Vaginosonography for early detection of endometrial carcinoma?

Osmers, R.; Völksen, M.; Schauer, A.

doi:10.1016/0378-5122(91)90300-f

Cited by 44 publications

(55 citation statements)

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“…Thus, the use of endometrial thickness as the only indicator for invasive assessment implies a large number of false positives, even at TVUS diagnosis, and of unnecessary assessments (Osmers et al, 1990;Ciatto et al, 1995). In the present study only a cutoff of X3 mm would be totally safe, granting for no missed cancer, but it would allow a limited (25.8%) reduction of unnecessary invasive assessments.…”

Section: Discussionmentioning

confidence: 59%

“…For this reason, special surveillance for EC has been suggested in breast cancer patients under adjuvant tamoxifen treatment (Jordan and Morrow, 1994;Neven et al, 1994) and periodic examination by transvaginal ultrasonography (TVUS) is commonly performed (Oladipo, 1993;Kedar et al, 1994). Increased endometrial thickness measured at TVUS has been reported as an indicator of endometrial proliferation and EC risk (Karlsson et al, 1995;Weber et al, 1997) and has been suggested as a criterion to prompt invasive diagnostic assessment (hysteroscopy, dilatation and curettage) in postmenopausal asymptomatic or symptomatic (AUB ¼ abnormal uterine bleeding) women (Goldstein et al, 1990;Osmers et al 1990;Cecchini et al, 1996;Langer et al, 1997;SmithBindman et al, 1998).…”

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confidence: 99%

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Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment

et al. 2003

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The association of endometrial thickness with the risk of developing endometrial cancer (EC) within 2 years was investigated in a consecutive cohort of 1205 breast cancer patients under tamoxifen treatment, undergoing transvaginal ultrasonography (TVUS) for follow-up purpose (asymptomatic, 1068) or for abnormal uterine bleeding (AUB, 137). Linkage with tumour registry allowed for the follow-up of 3184.3 person-years. According to underlying incidence, 1.85 EC cases were expected in the study cohort while 12 were observed (observed/expected ratio ¼ 6.49, 95% CI 3.35 -11.33; asymptomatic ¼ 4.09, 95% CI 1. symptomatic ¼ 35.71,. No EC was observed with thickness (half layer) o3 mm. Raising this threshold increased specificity with a substantial loss of sensitivity (X3, X4, X6, X9 mm; spec. ¼ 25.8, 44.5, 76.1, 91.5%, sens. ¼ 100, 91.6, 75.0, 66.6%). The presence of AUB was rather specific (88.94%) but poorly sensitive (41.67%). A combination of AUB presence/ absence and thickness allowed the best accuracy (AUB + thickness X3, X4 or X5; sens. ¼ 100, 81.6 or 91.6%; spec. ¼ 22.8, 40.4, or 56.7%). Breast cancer patients under tamoxifen might be selected for further invasive assessment on the basis of AUB and endometrial thickness assessed at TVUS.

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Section: Discussionmentioning

confidence: 59%

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confidence: 99%

Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment

et al. 2003

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“…In the postmenopausal period, different cut-off values for endometrial thickness have been proposed to determine whether additional investigation is required, particularly in asymptomatic women who carry a lower risk of malignancy compared with women with genital bleeding [18][19][20] . For focal endometrial lesions where the adjacent endometrium has an atrophic pattern, these cut-off values are poorly defined.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

Godoy¹,

Antunes²,

Morais³

et al. 2013

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy. ResumoOBJETIVO: Avaliar a acurácia da espessura endometrial ecográfica e características histeroscópicas em predizer malignidade em mulheres na pós-menopausa submetidas à ressecção cirúrgica de pólipos endometriais. MÉTODOS: Quinhentos e vinte e uma (521) mulheres na pós-menopausa submetidas à ressecção histeroscópica de pólipo endometrial entre janeiro de 1998 e dezembro de 2008 foram incluídas no estudo. Para cada valor de espessura endometrial ecográfica e tamanho dos pólipos na histeroscopia, a sensibilidade, a especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados em relação ao diagnóstico histológico de malignidade. Os melhores valores de sensibilidade e especificidade para o diagnóstico de malignidade foram determinados pela curva Receiver Operating Characteristic (ROC). RESULTADOS: O diagnóstico histológico identificou a presença de pré-malignidade ou malignidade em 4,1% dos casos. A espessura endometrial medida por ultrassonografia em casos de pólipos malignos foi maior quando comparado com pólipos benignos e pré-malignos. Na histeroscopia os pólipos malignos também foram maiores. A espessura endometrial de 13 mm mostrou uma sensibilidade de 69,6%, especificidade de 68,5%, VPP de 9,3% e VP...

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“…All patients underwent a gynecological evaluation, vaginal ultrasonography combined with color flow images of the uterine arteries, and endometrial biopsy, performed during a hysteroscopic examination. All patients had been treated with 20 to 30 mg of tamoxifen daily (Abic Ltd., Chemical and Pharmaceutical Industries, Netanya, Israel) for a period of 12 to 42 months (mean, 21.18 months). Informed consent was obtained from each patient after the nature of the study was fully explained.…”

Section: Methodsmentioning

confidence: 99%

Doppler flow evaluation of pathologic endometrial conditions in postmenopausal breast cancer patients treated with tamoxifen.

Tepper

Cohen

Altaras

et al. 1994

Journal of Ultrasound in Medicine

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A prospective pilot study was conducted to evaluate the usefulness of uterine artery blood flow in the detection of various pathologic endometrial conditions in 39 asymptomatic postmenopausal breast cancer patients who were treated with tamoxifen. No specific pattern was seen for the uterine artery pulsatility index values in the tamoxifen‐treated patients that could be related to any specific endometrial lesions, nor were any specific changes observed in the pulsatility index value with increasing severity of the pathologic endometrial conditions. Similarly, no correlation was found between ultrasonographically measured endometrial widths and uterine artery pulsatility index values. Thus, although pulsed Doppler flow ultrasonography has been shown previously to be effective in the detection of uterine cancer in non‐tamoxifen‐treated post‐menopausal patients, it probably does not contribute to the assessment of endometrial lesions in post‐menopausal breast cancer patients treated with tamoxifen.

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Vaginosonography for early detection of endometrial carcinoma?

Cited by 44 publications

References 0 publications

Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment

Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

Doppler flow evaluation of pathologic endometrial conditions in postmenopausal breast cancer patients treated with tamoxifen.

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