Transvaginal Ultrasonography Compared with Endometrial Biopsy for the Detection of Endometrial Disease

Langer, Róbert; Pierce, June J; O’Hanlan, Katherine A.; Johnson, Susan R.; Espeland, Mark A.; Trabal, Jose; Barnabei, Vanessa M.; Merino, María J.; Scully, Robert E.

doi:10.1056/nejm199712183372502

Cited by 226 publications

(99 citation statements)

References 21 publications

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“…Studies in postmenopausal women, either with or without HRT, have shown that TVS has a relatively low positive predictive value for endometrial pathologic features. 5,6 However, its high negative predictive value justifies its use in screening and serial assessment of the endometrium (unpublished data). The objective of this report was to compare the sonographic assessment of the endometrium and histologic findings in patients after 3 months in this placebo controlled study involving the use of idoxifene.…”

mentioning

confidence: 99%

Sonographic assessment of the endometrium in osteopenic postmenopausal women treated with idoxifene.

Fleischer

Wheeler

Yeh

et al. 1999

Journal of Ultrasound in Medicine

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Idoxifene is a novel selective estrogen receptor modulator that has shown beneficial effects on bone turnover and lipid metabolism in clinical studies. Preclinical studies have demonstrated that idoxifene has estrogen antagonist activities on the endometrium. This paper describes the results of a double-blind, placebo-controlled, and dose ranging study involving 331 osteopenic postmenopausal women who were treated with either placebo or idoxifene (2.5, 5, or 10 mg/day) for 12 weeks. In these women, endometrial assessment was carried out by transvaginal sonography and endometrial biopsy on selected patients at baseline and on all women at the end of treatment. Women with an endometrial thickness greater than 10 mm were excluded from the study. Aspiration endometrial biopsy was performed on women with an endometrial thickness between 6 and 10 mm at baseline and on all women after treatment. Of the 298 biopsies performed in the subjects at the end of treatment, 99% of the women were reported to have either a benign or atrophic endometrium (85%) or insufficient tissue for diagnosis (14%). Proliferative histologic features were reported in two cases (1%) (2.5 mg idoxifene) and atypical hyperplasia in one placebo patient. Even though idoxifene use was associated with a dose related increase in endometrial thickness as evaluated by transvaginal sonography, no relationship was established between endometrial histologic features and change in endometrial thickness. On histologic analysis, the increase in endometrial thickness seen on transvaginal sonography was not associated with proliferative or hyperplastic change in the epithelial (glandular) endometrial tissue. In 48 patients (16% of total) transvaginal sonography showed endometrial thickening of 5 mm or more over the study period. The endometrial histologic features were benign in all these patients. Nineteen percent of women developed intraluminal fluid, even though endometrial thickness was normal and unchanged and histologic features were normal. Our data show that after 3 months of treatment, no significant pathologic changes of the endometrium were observed. Our data indicate that measurements of endometrial thickness by transvaginal sonography may falsely suggest the presence of endometrial pathologic changes in some postmenopausal women treated with idoxifene. Additional testing using saline infusion sonohysterography is an important part of the transvaginal sonography pro-

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mentioning

confidence: 99%

Sonographic assessment of the endometrium in osteopenic postmenopausal women treated with idoxifene.

Fleischer

Wheeler

Yeh

et al. 1999

Journal of Ultrasound in Medicine

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“…10,11 To our knowledge, the effectiveness of ultrasound surveillance for endometrial carcinoma in an asymptomatic population group has only been addressed in postmenopausal women receiving hormone replacement therapy or placebos. 12 Langer et al compared transvaginal ultrasonography with endometrial biopsy and found that the false positive rate of ultrasonography was unacceptably high, suggesting that it is not a practical screening procedure in this group. 12 Other surveillance methods include endometrial cytologic sampling and endometrial biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…12 Langer et al compared transvaginal ultrasonography with endometrial biopsy and found that the false positive rate of ultrasonography was unacceptably high, suggesting that it is not a practical screening procedure in this group. 12 Other surveillance methods include endometrial cytologic sampling and endometrial biopsy. The former may be performed in an outpatient setting but has been shown to have a poor positive predictive value for early cancer detection in asymptomatic women.…”

Section: Discussionmentioning

confidence: 99%

The outcome of endometrial carcinoma surveillance by ultrasound scan in women at risk of hereditary nonpolyposis colorectal carcinoma and familial colorectal carcinoma

Dove–Edwin

Boks

Goff

et al. 2002

Cancer

205

130

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BACKGROUNDEndometrial carcinoma is the most common extracolonic malignancy associated with hereditary nonpolyposis colorectal carcinoma syndrome (HNPCC). The risk of endometrial carcinoma in HNPCC mutation carriers is approximately ten times that of the general population, and endometrial ultrasound surveillance to detect early cancer in asymptomatic individuals is recommended by the International Collaborative Group on HNPCC. There is little, if any, published data addressing the effectiveness of surveillance in HNPCC and familial colorectal carcinoma.METHODSThe outcomes of endometrial carcinoma surveillance scans were collected from the St Mark's Hospital Imperial Cancer Research Fund Family Cancer Clinic in the UK and the Netherlands Foundation for the Detection of Hereditary Tumors. Two hundred ninety two women from HNPCC (171) or HNPCC‐like (98) families between the ages of 25‐65 years were offered pelvic ultrasound surveillance scans for a period of up to 13 years.RESULTSResults were available from 269 women. The study period included a total of 825.7 years of risk. Two cases of endometrial carcinoma were reported. Neither case was detected by surveillance scanning. Both cases presented at an early stage with symptoms and were subsequently cured.CONCLUSIONSEndometrial carcinoma surveillance in hereditary colorectal carcinoma may not offer obvious clinical benefits. Cancer 2002;94:1708–12. © 2002 American Cancer Society.DOI 10.1002/cncr.10380

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“…5mm eşik değer olarak alındığında negatif prediktif değer %99 iken, 4mm alındığında %100 olmaktadır. Karsinomların %96'sında kalınlık 5mmnin üzerinde tespit edilmiştir [10][11][12][13]. Yapılan çalışmalarda postmenopozal kanamalı ve histopatolojik tanısı endometriyum kanseri olarak saptanan kadınlarda ise ortalama endometriyal kalınlık 13,9-21,1 mm tespit edilmiştir [14].…”

Section: Bulgularunclassified

Benign ve malign endometriyal patolojilerin klinik ve demografik özelliklerinin karşılaştırılması

Sümer¹,

Yenicesu²,

Boztosun³

et al. 2014

Cumhuriyet Med J

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Amaç. Bu çalışma endometriyum kanseri ve benign endometriyal patolojilerin klinik ve demografik verilerini karşılaştırmayı ve endometriyum kanseri için risk faktörlerini belirlemeyi amaçlamaktadır. Yöntem. Kliniğimizde 2006-2010 yılları arasında endometrioid tip endometrial karsinom tanısı almış 31, endometriyal hiperplazi tanısı almış 29 ve proliferatif endometriyum tanısı almış 28 olmak üzere toplam 88 histerektomi olgusu çalışmaya dahil edildi. Olguların demografik ve takip bilgileri klinik dosyalarından elde edildi. Bulgular. Gebelik ve parite sayısı, diyabet varlığı ve sigara kullanımı arasında fark bulunamazken; ortalama yaş, endometriyal kalınlık değeri, menarş yaşı, postmenapozal olmak ve hipertansiyon varlığı endometriyum kanseri grubunda farklı bulunmuştur. Sonuç. Endometriyum kanseri hastaları daha erken yaşta menarş görmektedir ve çoğu postmenapozaldir İleri yaş, artmış endometriyal kalınlık ve hipertansiyon endometriyum kanseri için diğer risk faktörleridir. Anahtar sözcükler: Endometriyum kanseri, risk faktörleri AbstractAim. The objective of this study is to compare clinical and demographic data of benign and malign pathologies of endometrium and to describe risc factors for endomatrial carcinoma. Method. Eighty-eight patients which was hysterectomised in our clinic between 2006 and 2010 was included. Twenty eight of these has the diagnosis as 'proliferative endometrium', twenty nine as 'hyperplasia of endometrium', thirty-one as 'endometrioid type of endometrial carcinoma'. Data were collected from patient files retrospectively. Results. Pregnancy and parity rate, presence of diabetes mellitus and smoking were not altered for groups. Endometrial thickness and presence of hypertension were significantly higher for carcinoma group. Endometrial carcinoma patients were generally postmenauposal and had younger menarche age. Discussion. Advanced age, early menarche, increased endometrial thickness, hypertension and postmenapouse are risk factors for endometrial carcinoma.

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Transvaginal Ultrasonography Compared with Endometrial Biopsy for the Detection of Endometrial Disease

Abstract: Transvaginal ultrasonography has a poor positive predictive value but a high negative predictive value for detecting serious endometrial disease in asymptomatic postmenopausal women.

Cited by 226 publications

References 21 publications

Sonographic assessment of the endometrium in osteopenic postmenopausal women treated with idoxifene.

Sonographic assessment of the endometrium in osteopenic postmenopausal women treated with idoxifene.

The outcome of endometrial carcinoma surveillance by ultrasound scan in women at risk of hereditary nonpolyposis colorectal carcinoma and familial colorectal carcinoma

Benign ve malign endometriyal patolojilerin klinik ve demografik özelliklerinin karşılaştırılması

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