The pedicle artery sign based on sonography with color Doppler imaging can replace second‐stage tests in women with abnormal vaginal bleeding

Timmerman, Dirk; Verguts, Jasper; Konstantinovic, Maja; Moerman, Philippe; Schoubroeck, Dominique Van; Deprest, Jan; Huffel, Sabine Van

doi:10.1002/uog.203

Cited by 162 publications

(81 citation statements)

References 32 publications

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“…When a focal disease such as polyp or submucous myoma is diagnosed, SH and HSC provide the same performances in the diagnosis and a surgical treatment should be proposed. EB does not seem to be necessary when we are sure about such focal lesion [22], but when endometrium is globally thickened a valuable endometrial sample is mandatory. This case concerns only a small number of patients presenting for abnormal uterine bleeding.…”

Section: Resultsmentioning

confidence: 99%

Sono-Guided Endometrial Biopsy: Comparison with Hysteroscopy Biopsy

Metzger

Bernard

Camatte

et al. 2004

Gynecol Obstet Invest

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Objective: To assess the feasibility, tolerance and diagnostic accuracy of endometrial biopsy (EB) during sonohysterography (SH) compared to EB after hysteroscopy (HSC) in endometrial disorders. Methods: 105 consecutive patients with irregular uterine bleeding were included prospectively in the calendar year 2001. SH and flexible HSC were performed in an office setting, subsequently and in a random order, by two different practitioners blind to the former experiment. SH-EB was performed using a 3.1-mm ultrasound-guided Bernard catheter in the uterine cavity still partly distended and with a gentle 20-ml syringe vacuum aspiration. The biopsy was directed on focal lesions or else randomly when no targets had previously been found. A Cornier Pipelle^® was used to perform EB after HSC. We investigated all patients by biopsy, independent of the endometrial thickness. HSC-EB was the gold standard. Results: For both methods, cervical catheterism was impossible in 20 patients, 75 of them successfully underwent both exams. Duration and tolerance were similar. SH was effective in the distinction between normal and pathologic cavities, as well as in the diagnosis of polyps. Endometrium appeared significantly thinner with HSC (1.8 mm) when compared to SH (2.9 mm, p < 0.05). Histological endometrial assessment failed in 30 cases of SH-EB and in 22 cases in HSC-EB (NS). There was a poor correlation of the histological results of both techniques. Hyperplasia has never been diagnosed by SH-EB, whereas 3 EB issued from HSC-EB brought up this diagnosis. Conclusion: SH-EB with our technique did not improve the diagnostic potential of SH and severe diagnosis was missed. Histological assessment should fail less when we exclude endometrial atrophy. The diameter of the catheter and the aspiration technique must be revised and the learning curve must be considered. Our technique cannot replace EB by HSC.

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Section: Resultsmentioning

confidence: 99%

Sono-Guided Endometrial Biopsy: Comparison with Hysteroscopy Biopsy

Metzger

Bernard

Camatte

et al. 2004

Gynecol Obstet Invest

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“…The dominant vessel may show branching within the endometrium, which may be described as either orderly or disorderly/chaotic. Dominant vessels may present as a single vessel (formerly referred to as the 'pedicle artery sign') 19 with or without branching. Multiple dominant vessels may have a 'focal origin' at the endometrial-myometrial junction or may have a 'multifocal origin'.…”

Section: Color and Power Doppler Assessmentmentioning

confidence: 99%

Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group

Leone¹,

Timmerman²,

Bourne³

et al. 2009

Ultrasound in Obstet & Gyne

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217

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“…However, the expected incidence of cancer in our study population is relatively low (0.5%-3%), [15][16][17] and other studies have found few if any endometrial cancers in their populations of patients with abnormal vaginal bleeding. 3,12 Nonetheless, we do not have the needed data to analyze whether the interrupted mucosa sign is helpful in differentiating endometrial polyps from cancers. A fourth limitation of our study was that, although all patients had pathologic correlation, 5 of the 82 patients only had blind endometrial biopsy, and it is possible that on blind endometrial biopsy, an endometrial polyp identified by sonography could potentially be missed ( Figure 5).…”

Section: Discussionmentioning

confidence: 99%

“…The most widely accepted and commonly used sonographic features of a polyp are an echogenic endometrial lesion with a single feeding vessel. [3][4][5] Although these findings are extremely helpful, they are not always sonographically evident, and visualization may depend on body habitus or timing of imaging during the phase of menstrual cycle ( Figure 1). 6 In our clinical practice, we have observed an additional sonographic finding: the interrupted mucosa sign, which may help in the diagnosis of endometrial polyps.…”

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confidence: 99%

Sonographic Evaluation for Endometrial Polyps

Kamaya

Lloyd

et al. 2016

J of Ultrasound Medicine

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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.

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The pedicle artery sign based on sonography with color Doppler imaging can replace second‐stage tests in women with abnormal vaginal bleeding

Abstract: Objective

Cited by 162 publications

References 32 publications

Sono-Guided Endometrial Biopsy: Comparison with Hysteroscopy Biopsy

Sono-Guided Endometrial Biopsy: Comparison with Hysteroscopy Biopsy

Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group

Sonographic Evaluation for Endometrial Polyps

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