrasound imaging for discrimination between benign and malignant endometrium in women with postmenopausal bleeding and sonographic endometrial thickness of at least 4.5 mm

“…However, many women with postmenopausal bleeding and endometrial thickness ≥ 5 mm do not have endometrial cancer and some do not have any endometrial pathology at all, but will still undergo -perhaps unnecessarily -interventional diagnostic procedures such as dilatation and curettage (D&C) or hysteroscopy. In the high-risk group of women with postmenopausal bleeding and a thick endometrium, the thicker the endometrium the higher the risk of malignancy 3,4 . Diagnostic methods other than a simple measurement of endometrial thickness, e.g.…”