T Van Den Bosch1,2, J Y Verbakel3, L Valentin4,5, L Wynants2,6, B De Cock2, M A Pascual7, F P G Leone8, P Sladkevicius4,5, J L Alcazar9, A Votino10, R Fruscio11, C Lanzani8, C Van Holsbeke12, A Rossi13, L Jokubkiene4,5, M Kudla14, A Jakab15, E Domali16, E Epstein17,18, C Van Pachterbeke10, T Bourne1,2,19, B Van Calster2, D Timmerman1,2. 1. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium. 2. Department of Development and Regeneration, KU Leuven, Leuven, Belgium. 3. Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. 4. Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden. 5. Department of Clinical Sciences, Lund University, Malmö, Sweden. 6. Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. 7. Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain. 8. Department of Obstetrics and Gynecology, Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy. 9. Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain. 10. Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium. 11. Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy. 12. Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium. 13. Department of Obstetrics and Gynecology, University of Udine, Udine, Italy. 14. Department of Perinatology and Oncological Gynecology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland. 15. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. 16. First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece. 17. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 18. Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 19. Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK.
Abstract
OBJECTIVE: To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology. RESULTS: The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m2 (range, 16.0-72.1 kg/m2 ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound. CONCLUSIONS: The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely.
OBJECTIVE: To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology. RESULTS: The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m2 (range, 16.0-72.1 kg/m2 ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound. CONCLUSIONS: The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely.
Authors: Jan Yvan Verbakel; Ruben Heremans; Laure Wynants; Elisabeth Epstein; Bavo De Cock; Maria Angela Pascual; Francesco Paolo Giuseppe Leone; Povilas Sladkevicius; Juan Luis Alcazar; Catherine Van Pachterbeke; Ligita Jokubkiene; Robert Fruscio; Tom Bourne; Ben Van Calster; Dirk Timmerman; Thierry Van den Bosch Journal: Int J Gynaecol Obstet Date: 2022-02-07 Impact factor: 4.447