Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: Is it always necessary to perform an endometrial biopsy?

Gull, Berit; Carlsson, S.Å.; Karlsson, Bengt; Ylöstalo, Pekka; Milsom, Ian; Granberg, S.

doi:10.1067/mob.2000.103092

Cited by 126 publications

(102 citation statements)

References 21 publications

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“…In a meta-analysis including almost 6000 women with postmenopausal bleeding this risk was estimated to be about 1 in 100 in women not using hormone replacement therapy and about 1 in 1000 in women using hormone 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 5 replacement therapy [2]. It is considered safe to refrain from endometrial sampling to obtain a histological diagnosis in women with postmenopausal bleeding and endometrial thickness < 4 mm [2,3,4]. This endometrial thickness cutoff is applicable both in users and non-users of hormone replacement therapy [2].…”

Section: A Imaging Techniques In the Management Of Postmenopausal Blmentioning

confidence: 99%

Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Valentin

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

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Transvaginal ultrasound plays a pivotal role in the management of non-pregnant women with abnormal vaginal bleeding. No other imaging technique has a role in the triage of these women. In women with postmenopausal bleeding ultrasound is used to categorize women as being at low or high risk of endometrial cancer, the result of the ultrasound examination being the basis for further management. In women with abnormal vaginal bleeding before menopause the role of ultrasound is less clear, because some common causes of abnormal vaginal bleeding before menopause cannot be diagnosed with ultrasound, e.g. infection, dysfunctional bleeding or problems with intrauterine contraceptive devices or contraceptive pills. Nonetheless, transvaginal ultrasound may sometimes be helpful also in women with abnormal vaginal bleeding before menopause. In this chapter ultrasound findings in women with endometrial cancer, endometrial polyps, endometrial hyperplasia, adenomyosis, uterine myomas including submucuous myomas, and leiomyosarcoma will be presented and ultrasound based triage of women with postmenopusal bleeding described. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractTransvaginal ultrasound plays a pivotal role in the management of non-pregnant women with abnormal vaginal bleeding. No other imaging technique has a role in the triage of these women. In women with postmenopausal bleeding ultrasound is used to categorize women as being at low or high risk of endometrial cancer, the result of the ultrasound examination being the basis for further management. In women with abnormal vaginal bleeding before menopause the role of ultrasound is less clear, because some common causes of abnormal vaginal bleeding before menopause cannot be diagnosed with ultrasound, e.g. infection, dysfunctional bleeding or problems with intrauterine contraceptive devices or contraceptive pills. Nonetheless, transvaginal ultrasound may sometimes be helpful also in women with abnormal vaginal bleeding before menopause. In this chapter ultrasound findings in women with endometrial cancer, endometrial polyps, endometrial hyperplasia, adenomyosis, uterine myomas including submucuous myomas, and leiomyosarcoma will be presented and ultrasound based triage of women with postmenopusal bleeding described.

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Section: A Imaging Techniques In the Management Of Postmenopausal Blmentioning

confidence: 99%

Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Valentin

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Algumas literaturas referem que apesar do ponto de corte do espessamento endometrial ser em torno de 4 a 5 mm, deve ser ressaltado que quando há essa alteração na ecografia, não necessariamente significa que se tem uma patologia do endométrio confirmada, mas sim um estudo evidenciando a necessidade de complementação diagnóstica, como por exemplo, através da histeroscopia 6 . A ultrassonografia (USG) transvaginal é, indubitavelmente, o método pelo qual se deve iniciar a propedêutica do endométrio e da cavidade uterina, seja para orientar o diagnóstico em mulheres com sangramento genital ou para rastrear aquelas assintomáticas [11][12][13][14][15] . Alguns estudos, entretanto, têm evidenciado que nem sempre existe correlação entre o achado de espessamento da mucosa uterina, obtido pela USG transvaginal, com as lesões existentes na cavidade uterina.…”

Section: Endométrio Patológicounclassified

“…Assim, em parte significativa das pacientes menopausadas, com eco endometrial espessado, verificou-se que as verdadeiras anormalidades intracavitárias consistiram em pólipo endometrial, sinéquia intra-uterina, mioma submucoso ou líquido intracavitário, especialmente muco [15][16][17][18][19][20] . Atualmente, o método propedêutico disponível mais apropriado para a avaliação da cavidade uterina em mulheres com suposto espessamento endometrial, sejam elas assintomáticas ou com sangramento vaginal, é a histeroscopia 14,[21][22][23] .…”

Section: Endométrio Patológicounclassified

Avaliação ultrassonográfica no espessamento endometrial: revisão de literatura

Silveira¹,

Rodrigues²,

Dias³

et al. 2017

Rev Pat Tocantins

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Introdução: A avaliação ecográfica do endométrio permite a análise minuciosa da mucosa uterina na prática clínica ginecológica, com o intuito de auxiliar no manejo das patologias endometriais. Neste artigo, fazemos uma revisão narrativa para avaliar o real papel da ecografia pélvica na visualização das doenças endometriais. As alterações uterinas, como pólipos, miomas, sinéquias uterinas, hiperplasia e câncer endometrial são morbidades frequentes na população feminina, tanto nas pacientes em idade reprodutiva como nas que estão na pós-menopausa. Os métodos de avaliação endometrial têm obtido diversos avanços nos tempos atuais, sendo o ultrassom transvaginal o método de escolha para investigação inicial das doenças endometriais, tanto nas pacientes com sangramento genital, quanto nas mulheres assintomáticas principalmente na pós-menopausa. Conclusão: A ecografia é o exame primordial e elementar na investigação de pacientes com sangramento uterino anormal ou sob suspeita de outras doenças que alteram o padrão endometrial, conduzindo o prognóstico do quadro investigado. Palavras-chave: Ultrassonografia, Doenças Uterinas, Endométrio. ABSTRACT Introduction: The ultrasound evaluation of the endometrium allows a detailed analysis of the uterine mucosa in gynecological clinical practice, in order to assist in the management of endometrial pathologies. In this article, we make a narrative review to evaluate the real role of pelvic ultrasound in the visualization of endometrial diseases. Uterine changes such as polyps, fibroids, uterine synechia, hyperplasia, and endometrial cancer are frequent morbidities in the female population, both in postmenopausal and post-reproductive age patients. Methods of endometrial evaluation have achieved several advances in the present times, with transvaginal ultrasound being the method of choice for the initial investigation of endometrial diseases, both in patients with genital bleeding and in asymptomatic women, especially postmenopausal women. Conclusion: Ultrasonography is the primary and elemental examination in the investigation of patients with abnormal uterine bleeding or under suspicion of other diseases that alter the endometrial pattern, leading to the prognosis of the investigated condition. Keywords: Ultrasonography, Uterine Diseases, Endometrium.

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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 of the endometrium in women with postmenopausal bleeding: Is it always necessary to perform an endometrial biopsy?

Cited by 126 publications

References 21 publications

Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Avaliação ultrassonográfica no espessamento endometrial: revisão de literatura

Benign ve malign endometriyal patolojilerin klinik ve demografik özelliklerinin karşılaştırılması

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