Sonographic Evaluation for Endometrial Polyps

Abstract

The Interrupted Mucosa Sign ndometrial polyps are benign focal overgrowths of endometrial tissue, often with variable amounts of vascularity and stroma encased by epithelium. Although the etiology of polyp development is unclear, endometrial polyps are quite common, identified in 13% to 50% of women with dysfunctional uterine bleeding and 10% of asymptomatic patients undergoing routine sonographic imaging. 1 Standard treatment is hysteroscopic removal to alleviate bleeding symptoms and exclude malignancy. 2 Aya Kamaya, MD, Pauline Chang Yu, MD, Carla Ramas Lloyd, MD, Bertha H. Chen, MD, Terry S. Desser, MD, Katherine E. Maturen, MD Received November 24, 2015, from the Departments of Radiology (A.K., T.S.D.) and Obstetrics and Gynecology (B.H.C.) Results-The mean age of the patients was 44.99 (SD, 9.88) years, 79.1% of whom were premenopausal. Pathologic diagnosis confirmed polyps in 58 (70.73%). A single feeding vessel was visualized in 36 patients with polyps (62.07%), whereas the interrupted mucosa sign was visualized in 34 (58.62%). The presence of a feeding vessel, the interrupted mucosa sign, or both detected 48 (82.76%) of the polyps. In the multivariate analysis, only the interrupted mucosa sign was a statistically significant predictor of pathologic diagnosis of a polyp (P = .035), with an odds ratio of 3.83 (95% confidence interval, 1.10-13.29). Other sonographic findings were not independent predictors of a polyp: mass (P = .35), single feeding vessel (P = .31), endometrial thickness (P = .88), and endometrial echogenicity (P = .45). The sensitivity, specificity, and positive predictive value of the interrupted mucosa sign were 59%, 75%, and 85%, respectively.Conclusions-The interrupted mucosa sign is a promising sonographic sign for identification of endometrial polyps, with greater predictive power than previously described signs. It has the potential to improve the diagnostic performance of sonography, especially when used in combination with other described signs.

Color Doppler Imaging of Vascular Abnormalities of the Uterus

“… 5 In a study by Timmerman et al, 10 identification of an endometrial vascular pedicle (pedicle artery sign) yielded a sensitivity of 76% and specificity of 95.3% for diagnosing EP. In a separate study by Kamaya et al, 11 the vascular pedicle sign was 62% sensitive for the presence of a polyp but was not an independent predictor of the presence of a polyp. They found however that identifying a discontinuity in the mucosa of a suspected polyp as it meets the surrounding endometrium—called the interrupted mucosa sign—was the only statistically significant variable in multivariate analysis for the diagnosis of EP and yielded a sensitivity, specificity, and positive predictive value of 50%, 75%, and 85%, respectively 11 …”

“…They found however that identifying a discontinuity in the mucosa of a suspected polyp as it meets the surrounding endometriumcalled the interrupted mucosa sign-was the only statistically significant variable in multivariate analysis for the diagnosis of EP and yielded a sensitivity, specificity, and positive predictive value of 50%, 75%, and 85%, respectively. 11 Although the vast majority of EPs are benign, hysteroscopic resection is often the treatment of choice even in asymptomatic patients given an uncertain malignant potential based on imaging alone. [6][7][8] Meta-analysis of nearly 10,000 patients having undergone polyp resection, indicated on the basis of presence of EP alone or EP with symptoms, found an overall incidence of endometrial neoplasia in surgical specimens to be 3.23% and slightly higher in postmenopausal women at 4.91%.…”

ACR Appropriateness Criteria® Abnormal Uterine Bleeding

“…US duplex Doppler evaluation of the vascularity of the endometrium can help identify vessels within endometrial polyps or cancer, or the lack of vascularity in the normal endometrium [30]. Visualization of a vascular pedicle during transvaginal color Doppler imaging has a specificity of 62% to 98% and a negative predictive value of 50% to 94% for the detection of endometrial polyps [34][35][36].…”

Superb Microvascular Imaging (SMI) - Doppler Technique in the Evaluation of the Endometrial Polyp and Submucosal Myoma in Postmenopausal Overweight Women

“…3,12 EPs are the benign focal enlargement of endometrial glands, stroma and vascular structures. 13,14 They are typically benign lesions, however they can show hyperplasia or malignant transformation at a rate of 0.1%. 14,15 They are responsible for 30% of post-menopausal bleedings and multiple polyps are seen in the post-menopausal period at a rate of 26%.…”