scholarly journals Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Shimaa Abdalla Ahmed ◽  
Hisham Abo-Taleb
Keyword(s):  
Diagnostic Accuracy ◽  
Real Time ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Screening Method ◽  
Observer Agreement ◽  
Diagnostic Efficiency ◽  
Offline Analysis ◽  
Post Menopausal ◽  
Time Evaluation

Abstract Background Our purpose was to evaluate the diagnostic performance of two-dimensional transvaginal ultrasound (2D-TVUS) and gel infusion sonography (GIS) at offline analysis for endometrial characterization compared with real-time evaluation during scanning. One hundred fifty women presented with PMB. At TVUS, endometrial thickness was ≥ 4 mm in 122 (81.3%) women and < 4 mm in 28 (18.72%). Among 122 women with endometrial thickness > 4 mm, GIS was successfully performed in 117 (95.9%). Examinations were stored as video clips for later evaluation (offline analysis) by two less experienced radiologists. Endometrial lesions were classified into four categories: no endometrial abnormality, hyperplasia, polyps, and cancer. Diagnostic efficiency of real-time and offline analysis for diagnosis of each category was calculated and compared, and inter-observer agreement for offline analysis was calculated. Results All patients underwent hysteroscopy and/or hysterectomy. Histopathological results confirmed no endometrial abnormality in (27.3%, 41/150), endometrial hyperplasia in (12.7%, 19/150), endometrial polyps in (17.3%, 26/150), and endometrial cancer in (42.7%, 64/150). Overall diagnostic accuracy of real-time imaging was 89.7% (CI 84–91%)). The highest accuracy 92.7% (CI 88–98%) was seen in the diagnosis of cancer, and polyps 91.5% (CI 86–97%). The lowest accuracy 75% (CI 69–82%) was seen in hyperplasia. Overall diagnostic accuracy of offline analysis was 81%, and it increased to 88% (CI 83–92%) after a restricted analysis of good quality clips. The highest accuracy 90.7% (CI 83–95%) was seen in the diagnosis of polyps, and cancer 90.4% (CI 83–96%). The lowest accuracy 71% (CI 69–75%) was seen in hyperplasia. At offline analysis, the inter-observer agreement was substantial k = 0.77 (CI 71–84) in the evaluation of four endometrial categories after the exclusion of bad quality videos. It was excellent in exclusion of endometrial abnormalities k = 0.85 (0.78–0.90), substantial in the diagnosis of polyps k = 0.71 (0.69–0.88), cancer k = 0.61 (0.61–0.77), and moderate in the diagnosis of hyperplasia k = 0.41 (0.30–0.41). Conclusion Offline 2D analysis with a good image quality has comparable accuracy to a real-time evaluation during scanning in the diagnosis of endometrial lesions. It can increase the accuracy of sonography in ruling out endometrial abnormalities and diagnose non-hyperplastic endometrial pathologies. High NPV and substantial reproducibility can make it an efficient initial screening method in a post-menopausal bleeding.

scholarly journals Multiparametric transvaginal ultrasound in the diagnosis of endometrial cancer in post-menopausal bleeding: diagnostic performance of a transvaginal algorithm and reproducibility amongst less experienced observers

2021 ◽  
Vol 94 (1119) ◽  
pp. 20201195
Author(s):  
Shimaa Abdalla ◽  
Hisham Abou-Taleb ◽  
Dalia M. Badary ◽  
Wageeh A. Ali
Keyword(s):  
Endometrial Cancer ◽  
Real Time ◽  
Diagnostic Performance ◽  
First Line ◽  
Multiple Parameters ◽  
Good Technique ◽  
Offline Analysis ◽  
Post Menopausal ◽  
High Degree ◽  
Time Evaluation

Objective: (a) To comparatively evaluate the performance of grayscale ultrasound features, power Doppler (PD) blood flow characteristics, and gel infusion sonography (GIS) in diagnosing endometrial cancer during real-time examination, (b) to compare the performance of real-time diagnosis of endometrial cancer by experienced observers with offline analysis by blinded observers using similar sonographic criteria during review of cine loop clips. Methods: 152 females with post-menopausal bleeding (PMB) had ET ≥ 4 mm at first-line ultrasound were included. Two experienced radiologists evaluated endometrial patterns at real-time evaluation (grayscale ultrasound, PD, and GIS), then examinations were stored as video clips for later evaluation by two less-experienced radiologists. The reference standard was hysteroscopy (HY) and/or hysterectomy with the histopathological examination. The area under (AUC) the receiver operating characteristic (ROC) curve was calculated to assess the diagnostic performance for the prediction of endometrial cancer. Results: Among 152 females with ET ≥ 4 mm at first line TVUS, 88 (57.9%) patients had endometrial cancer on final pathologic analysis. Real-time ultrasound criteria (ET ≥ 5 mm with the presence of irregular branching endometrial blood vessels or multiple vessels crossing EM or areas with densely packed color-splash vessels with non-intact or interrupted EMJ at the grayscale ultrasound and/or GIS) correctly diagnosed 95% of endometrial cancers with 92% diagnostic efficiency. There is comparable accuracy of real-time evaluation (96%) and offline analysis (92%) after the exclusion of poor quality videos from the analysis. The diagnostic criteria showed good to an excellent agreement between real-time ultrasound and offline analysis. Conclusion: When real-time ultrasound is performed with good technique, utilizing multiple parameters, it is possible to diagnose endometrial cancer with a high degree of accuracy and reproducibility. Advances in knowledge: when real-time ultrasound is performed with good technique, utilizing multiple parameters, it is possible to diagnose endometrial cancer with a high degree of accuracy and reproducibility.

scholarly journals Role of transvaginal ultrasound in assessment of endometrial pathology in patients with post-menopausal bleeding

2017 ◽  
Vol 6 (4) ◽  
pp. 1376 ◽  
Author(s):  
Sudha Menon ◽  
Sreekumari R
Keyword(s):  
Diagnostic Tool ◽  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
High Negative Predictive Value ◽  
Post Menopausal ◽  
A Prospective Study ◽  
Endometrial Pathology

Background: Post-menopausal bleeding (PMB) is the most distressing problem in females Endometrial thickness (EMT) as assessed by transvaginal ultrasound (TVS) aids in diagnosing endometrial pathology. This study analyses usefulness of TVS as a diagnostic tool in the evaluation of PMB.Methods: A prospective study was conducted in 100 patients. Correlation of EMT by TVS was compared with gold standard of histopathological examination (HPE) of the endometrium by fractional curettage (FC).Results: Mean age was 56.9±8.03 years and mean parity status was 2.83±1.45. Mean duration after menopause to presentation of bleeding per vaginum was 5.7±3.85 years. As per the receiver operating characteristic curve (ROC) analysis, an EMT of 10.8 mm had a high negative predictive value (99.1%) for malignancy with moderate specificity (62.79%) and high sensitivity (92.3%).Conclusions: TVS can be easily performed and is less expensive and a useful diagnostic tool in the evaluation of PMB with a cut off value of 10.8 mm EMT gives a high sensitivity (92.3%) and moderate specificity (62.79%).

Role of Transvaginal Ultrasonography in Diagnosing Endometrial Hyperplasia in Postmenopausal Women with Abnormal Uterine bleeding taking Histopathology as Gold Standard

2021 ◽  
Vol 15 (6) ◽  
pp. 1229-1230
Author(s):  
S. Bilal ◽  
M. Gulshan ◽  
M. Tahir
Keyword(s):  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
False Negative ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Ultrasonography ◽  
Post Menopause ◽  
Post Menopausal

Aim: Diagnostic accuracy of transvaginal ultrasonography in diagnosing endometrial hyperplasia in post-menopausal women with abnormal uterine bleeding taking histopathology as gold standard. Settings & duration: Department of Radiology, CMH, Rawalpindi from 25-08-17 to 24-02-18 Methodology: A total of 203 post-menopausal females having AUB were included. Patients who had cervical and vaginal pathologies other than EH were excluded. The ultrasound was done with Endovaginal probe of Toshiba aplio 500. On ultrasound, endometrial thickness was taken. Endometrial biopsy was carried out using hysteroscopy. Final diagnosis was based upon histopathology report. Results: In TVS positive patients, 103 were True Positive and 12 were False Positive. Among 88 TVS negative patients, 04 were False Negative whereas 84 were True Negative (p=0.01). Overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of transvaginal ultrasonography in diagnosing endometrial hyperplasia in post-menopause women with abnormal uterine bleeding taking histopathology as gold standard was 96.3%, 87.5%, 89.6%, 95.5% and 92.1% respectively. Conclusion: Diagnostic accuracy of TVS in diagnosing endometrial hyperplasia in post-menopause women with AUB is high, so TVS should be the first line investigation in diagnosis of endometrial hyperplasia. Keywords: Abnormal uterine bleeding, TVS, endometrial hyperplasia

Post-menopausal bleeding – Is transvaginal ultrasound a useful first-line investigation in tamoxifen users?

2018 ◽  
Vol 24 (2) ◽  
pp. 72-78 ◽  
Author(s):  
A Abdaal ◽  
Y Mushtaq ◽  
L Khasati ◽  
J Moneim ◽  
F Khan ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Outcome Data ◽  
Tamoxifen Treatment ◽  
First Line ◽  
Tamoxifen Group ◽  
History Of ◽  
Post Menopausal ◽  
Endometrial Pathology

Objective To evaluate the role of transvaginal ultrasound triage in women with a history of tamoxifen treatment who present with post-menopausal bleeding. Study design A retrospective review was undertaken of patients who presented with symptoms of post-menopausal bleeding and underwent ultrasound triage. Endometrial thickness and ultrasonographic features were then correlated with hysteroscopic and histopathological outcome data. The findings and outcomes for women with a history of tamoxifen use (tamoxifen group) were compared to those who had not taken tamoxifen (non-tamoxifen group). Results A total of 614 women with post-menopausal bleeding underwent transvaginal ultrasound triage, of whom 53 had a history of current or previous tamoxifen treatment. An endometrial thickness of ≥5 mm or the presence of other abnormal features was used to triage women to further investigation by hysteroscopy and biopsy. Endometrial thickness was significantly greater in the tamoxifen group (11 mm vs. 6 mm). Nearly all of the tamoxifen group were triaged to further investigation (98.1%), compared with significantly fewer in the non-tamoxifen group (68.3%) Overall, the incidence of endometrial pathology was also significantly higher in tamoxifen patients (43.4% vs. 31.7%). Conclusion For women presenting with post-menopausal bleeding, the use of transvaginal ultrasound as a triage tool is rarely helpful in evaluating women who have a history as tamoxifen use, as most will require further investigation with hysteroscopy and biopsy. A post-menopausal bleeding protocol that omits transvaginal ultrasound for women with a history of tamoxifen use may be an appropriate and effective pathway for managing these patients.

Sign in / Sign up

Export Citation Format

Share Document