Current view of the diagnosis of endometrial polyp: A retrospective study

Guideline No. 447: Diagnosis and Management of Endometrial Polyps

Objective To explore the diagnostic value of transvaginal ultrasound in endometrial polypoid lesions. Methods Three hundred and forty-four cases with endometrial polypoid lesions diagnosed in Hankou Hospital of Wuhan from April 2012 to December 2016 were selected as the research objects.All patients underwent color Doppler ultrasonography before surgery.The image features were analyzed, and the specificity, sensitivity and accuracy of ultrasound diagnosis of endometrial lesions were analyzed and pathological results served as the gold standard. Results According to the postoperative pathological diagnosis, 142 cases were with endometrial polyps, Including 136 cases with simple endometrial polyps and 6 cases with endometrial polyps combined with endometrial carcinoma; 160 cases were diagnosed with endometrial polyps via transvaginal ultrasound, 38 cases were misdiagnosed (11.05%, 38/344), 20 cases were missed diagnosis(5.81%, 20/344), using the postoperative pathological results as the gold standard, the sensitivity of transvaginal ultrasonography in the diagnosis of endometrial lesions was 85.92% (122/142), the specificity was 81.19% (164/202), the accuracy was 73.14% (286/344), and the diagnostic accuracy of ultrasonography was consistent with the pathological diagnosis (Kappa>0.75). Conclusion The value of transvaginal ultrasound is to observe the presence of uterine lesions, the identification of benign and malignant lesions still need hysteroscopy examination. Key words: Endometrial Polyps; Transvaginal Ultrasound; Diagnostic Value

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. 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. 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. 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. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Risk factors for complications of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass

Global climate change is negatively impacting global biodiversity and ectothermic vertebrates, with amphibians being the most imperiled vertebrate taxa. Increased mean global atmospheric temperatures, high rates of habitat degradation, and exposure to infectious diseases, such as chytridiomycosis, have contributed to population declines and extinctions of rare and endangered amphibian species. Field-based monitoring of physiological endocrine traits can help determine the sub-lethal effects of environmental stressors and provide early alerts when populations are chronically stressed. Recent advances in amphibian stress endocrinology include the development and use of non-invasive methods to quantify the glucocorticoid, or stress biomarker, corticosterone. Non-invasive methods, such as urinary, skin and buccal swabs, and water-borne hormone monitoring methods (suited for terrestrial and aquatic dwelling species), are available to quantify baseline and short-term physiological stress responses of amphibians under field settings. In this review, we illustrate, by using two case studies of aquatic and terrestrial amphibian species, the applications of non-invasive corticosterone monitoring methods to advance the ecological knowledge and conservation of imperiled amphibian species, discuss the limitations of these methods, and provide future directions for the use of non-invasive hormone monitoring methods. We highlight the use of non-invasive field endocrinology methods to monitor the impacts of environmental stressors on the physiology of amphibians, which can be applied to advance ecological research, conservation, and management of imperiled species.

The frequency of hyperproliferative pathology of endometrium is about 60–70% in the structure of gynecological pathology of postmenopausal women. Endometrial polyps are a fairly frequent gynecological pathology for women of all ages, but the overwhelming majority of them are diagnosed at the age of 40–60 years. According to a number of studies, the frequency of endometrial polyps is 39.2–69.3%, and the endometrial polyposis occupies the first place in the structure of intrauterine pathology in postmenopausal. Given the important role of inflammation in the etiology of endometrial polyps and the risk of infectious complications in the postoperative period, there is a need for a comprehensive approach to the examination and treatment of this pathology. To date, ultrasound diagnostics and hysteroscopy are considered the standard for diagnosing endometrial polyps. However, the use of hysteroscopic technique in postmenopausal patients has a number of limitations, which are primarily associated with the possible occurrence of anesthetic and surgical complications. With age in the body, women experience atrophic changes in the genital area, which are often the cause of the formation of stenosis and obliteration of the cervical canal, which increases the risk of injury during his burying and can lead to the formation of a «false» course and even perforation of the uterus. This causes a more complicated postoperative period, which is characterized by a pain syndrome, the presence of subfebrile, hematometry, etc. In addition, given the growth in postmenopausal frequency of extragenital pathology and metabolic syndrome, during the surgical interventions and in the postoperative period, the risk of thrombotic complications increases. The article presents the substantiation of the expediency of conducting anti-inflammatory therapy in the postoperative period in postmenopausal patients after hystero-rectoscopic removal of polyps. The risk of complications of inflammatory nature after hysteroscopy is quite high and is 3–10%. The expediency of using the combined treatment regimen of endometrial polyps in this patient population using the enzyme complex Distreptaza®, which reduces the severity and duration of the pain syndrome, reduces the risk of developing subfebrile and formation of hematometry.

The aim of this paper is to report a rare case in which two dental anomalies in primary dentition coexisted-fusion and concrescence in a 4-year-old boy. This highlights the significance of the accurate early diagnosis of these dental anomalies. Odontogenic anomalies are frequently encountered in dental practice. These anomalies can occur due to abnormalities during the differentiation stage and lead to abnormalities in the hard tissue formation. Dental anomalies in number and form include fusion, gemination, and concrescence. Primary dentition with fusion between the right central and lateral primary incisors with increased mesiodistal width. Concrescence between the left central and lateral primary incisors with a groove through the incisal edge. Clinical observation along with radiographic evaluation using intraoral periapical (IOPA) radiographs and orthopantomogram (OPG) were used to arrive at a diagnosis. Early diagnosis of concrescence will reduce the risk of possible complications associated with any need of extraction later on. Monitoring the patient and long-term follow-up is required to manage the case with coexisting anomalies of true fusion and acquired concrescence. A thorough history taking and clinical and radiographic evaluation of fusion and concrescence at an early stage result in an accurate diagnosis. A careful monitoring plan is a key to reduce the risk of possible complications later on.

This study aimed to explore the diagnosis of endometrial polyps (EMP) by ultrasound imaging based on multi-operator algorithms combined with hysteroscopy. This study is the first to investigate the resolution of the ultrasound adaptive beamforming algorithm (MOAD), after which the proposed algorithm was applied to ultrasound diagnosis of 102 patients with EMP and pathologically diagnosed with vaginal irregular bleeding, and the evaluation efficacy of the MOAD algorithm based on EMP was compared. The resolution of the MOAD-based imaging algorithm (0.0645) was significantly lower than that of the diagonal loading operator (0.1475), the symbol coherence coefficient operator (0.1342), and the generalized coherence factor operator (0.1234), with significant differences ( P &lt; 0.05 ). The proportion of patients with EMP aged 46–55 years was the largest (55.9%). There were 64 cases of EMP that produced complications, of which the proportion of patients with uterine fibroids (41.52%), abnormal uterine bleeding (76.24%), and menstrual changes (42.57%) was relatively large. Patients with nonfunctioning polyps accounted for the largest proportion (84.46%), followed by those with basal polyps (76.24%), and the difference was statistically significant ( P &lt; 0.05 ). The positive cases of EMP detected by ultrasound imaging (38 cases) were significantly lower than those with pathological diagnosis (94 cases), and the difference was statistically significant ( P &lt; 0.05 ). The SE, SP, FNR, and FPR of EMP diagnosed by ultrasound imaging combined with hysteroscopy were 64.45%, 84.67%, 35.48%, and 13.36%, respectively. It has high diagnostic value compared with single ultrasound imaging diagnosis, and the difference was statistically significant ( P &lt; 0.05 ). In conclusion, the imaging based on the MOAD algorithm is obvious and the pixel resolution can be successfully improved. The diagnostic value of ultrasound combined with hysteroscopy for EMP was better than that of ultrasound alone ( P &lt; 0.05 ), and it had a high diagnostic value.

A disintegrin-like and metalloproteinase domain with thrombospondin-type 1 motifs (ADAMTS) protein superfamily includes 19 secreted metalloproteases. Proteolytic substrates of ADAMTS enzymes have been linked to female reproductive function. Herein, we aimed to investigate serum ADAMTS-1, -9 and -20 levels in women with and without endometrial polyps (EPs). The study group (n = 40) consisted of women who had hysteroscopically detected and histologically confirmed EPs whereas control group (n = 40) was recruited from those women without any endometrial pathology. Data recorded for every woman were as follows: age, body mass index, gravidity and parity, number of miscarriages, smoking status and serum ADAMTS-1, -9 and -20 levels. ADAMTS-1, -9 and -20 values were measured by commercially available ELISA kits. No statistically significant differences between the groups were observed in terms of demographics. There were also no statistically significant differences between the groups with regard to ADAMTS-1 and -20 levels, although both of them were lower in the study group. However, ADAMTS-9 was significantly lower in the study group compared to the controls (p = .010). The optimal cut off value of ADAMTS-9 in predicting EPs was found to be 163.2 ng/mL with 100% sensitivity and 35% specificity. In conclusion, ADAMTS-9 protein is decreased in women with EPs.Impact statementWhat is already known on this subject? Endometrial polyps (EPs) are common and are generally benign gynaecologic disorders. ADAMTS enzymes comprise a zinc metalloproteinase gene family that has roles in vascular biology, inflammation and especially in the control of the function and structure of the extracellular matrix (ECM). ECM plays an important role in the pathogenesis of myomas, adenomyosis and abnormal uterine bleeding, as well as EPs. There is an interest in these proteases, especially with regard to the physiology of ovulation and implantation. They are also associated with carcinogenesis and metastasis. One of the most feared consequences of EPs is the risk of malignancy. Therefore, it is important in gynaecology practice to diagnose these endometrial abnormalities.What do the results of this study add? This is the first study performed to investigate the relationship between some ADAMTS (-1, -9 and -20) proteases and uterine polyps. Our results demonstrate novel molecular mediators contributing to EPs physiopathology.What are the implications of these findings for clinical practice and/or further research? ADAMTS-9 is defined as a tumour suppressor gene in various malignancies. Decreased ADAMTS-9 protein, which is the product of this gene, may have a role in the pathogenesis of EPs. There is a need for further research that should be done with benign–malign EPs.

The objective: to find out the level of verification of endometrial hyperplastic processes (GPE) in women with uterine infertility based on the comparison of ultrasound and pathomorphological studies. Materials and methods. 64 patients of reproductive age was performed ultrasonographic study and diagnostic endometrial biopsy. Results. Three groups of GPE have been identified: polyps – 33 cases, hyperplasia –15, combination of glandular hyperplasia with endometrial polyp – 16. The endometrial polyps included: glandular – seven cases, glandular-fibrous with an advantage of the glandular component – 13, and glandular-fibrous with the advantage of the stromal component – 13. The accuracy of the verification of glandular polyps was 82%. Glandular-fibrotic polyps with an advantage of the glandular component were diagnosed in 82%. Glandular-fibrous endometrial polyps with the advantage of the stromal component were the most difficult for ultrasonic verification. The accuracy of their diagnosis was 50%. Such characteristics as nodular form, intramural position, increased echogenicity and absence of inclusions were the basis for erroneous diagnosis of uterine fibromyomas. Endometrial hyperplasia was verified at 97%. The remaining 3% were histologically diagnosed with endometrial polyposis, which were not established by ultrasound, and were considered as hyperplasia of the endometrium. Ultrasound diagnosis of the combination of endometrial hyperplasia and polyps reached 77%. The polyps on the background of endometrial hyperplasia appeared as fibromyomatous nodes. The determining role in correct diagnosis was played by hysteroscopy. Conclusion. The comparison of ultrasound data and morphological evidence suggests high accuracy of GPE detection and morphological verification. However, in some cases GPE ultrasound does not precisely determine the nature of pathological changes. Therefore, the study of the pathomorphological features of remodeling of the endometrium in the GPE remains open and requires new promising approaches. One of them, based on certain pathomorphological changes in GPE, is the use of blood flow research, in particular transvaginal color doppler, which may allow to improve the accuracy of the diagnosis of GPE. Key words: endometrial hyperplasia, endometrial polyp, endometrial hyperplasia, ultrasound diagnosis, pathomorphology, reproductive age.

Large clinical studies have established that usually both endometrial and cervical polyps are benign pathologies, but in 0.2–1.5% their malignant transformation may occur, which is more often diagnosed in women with risk factors.Management of patients with polyps and endometrial hyperplasia depends on many factors and requires the establishment of clear hysteroscopic and morphological criteria by which it is possible to reliably predict the oncological risk, timely determine adequate treatment and its results.The objective: to study the pathomorphological characteristics of endometrial hyperplasia with atypia in patients with polyposis for determination of early pathomorphological markers of oncogenesis. Materials and methods. A prospective, randomized cohort study was conducted in 72 patients aged 21 to 57 years with abnormal uterine bleeding, endometrial hyperplasia, and polyps. All patients underwent hysteroresectoscopy as a treatment method with histological examination of the removed material.Histological and morphometric examination of endometrial biopsies was performed. According to the results of the pathomorphological conclusion, two study groups were formed: I group – 38 women with endometrial hyperplasia without atypia, II group – 14 patients with endometrial hyperplasia with atypia, the control group included 20 women without endometrial hyperplastic processes.Results. It was established that in endometrial hyperplasia without atypia, the glands were located unevenly, had different shapes and sizes, but the glandular epithelium structurally differed slightly from the proliferation stage (simple hyperplasia). The stromal component was dominated by fibroblast-like cells, moderately expressed, mainly lymphocytic, infiltration, congestive pleurisy. Clinically significant morphometric changes in epithelial cells were not detected.In the II group of patients a pronounced structural reorganization of the endometrium with glands of various shapes and sizes was detected, the glandular structures had an irregular shape with numerous papillary invaginations, micropapillary formations with the formation of “epithelial septa”.The glandular epithelium was observed mainly multi-row with loss of polarity relative to the basement membrane, foci of adenoacanthosis. Blood vessels are unevenly distributed, thin-walled, with signs of stasis and thrombi. Morphometry demonstrated the presence of numerous mitoses, including pathological ones, both in epithelial cells and in the stroma, and a violation of the nuclear-cytoplasmic ratio.Therefore, according to the results of the study the presence of dysplastic or malignant diseases can be suspected at early stages in patients with endometrial hyperplasia and the presence of clinically safe endometrial or cervical polyps, and for their identification, hysteroscopy with pathomorphological assessment of oncological risk is proposed.Conclusions. In patients with endometrial hyperplasia with signs of atypia in the presence of endometrial polyps, an increase in the area of ​​the cell nucleus, an increase in the nuclear-cytoplasmic ratio, as well as mitoses, including pathological ones, are often found. The presence of hyperplasia in combination with endometrial polyps requires the earliest possible pathomorphological diagnosis of the endometrium in order to verify pathological atypical histological changes in endometrial cells and polyps, which may be predictors of malignancy.Timely diagnosis and histological identification of endometrial hyperplasia with atypia is extremely important for preserving the reproductive health of women and preventing their malignancy and cancer risk.

Objective. To study the microbiota of the reproductive tract (vagina, uterine cavity) in patients with endometrial hyperplasia and polyps. Material and methods. The study included 60 patients: 20 patients with endometrial hyperplasia (group 1), 20 patients with endometrial polyps (group 2) and 20 patients without endometrial pathology (group 3, control group). The microbiota of the reproductive tract was assessed by real-time PCR method using AmpliSens Florocenosis kits. Results. In patients with endometrial hyperplasia and polyps in the vagina and uterine cavity, an increase in the number of opportunistic microorganisms was observed in the vagina and uterine cavity against the background of a decrease in the content of lactobacilli. Gardnerella vaginalis (35.0 and 10.0% respectively) and Ureaplasma parvum (55.0 and 10.0% respectively) were detected in the vagina of group 1 patients significantly more often than in group 3 patients against the background of a 1.2-fold decrease in the number of lactobacilli. Gardnerella vaginalis (40.0 and 10.0%, respectively) and Staphylococcus spp. (70.0 and 30.0%, respectively) were detected in the vagina of group 2 patients significantly more often than in group 3 patients against the background of a 2-fold decrease in the number of lactobacilli. Conclusion. Prevention of endometrial pathology consists not only of timely detection of anovulation and its prevention, correction of endocrine disorders, but also treatment of patients with dysbiosis of female genital organs.

Use and limitations of noninvasive and invasive methods for studying pulmonary function

This report demonstrates the advantages of tunnel dissection ensuring organ-sparing procedure with the best functional result. However, intra- and postoperative complications are possible after STER. The risk of complications and complexity of surgery depend on transverse size (>3.5 cm), shape and localization of tumor. Larger neoplasm is accompanied by more difficult surgery and higher risk of complications. Therefore, adequate selection of patients for STER is essential.

The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.