Endometrial Ultrasonography - An Alternative to Invasive Assessment in Women with Postmenopausal Vaginal Bleeding

1996 ◽  
Vol 82 (1) ◽  
pp. 38-39 ◽  
Author(s):  
Silvia Cecchini ◽  
Stefano Ciatto ◽  
Rita Bonardi ◽  
Grazia Grazzini ◽  
Antonia Mazzotta
Keyword(s):  
Endometrial Cancer ◽  
General Anesthesia ◽  
Endometrial Carcinoma ◽  
Vaginal Bleeding ◽  
Endometrial Thickness ◽  
Diagnostic Assessment ◽  
Vaginal Sonography ◽  
Postmenopausal Vaginal Bleeding

Aims and background To test the reliability of endometrial sonography in selecting women with abnormal postmenopausal vaginal bleeding for further diagnostic assessment. Methods Endometrial thickness was measured in 368 consecutive women by abdominal or vaginal sonography prior to invasive assessment (hysteroscopy, curettage). The association of abnormal endometrial thickness (4 mm or greater) with endometrial cancer was determined. Results Abnormal endometrial thickness was observed in 116 of 368 women. Subsequent assessment diagnosed endometrial carcinoma in 16 subjects, 15 of whom had abnormal endometrial thickness. One case with normal endometrial thickness was suspected at sonography because of the irregular appearance of the endometrium. Conclusions Had it been used to select subjects for further assessment, sonography would have missed no cancer, and unnecessary invasive assessment (under general anesthesia in 20% of cases) would have been spared in 68% (251/368) of the subjects. Endometrial sonography should be routinely used to select women with postmenopausal vaginal bleeding for further investigations.

Assessment of Risk Scoring Model for Prediction of Endometrial Cancer Among Symptomatic Postmenopausal Women (A Prospective Cohort Study)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Magdy M Abd Elgawaad ◽  
Amr M El Helaly ◽  
Malames M Faisal ◽  
Asmaa F Kasem
Keyword(s):  
Endometrial Cancer ◽  
Family History ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Serous Carcinoma ◽  
Scoring Model ◽  
Gynecological Malignancy ◽  
Risk Scoring ◽  
Study Population

Abstract Background Endometrial carcinoma is the most common gynecological malignancy in the developed countries and the third common gynecological malignancy in Egypt after breast and ovarian cancers. Aim of the Work to evaluate this risk scoring model on Egyptian patients and to study the effect of adding other patient characteristics (DM, BMI and relevant family history) on the sensitivity and specificity of RHEA scoring model. Patients and Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between September 2017 and December 2018. A total of 100 women with postmenopausal bleeding and endometrial thickness > 4mm were included in the study. Results Histological examination revealed that benign pathology (n = 65) (73%) was found to be: most common cause was endometrial hyperplasia without atypia (20.3%) followed by chronic endometritis (13.5%), then endometrial polyp (11.3%), cystic atrophy of endometrium (8.9%), proliferative endometrium (8.9%), endometrial hyperplasia with atypia (6.7%) and lastly mucous polyp (3.4%) while malignant histopathology(n = 24)(27%) which is significantly higher than the international rates showed: Endometriod adenocarcinoma (n = 19)(21.3%), papillary serous carcinoma (n = 4)(4.5%) and undifferentiated carcinoma (n = 1)(1.1%). The current study showed that RHEA score performs in our study population with a comparable validity to that reported by its inventors with sensitivity 79.2% (57.8% - 92.9%) vs. 87.5% and specificity 84.6% (73.5% - 92.4%) vs. 80.1% respectively. In results of the current study it was found that the time since onset of menopause rather than age was associated with endometrial cancer with the optimum cut-off for postmenopausal duration was estimated to be 9 years achieving a sensitivity of 87.5% and a specificity of 60.0%, but it needs multivariate analysis on larger and more representative sample size to confirm this association, A statistically significant regression model was including only postmenopausal duration, recurrent bleeding and endometrial thickness. None of age, BMI, family history or hypertension proved a statistically significant predictive effect after adjustment for other predictive variables. Conclusion Taking in consideration the higher prevalence of endometrial carcinoma in the sample of the current study, the wide 95% confidence intervals for the different validity indices for the RHEA scores derived from this study, it seems that RHEA score performs in this study population with a comparable validity to that reported by its inventors.

Vaginal bleeding during menopause hormone therapy. Is it always endometrial cancer? How to choose the appropriate tactics for examination and management of patients?

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 37-43
Author(s):  
Anna E. Protasova ◽  
Irina A. Solntseva ◽  
Ekaterina N. Vandeeva
Keyword(s):  
Endometrial Cancer ◽  
Hormone Therapy ◽  
Genital Tract ◽  
Vaginal Bleeding ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Menopausal Hormone Therapy ◽  
Modern Analysis ◽  
Menopause Hormone Therapy ◽  
Postmenopausal Vaginal Bleeding

The article provides an overview of the possible causes of bleeding from the genital tract in peri- and postmenopausal women. The correct approach to patients with abnormal uterine bleeding during menopausal hormone therapy is described. A modern analysis of data on the diagnosis and treatment of postmenopausal vaginal bleeding against the background of menopausal hormone therapy was carried out. The modern possibilities of endometrial diagnostics and treatment are shown.

scholarly journals Endometrial cancer: Diagnostic methods in postmenopausal vaginal bleeding

2003 ◽  
Vol 11 (2) ◽  
pp. 97-101
Author(s):  
Aljosa Mandic ◽  
Tamara Vujkov
Keyword(s):  
Endometrial Cancer ◽  
Vaginal Bleeding ◽  
Transvaginal Ultrasound ◽  
Correct Diagnosis ◽  
False Negative ◽  
Endometrial Biopsy ◽  
Diagnostic Methods ◽  
Histological Evaluation ◽  
Leading Symptom ◽  
Postmenopausal Vaginal Bleeding

Postmenopausal vaginal bleeding (PMB) is the leading symptom of endometrial cancer. More than 70% of patients with endometrial cancer are postmenopausal. Despite PMB as a leading symptom in diagnosis of endometrial cancer, PMB could be caused by some benign processes in endometrium such as hyperplasia and focal endometrial disease, such as a polyp. The golden standard for histological evaluation of the endometrium is curettage. Transvaginal ultrasound (TVS) and measurement of endometrium thickness is also one of the favored methods in the last decade. Sonographic imaging of the endometrium can be extremely helpful, because endometrial cancer is nearly always associated with thickening and heterogeneity of the endometrium except in case of atrophy-associated adenocarcinoma of the endometrium, which is not associated with thickening. Hysteroscopy found place as a favored method in diagnosis of focal endometrial lesions. Saline infusion sonohysterography (SIS) is a relatively new imaging procedure. The SIS will show whether the endometrium is diffusely thickened, in which case curettage would be the next step, or focally thickened, in which case hysteroscopy with biopsy would be the next step. Combination of some diagnostic procedures, such as TVS, SIS, hysteroscopy, endometrial biopsy and curettage, should decrease false positive and false negative results which may affect the correct diagnosis and treatment.

scholarly journals The Association of Body Mass Index and Ki67 Values in Patients with Endometrial Carcinoma

2019 ◽  
Vol 70 (9) ◽  
pp. 3277-3280
Author(s):  
Alexandru Furau ◽  
Marius Lucian Craina ◽  
Cristian Furau ◽  
Tudor Constantin Luca ◽  
Bogdan Corneliu Andor ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Endometrial Cancer ◽  
Survival Rate ◽  
Endometrial Carcinoma ◽  
Body Mass ◽  
Vaginal Bleeding ◽  
Control Sample ◽  
Ki 67 ◽  
Her 2 ◽  
Endometrial Cancers

Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer. The study included all patients who had been evaluated for vaginal bleeding in Obstetrics and Gynecology Department of Clinical Emergency County Hospital, Timisoara between 2016-2018. Of the 195 cases of uterus scraping, 19 cases were labelled as malignant endometrial pathology. For the statistical analysis we calculated some descriptive statistics for the age parameter and the BMI (body mass index) parameter in our disease sample and we compared the BMI values to the BMI values from the control sample As well, we tested to see if there is an association between the Ki-67 values and the HER-2 / neu status in patients with or without endometrial carcinoma. In order to test the significance we applied a Mann -Whitney test, for a = 0.05 set as a confidence level. Unfortunately, in the case of our study group, type 1 endometrial cancers are found in only 5 cases, unlike other countries where most of endometrial cancers are diagnosed early (80% in the first stage) and the 5-year survival rate is about 95%. In any case, the 5-year survival rate is much lower if there is involvement of regional lymph nodes or distant metastasis (68% and 17%, respectively) - as in our case where all cases were classified as Stage III and IV. By running the statistical test we obtained extremely significant differences in the BMI of our patients (p[0.001), the diseased patients tend to have higher BMI values. As well, when we tested the possible association between the Ki-67 values and the HER-2 / neu status in our two groups (patients with or without endometrial carcinoma) we obtained extremely significant differences (p[0.001). The Ki-67 values are increasing proportionally with the carcinoma staging. An endometrial biopsy is the most commonly used test for endometrial cancer and is very accurate in postmenopausal women.

scholarly journals A Risk-Scoring Model for the Prediction of Endometrial Cancer among Symptomatic Postmenopausal Women with Endometrial Thickness > 4 mm

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Luca Giannella ◽  
Kabala Mfuta ◽  
Tiziano Setti ◽  
Lillo Bruno Cerami ◽  
Ezio Bergamini ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Postmenopausal Women ◽  
Vaginal Bleeding ◽  
Risk Model ◽  
Endometrial Thickness ◽  
Patient Characteristics ◽  
Roc Curve Analysis ◽  
Decision Algorithm ◽  
Scoring Model ◽  
Risk Scoring

Objective. To develop and test a risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women at risk of intrauterine malignancy.Methods. We prospectively studied 624 postmenopausal women with vaginal bleeding and endometrial thickness > 4 mm undergoing diagnostic hysteroscopy. Patient characteristics and endometrial assessment of women with or without endometrial cancer were compared. Then, a risk-scoring model, including the best predictors of endometrial cancer, was tested. Univariate, multivariate, and ROC curve analysis were performed. Finally, a split-sampling internal validation was also performed.Results. The best predictors of endometrial cancer were recurrent vaginal bleeding (odds ratio(OR)=2.96), the presence of hypertension(OR=2.01)endometrial thickness > 8 mm(OR=1.31), and age > 65 years(OR=1.11). These variables were used to create a risk-scoring model (RHEA risk-model) for the prediction of intrauterine malignancy, with an area under the curve of 0.878 (95% CI 0.842 to 0.908;P<0.0001). At the best cut-off value (score ≥ 4), sensitivity and specificity were 87.5% and 80.1%, respectively.Conclusion. Among symptomatic postmenopausal women with endometrial thickness > 4 mm, a risk-scoring model including patient characteristics and endometrial thickness showed a moderate diagnostic accuracy in discriminating women with or without endometrial cancer. Based on this model, a decision algorithm was developed for the management of such a population.

Estimating the Risk of Endometrial Cancer in Symptomatic Postmenopausal Women: A Novel Clinical Prediction Model Based on Patients' Characteristics

2011 ◽  
Vol 21 (3) ◽  
pp. 500-506 ◽  
Author(s):  
Nikolaos Burbos ◽  
Patrick Musonda ◽  
Timothy J. Duncan ◽  
Simon G. Crocker ◽  
Edward P. Morris ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Carcinoma ◽  
Postmenopausal Women ◽  
Vaginal Bleeding ◽  
Clinical Characteristics ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Model Based ◽  
Receiver Operating Characteristics Curve ◽  
Receiver Operating

IntroductionThe aim of this study was to develop a multivariable model to predict the risk of endometrial carcinoma in postmenopausal women with vaginal bleeding using individuals' clinical characteristics.Patients and MethodsThis prospective study of consecutive postmenopausal women presenting with vaginal bleeding was conducted at a gynecological oncology center in the United Kingdom for a 46-month period. All women underwent transvaginal ultrasound scanning as the initial investigation tool to evaluate the endometrium. Women found to have an endometrial thickness 5 mm or more had endometrial sampling performed.ResultsOf a total of 3548 women presenting with vaginal bleeding during the study period, 201 (6%) women had a diagnosis of endometrial carcinoma. An investigator-led best model selection approach used to select the best predictors of cancer in the multiple logistic regression model showed that patient's age (odds ratio [OR], 1.06), body mass index (OR, 1.07), recurrent episodes of bleeding (OR, 3.64), and a history of diabetes (OR, 1.48) increased the risk of endometrial malignancy when corrected for other characteristics. The mentioned clinical variables satisfied the criteria for inclusion in our predictive model called FAD 31 (F for the frequency of bleeding episodes, A for the age of the patient, D for diabetes, and the number 31 represents the BMI cut-off value). The total score for the model varies from 0 to 8. The area under the receiver operating characteristics curve for the developed model was 0.73 (95% confidence interval, 0.70-0.77).DiscussionWe have developed a simple model based on patients' clinical characteristics in estimating the risk of endometrial cancer for postmenopausal women presenting with vaginal bleeding. The model shows reasonable discriminatory ability for women with cancer and without, with an area under the receiver operating characteristics curve of 0.73. This will allow clinicians to individualize the diagnostic pathway for women with postmenopausal vaginal bleeding.

A STUDY OF ENDOMETRIAL THICKNESS IN TRANS VAGINAL SONOGRAPHY IN RELATION WITH HISTOPATHOLOGY REPORT IN DILATION & CURRATAGE IN AUB WOMEN

2019 ◽  
pp. 1-2
Keyword(s):  
Comparative Study ◽  
Endometrial Thickness ◽  
P Value ◽  
First Line ◽  
Non Invasive ◽  
Dilation And Curettage ◽  
Study Results ◽  
Vaginal Sonography ◽  
In Trans

A study of of endometrial thickness on TVS in relation with histopathology report on dilation and curettage. AIM AND OBJECTIVE-To set a cut off limit of endometrial thickness on TVS for differtiating between normal and abnormal endometrium. MATERIAL AND METHOD-hospital based comparative study. RESULTS-TVS is non invasive ,simple first line procedure in AUB women. Mean endometrial thickness in normal endometrial group was 8.00±2.44 mm and in abnormal endometrial group was 15.16±33 mm.The difference was found highly significant (p value<.001)

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