Evaluation of International Endometrial Tumor Analysis Sonographic Criteria in diagnosis of Endometrial Carcinoma

Postmenopausal vaginal bleeding is a sign that should not be Ultrasound imaging has become an effective diagnostic tool of gynecological practice throughout the years. Endometrial diagnosis typically involves invasive investigational approaches. Today, however, with the advent of high-resolution transvaginal ultrasound and Doppler ultrasonography (non-invasive diagnostic tool), is an alternative candidate to replace invasive approaches. The aim of this study is to evaluate the contribution of the terms and definitions described by the IETA group when designing a malignancy model for better diagnosis of malignancy in cases with postmenopausal uterine bleeding. In the present study 120 patients with postmenopausal bleeding were included in the study. The study was conducted from April 2017 to April 2019 at Tanta University hospitals, Obstetrics & Gynecology and Diagnostic Radiology departments. Both patients were subjected to the following: full history taking, general examination, local examination, 2D transvaginal ultrasonography, Doppler study, hysteroscopy examination, endometrial biopsy. Symptomatic postmenopausal women with endometrial thickness > 5 mm have been chosen because women with a lower endometrial thickness have a very low incidence of cancer and a prospective evaluation.

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ACCURACY OF TRANSVAGINAL ULTRASONOGRAPHY COMPARED TO ENDOMETRIAL BIOPSY FOR THE ETIOLOGICAL DIAGNOSIS OF ABNORMAL PERIMENOPAUSAL BLEEDING

Medicine and Pharmacy Reports ◽

10.15386/cjmed-670 ◽

2017 ◽

Vol 90 (1) ◽

pp. 33-39

Author(s):

Renata Nicula ◽

Doru Diculescu ◽

Codruţa Claudia Lencu ◽

Răzvan Ciortea ◽

Carmen Elena Bucuri ◽

...

Keyword(s):

Transvaginal Ultrasound ◽

Endometrial Adenocarcinoma ◽

Age Groups ◽

Clinical Manifestations ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Accurate Identification ◽

Non Invasive ◽

Number Of Patients ◽

Invasive Method

Background and aims. Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management.Method. The study included 103 patients aged between 41.5–55.11 years, divided into 3 age groups: 40-44 years (n=10), 45-49 years (n=54) and ≥50 years (n=39).Results. Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes.Conclusions. Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171394 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1376 ◽

Cited By ~ 1

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%).

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Clear Cell Carcinoma of the Endometrium in a Patient Presenting with Postmenopausal Bleeding but Negative Endometrial Biopsy

Case Reports in Oncology ◽

10.1159/000520878 ◽

2021 ◽

pp. 1768-1772

Author(s):

Swechchha Silwal ◽

Sumeet Kumar Yadav ◽

Benedict Amalraj ◽

Mohamed Mandeel ◽

Geetha Krishnamoorthy

Keyword(s):

Endometrial Cancer ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Endometrial Biopsy ◽

Postmenopausal Bleeding ◽

Gynecological Malignancy ◽

The Usa

Endometrial carcinoma is the most common gynecological malignancy in the USA with approximately 66,570 cases and 12,940 deaths in 2020. Clear cell carcinoma (CCC) of the endometrium is an estrogen-independent type II endometrial cancer which accounts for <5% of endometrial cancer. When diagnosed roughly, 45% of patients have extrauterine metastases. Current American College of Obstetrics and Gynecology guidelines recommend transvaginal ultrasound for postmenopausal bleeding and a biopsy for those with endometrial thickness >5 mm. However, we present a case of a postmenopausal woman with a history of fibroid where endometrial biopsy has failed to make diagnosis twice. Hence, further testing should be performed in patients with unexplained postmenopausal bleeding including vaginal hysterectomy with lymph node dissection.

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A Feasibility Study of Screening for Endometrial Carcinoma in Postmenopausal Women by Ultrasonography

Tumori Journal ◽

10.1177/030089169508100506 ◽

1995 ◽

Vol 81 (5) ◽

pp. 334-337 ◽

Cited By ~ 12

Author(s):

Stefano Ciatto ◽

Silvia Cecchini ◽

Rita Bonardi ◽

Grazia Grazzini ◽

Antonia Mazzotta ◽

...

Keyword(s):

Endometrial Carcinoma ◽

Statistical Power ◽

Endometrial Thickness ◽

Endometrial Biopsy ◽

Consecutive Series ◽

Large Populations ◽

Low Incidence ◽

The Cost ◽

Lost To Follow Up

Background Abnormal endometrial thickness assessed by ultrasonography has been reported as a reliable indicator for early asymptomatic endometrial carcinoma. Study design We evaluated the feasibility and the performance of screening by ultrasonography in a consecutive series of postmenopausal volunteers. Results A total of 2,025 women were screened, and 117 (5.8%) showed abnormal endometrial thickness. Ninety-eight subjects consented to be assessed by outpatient endometrial biopsy, which was not possible in 32 for cervical stenosis. Three cancers were detected among 66 assessed subjects, 34 not-assessed subjects were controlled by repeat sonography (no change), and 17 were lost to follow-up. No other cancer was recorded by the local Cancer Registry among screened subjects. The prevalence/incidence ratio was 2.65:1, and the cost per screen-detected cancer was 18,571,000 Italian lire. Conclusions Screening by endometrial sonography is feasible on a practical basis, but its efficacy needs to be proven by prospective controlled studies which would enroll large populations to ensure sufficient statistical power, considering the low incidence and the low lethality of the disease. Studies of screening for other carcinomas may be considered of higher priority.

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AN OVERVIEW OF ENDOMETRIAL HYPERPLASIA

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i2.1007 ◽

2021 ◽

Vol 10 (2) ◽

pp. 2676-2680

Author(s):

Priya M Gokula ◽

Keyword(s):

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Endometrial Cells ◽

Dilation And Curettage ◽

Malignant Condition ◽

Day By Day

Endometrial Hyperplasia is referred as the endometrial cells of uterus, which keep on growing or multiplying instead of shedding because of high levels of estrogen and low or insufficient levels of progesterone. It is a pre-malignant condition but which are not invasive in nature. EH usually occurs in women between 50 – 55 yrs. Endometrium being a hormone dependent tissue depends on estrogen and progesterone for proliferation and shedding. Endometrial thickness gradually increases day by day. EH is caused by PCOS and chronic anovulation in premenopausal women. Obesity, lynch syndrome are other causes of EH. In 1994, WHO classified this EH into four groups. In 2014, WHO revised this classification into two types, one is endometrial Hyperplasia (without atypia) and second one is atypical endometrial hyperplasia or EIN. Patient with EH experiences abnormal uterine bleeding, bleeding in between periods etc… Age, nulliparity, obesity, smoking, diabetes mellitus are the risk factors and is diagnosed by endometrial biopsy, dilation, and curettage, a transvaginal ultrasound, hysteroscopy. Management of EH is based on its types. Hyperplasia without atypia is managed by the levonorgestrel-releasing intrauterine system (LNG-IUS), oral progestogens, and surgery. Atypical EH is managed by surgery hysterectomy

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Hysteroscopy in the diagnosis of postmenopausal bleeding

Menopause International: The Integrated Journal of Postreproductive Health ◽

10.1258/175404507781605587 ◽

2007 ◽

Vol 13 (3) ◽

pp. 132-134 ◽

Cited By ~ 11

Author(s):

Bramara Guruwadayarhalli ◽

Siân E Jones ◽

Vyjayanthi Srinivasan

Keyword(s):

Gold Standard ◽

Hospital Admissions ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Endometrial Biopsy ◽

Postmenopausal Bleeding ◽

First Line ◽

Endometrial Cavity ◽

Outpatient Hysteroscopy ◽

Transvaginal Ultrasound Scan

Postmenopausal bleeding (PMB) accounts for 5% of gynaecology referrals. Investigations should exclude malignancy and pre-malignancy, and diagnose the benign conditions that need treatment. The three modalities that are most commonly used are transvaginal ultrasound scan (TVS), endometrial biopsy (EB) and hysteroscopy. Most authors agree that the first-line investigation should be TVS, followed by endometrial assessment (EB or hysteroscopy) if the endometrial thickness is >4 mm. When scanning demonstrates the possibility of pathology, outpatient hysteroscopy and biopsy are the gold standard for investigating the endometrial cavity. Focal pathology can be removed during the hysteroscopy, thereby reducing hospital admissions and costs.

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

10.36106/paripex/1 ◽

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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A Clinico-pathological Study of Transvaginal Endometrial Thickness Measurement in Asymptomatic Postmenopausal Patients and Patients with Postmenopausal Bleeding

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.851 ◽

2019 ◽

pp. 1

Author(s):

Ayse Filiz Gokmen Karasu ◽

Seda Ates ◽

Tugba Gurbuz ◽

Nurhan Sahin ◽

Taha Takmaz ◽

...

Keyword(s):

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Thickness Measurement ◽

University Hospital ◽

Postmenopausal Bleeding ◽

Pathological Study ◽

Endometrial Polyps ◽

Endometrial Sampling ◽

Proliferative Endometrium

Objective: We aimed to determine the frequency of endometrial pathologies of patients who presented to our outpatient clinic with postmenopausal bleeding (PMB) and asymptomatic menopausal patients with a finding of thickened endometrium on transvaginal ultrasonography.Study Design: This study was performed at Bezmialem University Hospital. Women who presented to our clinic from January 2015 to January 2017 were analyzed. Patients were divided to two groups. All patients underwent transvaginal ultrasound with a 7.5 MHz probe. Endometrial sampling was performed by either blind D&C (dilatation & curettage) or pipelle sampling. We excluded patient specimens that were obtained by hysteroscopy.Results: Electronic records of a total of 368 patients in menopause were inspected. Out of these patients; 287 (78%) underwent endometrium sampling indicated by bleeding. Eighty-one patients (22%) were asymptomatic; however, a thickened endometrium echo on TVUSG examination (≥ 5 mm) was suspected. The median age was 57 (42-85). In both groups the two leading causes of endometrial pathology was; endometrial polyps followed by proliferative endometrium. The frequency of endometrial cancer was 9.4 % for the PMB group and 1.2 % in the asymptomatic patient groupConclusion: Evaluation of PMB as soon as possible is essential for diagnosing endometrial pathologies. Role of endometrial thickness is decisive in detecting patients at high risk for malignancy especially with comorbid conditions. Histopathological evaluation is mandatory for ruling out malignancy.

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Through thick and thin: Diagnosis of transthyretin cardiac amyloidosis through non-invasive multimodality imaging

Proceedings of Singapore Healthcare ◽

10.1177/20101058211006146 ◽

2021 ◽

pp. 201010582110061

Author(s):

Raja Ezman Raja Shariff ◽

Hafisyatul Aiza Zainal Abidin ◽

Sazzli Kasim

Keyword(s):

Cardiac Amyloidosis ◽

Troponin T ◽

Multimodality Imaging ◽

High Sensitivity ◽

Dark Blood ◽

Non Invasive ◽

Doppler Study ◽

Alternative Means ◽

High Sensitivity Troponin T

Cardiac amyloidosis is a severely underdiagnosed cause of heart failure with preserved ejection fraction. We report a case of highly probable transthyretin (ATTR) cardiac amyloidosis (ATTR-CA) diagnosed through the assistance of non-invasive multimodality imaging. An 81-year-old man presented with worsening dyspnoea, reduced effort tolerance and limb swelling. Examination and bedside investigations demonstrated congestive cardiac failure. On arrival, N-terminal-pro B-type natriuretic peptide was 2400 ng/L, and high-sensitivity troponin T was 78 mmol/L. Echocardiography showed severe left and right ventricular hypertrophy, and a Doppler study revealed diastolic dysfunction. Cardiac magnetic resonance imaging revealed on non-conventional dark blood sequence an abnormal inversion time for nulling myocardium suggestive of infiltrative disease, including amyloidosis. The patient was referred for nuclear-based studies involving technetium-99m pyrophosphate which demonstrated changes highly diagnostic of ATTR-CA. Early diagnosis of ATTR-CA remains paramount due to the increasing availability of disease-modifying therapies. Current guidelines recognise the role of multimodality imaging in confidently recognising the disease without the need for histological evidence in the appropriate context, providing an alternative means of diagnosis.

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Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽

10.3390/diagnostics11030442 ◽

2021 ◽

Vol 11 (3) ◽

pp. 442

Author(s):

Norbert Stachowicz ◽

Agata Smoleń ◽

Michał Ciebiera ◽

Tomasz Łoziński ◽

Paweł Poziemski ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Menopausal Status ◽

Power Doppler ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Scoring Systems ◽

Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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