Ultrasonographic “endometrial three‐layer” pattern: A unique finding in ectopic pregnancy

Abstract

Although diagnostic ultrasonography is playing an increasing role in the investigation of the patient with suspected ectopic pregnancy (EP), it has significant limitations in the very early stages of pregnancy.By sonographically exploring the intrauterine echoes in 45 cases of documented EP, we demonstrated a unique pattern in 28 cases (62.2%). A well-defined spheric structure forming an endometrial three-layer (ETL) pattern was seen, probably formed by a midline echo between the two adjacent edematous proliferative layers of the endometrium, the latter resembling the late proliferative endometrium. The diagnosis of EP remains a clinical challenge for the gynecologist, despite improvements in diagnostic tests and procedures. There are a number of methods for establishing the presence of an EP: history, physical examination, biochemical tests, and imaging methods. These can all be used to diagnose EP as early as possible.The combination of serum P-HCG and vaginal ultrasonography has shown a high sensitivity and specificity for the diagnosis of ectopic pregnancy in several clinical studies:-' but despite these new technologies, the early diagnosis of EP in most cases is still a clinical challenge. In the past, the role of transabdominal (TA) ultrasonography of the pelvis was mainly t o exclude an intrauterine pregnancy and to identify fluid or blood in the pelvis.'^^ However, the transvaginal

Evaluation of sonographic endometrial patterns and endometrial thickness as predictors of ectopic pregnancy

“…A previous study showed a sensitivity of 62% for the endometrial three‐layer pattern in the diagnosis of EP. Because the present study would add other variables, a sensitivity of 80% was expected.…”

“…found the trilaminar pattern to be more specific (94%) but less sensitive (38%), with a positive predictive value of 92% and a negative predictive value of 46%. Lavie et al . reported a specificity of 100% and a sensitivity of 62% for the trilaminar pattern, with a positive predictive value of 100% and a negative predictive value of 84%.…”

“…Serial measurement of the beta subunit of hCG (β‐hCG) and TVS to identify and assess adnexal masses do not resolve the diagnostic dilemma in many affected women . The role of the endometrial pattern and thickness in the prediction of EP has been assessed in only a few studies . With this background in mind, the aim of the present study was to investigate how endometrial pattern and thickness can be used for the prediction of EP.…”

“…2 The role of the endometrial pattern and thickness in the prediction of EP has been assessed in only a few studies. [6][7][8][9][10][11][12][13] With this background in mind, the aim of the present study was to investigate how endometrial pattern and thickness can be used for the prediction of EP. After enrollment, a history was taken and a clinical examination performed.…”

“…The endometrial pattern, the endometrial thickness, and the presence of an adnexal mass 2,14 and/or an extrauterine gestational sac were noted. The endometrial patterns were divided into four categories: (1) trilaminar pattern (endometrial three-layer pattern), consisting of three hyperechoic layers separated by two intervening hypoechoic layers; [11][12][13] (2) homogeneous hyperechoic pattern; (3) heterogenous hyperechoic pattern, defined as a mixed echogenic pattern with or without the presence of fluid in the uterine cavity and with or without cystic spaces in the endometrium; and (4) pseudogestational sac, defined as a central oval shape with a thin echogenic rim and absence of the double decidual sign. 14 The endometrial thickness was obtained in the sagittal midline plane and measured as the maximum anteroposterior thickness as described by Bredella et al 15 Women with a gestational sac or adnexal mass outside the uterine cavity indicating an EP were managed medically or surgically as per the department protocol.…”