Sonohysterogram and Uterine Neoplasia: The Significance of the Changes in Endometrial Findings [3M

Abstract

INTRODUCTION: We assessed the significance of variations in endometrial echo (EE) findings between transvaginal sonogram (TVS) and saline infusion sonohysterogram (SIS). METHODS: A prospective study of 440 women 50 years and older, who underwent TVS, SIS and pathological sampling for endometrial assessment. Endometrial findings and measurements on TVS and SIS were evaluated and assessed in benign and Cancer/hyperplasia cases. RESULTS: Patients median age was 60.1+/-8.1 (range 50-91) and mean BMI was 33.3+/-7.2. The main indication for evaluation was bleeding (87.3%) and 34/440 (7.7%) had either cancer or hyperplasia. In 4/34 (11.8%) cases with cancer or hyperplasia the EE was poorly visualized on TVS and 3/34 (8.8%) had intracavitary fluid. Only 3 (8.8%) had EE between 4-5mm and the rest had “thick EE.” On SIS 23/34 (67.6%) had polyps, 10/34 (29.4%) had focal thickening and only 1/34(2.9%) had diffuse thickening. As for EE thickness on SIS, 13/27 (48.1%) had EE <5mm and in 11/27 (40.7%) cases it was <4mm. The mean EE on TVS was 14.7±8.6mm as compared to 5.9±3.7mm, on SIS (p < 0.0001). In 319/440 (92.3%) of cases with benign pathology, the TVS EE was significantly thicker than sis, even after excluding cases with polyps (n=159), focal thickening (n=62) and submucosal fibroids (n=35): 6.5±4.3mm on TVS vs 3.9±2.4mm on SIS, (n=63, p=0.001). EE conversion formula was created using scatterplot of the measurements with regression line: TVSEE =1.41×SISEE. CONCLUSION: SIS EE was significantly thinner than TVS EE both in the cancer/hyperplasia and the benign groups. The EE conversion formula is: TVS EE=1.41xSIS EE. This finding suggests that the current interpretation of thin endometrium on TVS may not be applied in SIS.