Endometrial Abnormalities In Women Research Articles

Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF

Objectives: To compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-US) to office hysteroscopy (OH) in the screening of uterine cavity with normal hysterosalpingography (HSG) findings for subtle endometrial abnormalities before in vitro-fertilization (IVF). Methods: A prospective cohort cost-modeling study was carried out in a University hospital. We included 120 infertile women with a normal uterine cavity on HSG scheduled for IVF. All cases were evaluated by 3D-US, and the results were compared with OH findings. Results: OH revealed cavitary endometrial lesions (CLs) in thirty-four women (28.3%). Endometrial polyps were the most common detected lesions (16, 47.1%). 3D-US had 88.2% sensitivity, 96.5% specificity, 90.9% positive predictive value, 95.4% negative predictive value, and 94.2% overall accuracy for CLs. The overall agreement between 3D-US and OH was near-perfect (κ=0.86, 95% CI=0.75-0.96). Irregular menstrual bleeds and prior endometrial procedures were significant predictors for CLs (aOR=24.96, 95% CI=2.71–230.04, P=0.005, aOR=9.16, 95% CI=2.13–39.3, P=0.002, respectively). A selective screening strategy discerning OH to women with these predictors and/or women with abnormal 2D-US would have an NPV of 92.8 % with substantial cost benefits. Conclusions: In the pre-IVF work up, 3D-US, a non-invasive imaging modality, seems to be nearly comparable to OH. Office hysteroscopy screening prioritizing women with abnormal 2D-US, irregular menstrual periods and/or prior endometrial traumatization could yield a satisfactory cost-effective approach for identifying endometrial lesions.

Sonohysterography for evaluation of endometrial abnormalities associated with tamoxifen therapy for breast cancer

ObjectiveTo evaluate sonohysterography for the diagnosis of endometrial abnormalities in women treated with tamoxifen for breast cancer. Patients and methodsWe assessed 37 women treated with tamoxifen for breast cancer who underwent sonohysterography and correlative endometrial biopsy for evaluation of postmenopausal bleeding or thickened endometrium greater than 8mm. In 14 patients, endometrial biopsy was followed by endovaginal sonography to ensure removal of endometrial pathology. Sonohysterography findings were compared with histopathology results. ResultsSonohysterography findings coincided with histopathology results in 27 of 37 cases including 19 of 23 cases of endometrial polyps, 6 of 8 cases with thickened endometria and two cases had normal endometrium. Sonohysterography findings did not coincide with histopathology in 3 of the 14 cases who underwent endovaginal sonography after endometrial biopsy compared to 7 of the 23 cases who did not undergo such examination and 4 of these missed 7 cases were for endometrial polyps. ConclusionSonohysterography is a useful procedure for the diagnosis of endometrial abnormalities in tamoxifen-treated women. Endometrial abnormalities are better diagnosed on sonohysterography than on endometrial biopsy which has the limitation of some missed endometrial polyps, a problem that may be minimized by performing endovaginal sonography after endometrial biopsy.

Comparetive study between saline sonohysterography,transvaginal ultrasound and biopsy in evaluation of endometrial disease in postmenopausal bleeding

Background : Transvaginal ultrasound is used conventionally as initial investigation of patients with postmenopausal bleeding, but saline contrast sonohysterography is a better technique to reliably distinguish focal from diffuse endometrial lesion.
 Patients and methods: During the period from November 2011 to MAY 2012 ,40 female patients with postmenopausal bleeding were submitted to sequential examination by transvaginal ultrasound ,and sonohysterography .the presence of focal endometrial lesions and type of lesion (endometrial hyperplasia ,polyp, submucous myoma ,or malignancy )were noted .predictive values were calculated by correlating the results with final diagnosis reached by endometrial biopsy.Objectives: to compare the ability of transvaginal ultrasonography and saline infusion sonohysterography as initial modality for the diagnosis of endometrial abnormalities in women with PMB by correlating the results with endometrial biopsy.
 Result:The sonohysterography had 89.4 % sensitivity and 90% specificity , DA 90%, compared to 60%sensitivity and 70%specificity achieved by transvaginal sonography .
 The diagnostic performance of sonohysterography for 3 main endometrial abnormalities (i.e. endometrial hyperplasia ,polyps and submucous myoma ) was better than transvaginal sonography. The best results were seen in cases of submucos myoma where sensitivity and specificity of sonohysterography reached to 100% as compared to TVS (66% and 95.24% respectively).
 Conclusion:The results have substantiated that sonohysterography is a better tool than transvaginal sonography for the assessment of endometrial intra-cavity lesion .by providing accurate differentiation between focal and diffuse endometrial lesions.

Endometrial Abnormality in Women With Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy associated with infertility and metabolic disorder in women of reproductive age. Although the clinical and biochemical features are heterogeneous with individuals, the most widely accepted clinical characteristics of PCOS are oligo- or anovulation combined with hyperandrogenism. With the higher rate of implantation failure after induction of ovulation or higher risk of spontaneous miscarriage after pregnancy, the reduced fertility is apparently attributed not only to anovulation but also to endometrial dysfunction in patients with PCOS. Here we review the features of the endometrial abnormalities in women with PCOS. The ability to improve the endometrial functions is of potential therapeutic targets to increase reproductive outcome of women with PCOS.

Prokineticin 1 mRNA expression in the endometrium of healthy women and in the eutopic endometrium of women with endometriosis

To examine prokineticin 1 (PROK1) mRNA expression in eutopic endometrial glands obtained from patients with or without endometriosis, to investigate the presence of additional endometrial abnormalities in women with endometriosis. Prospective laboratory study. University hospital. Twelve control women and 12 patients affected by endometriosis in the secretory phase of the menstrual cycle. Endometrial specimens were obtained from women affected (cases) or not (control group) by endometriosis. Endometrial glands were freshly isolated from endometrial biopsies. PROK1 mRNA expression levels by real-time polymerase chain reaction analysis. PROK1 mRNA was detectable in 4 of 12 (33%) samples obtained from women affected by endometriosis, whereas 10 of 12 (83%) samples obtained from normal women were positive for PROK1 detection by real-time polymerase chain reaction. Moreover, detectable PROK1 mRNA levels were 10 times lower in samples obtained from women with endometriosis than in samples obtained from control women. PROK1 is a newly discovered angiogenic factor implicated in the vascular function of peri-implantation endometrium and early pregnancy. An altered expression of PROK1 could be one of the several biochemical abnormalities characterizing eutopic endometrium in endometriosis.

Sonohysterographic findings of endometrial abnormalities in women with polycystic ovarian disease

Sonohysterographic findings of endometrial abnormalities in women with polycystic ovarian disease

P07.07: Sonohysterographic findings of endometrial abnormalities in women with polycystic ovary disease

P07.07: Sonohysterographic findings of endometrial abnormalities in women with polycystic ovary disease

Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen

Objective The goal of this work was to study the role of transvaginal ultrasonography (TVUS) together with colorflow Doppler imaging (CFDI) in the detection of significant endometrial abnormalities induced by tamoxifen. Methods Over a 6-year period, 304 women on tamoxifen as adjuvant therapy for breast cancer were recruited into the current study. Standard demographic data as well as duration of tamoxifen use were collected. Patients were assessed at study entry and at yearly intervals with TVUS together with CFDI. All patients had an endometrial biopsy at the time of study entry, and repeat endometrial evaluations were done subsequently only if there were abnormal ultrasound findings or the presence of irregular vaginal bleeding. All ultrasonic characteristics and Doppler flow measurements were recorded. Descriptive statistics were used to describe the study group. Logistic regression was used to identify significant treatment- and ultrasound-related factors associated with the presence of significant uterine pathology. Results One thousand and sixty-one ultrasound assessments were performed on 304 patients over a 6-year period. The mean age was 52.33 (range, 29–79). Seventy-two percent of the patients were postmenopausal at the time of breast cancer diagnosis. The median concentrations of estrogen and progesterone receptor were 75 and 73 fmol/L, respectively. Fifty-eight percent of the patients had received cytotoxic chemotherapy. The mean duration of tamoxifen use was 48.2 months. Thirty-two percent of the ultrasound examinations had associated significant uterine pathology defined as conditions that required further medical or surgical investigation and treatment. However, 80% of the abnormalities represented benign polyps. Six cases of primary endometrial cancer were detected. All cases presented with irregular bleeding. No recurrence of disease was detected at a median follow-up of 48 months. One case of metastatic breast cancer to the uterus was encountered. By setting the endometrial thickness cutoff at more than 9 mm to represent significant abnormality in this patient population, the sensitivity was 63.3%, specificity was 60.4%, positive predictive value was 43.3%, and negative predictive value was 77.5%. To detect endometrial cancer, the endometrial thickness cutoff at 9 mm had a positive predictive value of only 1.4%. Logistic regression analysis showed only endometrial thickness greater than 9 mm (OR 3.99, CI = 1.26–12.65, P = 0.018) and spiral artery pulsatility index measurement (OR 4.18, CI = 1.25–13.92, P = 0.02) to be associated with significant uterine abnormalities. Conclusions Routine sequential ultrasound surveillance in asymptomatic women on tamoxifen is not useful because of its low specificity and positive predictive value. A significant portion of screened asymptomatic women would need to undergo needless surgical evaluations of their endometrium if widespread use of ultrasound is implemented in this patient population.

Endometrial disease diagnosed by transvaginal ultrasound and dilatation and curettage

This study is designed to compare endometrial thickness measured by transvaginal ultrasound with endometrial pathology by dilatation and curettage. Fifty-four women with postmenopausal bleeding were evaluated. Endometrial thickness, including both layers of the endometrium, was measured by transvaginal ultrasound after which fractional curettage was performed and samples taken were then dispatched for histologic examination. Median endometrial thicknesses of 5 mm, 8.5 mm and 6 mm were found for benign, hyperplastic and carcinomatous endometrium, respectively. Of the eight hyperplastic samples, two cases had 4 mm, and one case had 3mm endometrial thickness. Similarly, of the nine malignant samples, three cases had an endometrial thickness of 3 mm. Three mm has been found to be the best cut off point for endometrial abnormalities in postmenopausal bleeding with 100% sensitivity but low specificity (13%). Fractional curettage seems to be the best method for detecting endometrial abnormalities in women with postmenopausal bleeding.

A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen

OBJECTIVE: Our purpose was to compare the screening effectiveness and acceptability of transvaginal ultrasonography (with sonohysterography if endometrial thickness was >4 mm) with office hysteroscopy. STUDY DESIGN: This randomized crossover study comprised 53 consecutive asymptomatic (without vaginal bleeding) postmenopausal patients with breast cancer who had taken tamoxifen (20 or 40 mg/day) for at least 6 months. RESULTS: Two patients had endometrial cancer (1 primary, 1 breast secondary), both detected only by transvaginal ultrasonography. Twenty-six patients had at least 1 polyp (total 47, all benign). The women who had polyps were not significantly different in their age, body mass, months of tamoxifen intake, or the cumulative dose. The sensitivity and specificity of transvaginal ultrasonography were 85% and 100%, respectively. The corresponding values for office hysteroscopy were 77% and 92%. It was significant that more patients preferred transvaginal ultrasonography to hysteroscopy ( P < .001). CONCLUSION: Transvaginal ultrasonography (plus sonohysterography) may be more effective and acceptable than office hysteroscopy for detecting endometrial abnormalities in women taking tamoxifen. (Am J Obstet Gynecol 1998;179:62-70.)

The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities

To evaluate the diagnostic accuracy of transvaginal ultrasonography for endometrial abnormalities in women with abnormal uterine bleeding. In a prospective study, 136 consecutive patients underwent transvaginal ultrasonography, hysteroscopy, and endometrial sampling through suction curettage or directed biopsy. The ultrasonographic findings were evaluated on the basis of the final diagnosis established by hysteroscopy and histologic examination. Receiver operating characteristic curve analysis and likelihood ratios were used. Likelihood ratios algebraically combine sensitivity and specificity to describe more than the independent values themselves, specifically the change in odds favoring disease given a particular test result. In 21 of the 136 patients, hysteroscopy detected polyps or submucous myomas, which curettage failed to detect. In 67 premenopausal women, ultrasonography demonstrated a sensitivity in diagnosing endometrial abnormalities of 88% and a specificity of 68%, using a cutoff point of 5 mm of single-layer endometrial thickness. The positive likelihood ratio was 2.8 (95% confidence interval [CI] 1.66-4.55) and negative likelihood ratio 0.18 (95% CI 0.07-0.46). In 69 postmenopausal women, using a cutoff point of 3 mm, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 97%, 74%, 3.7 (95% CI 2.18-6.38), and 0.04 (95% CI 0.01-0.28) respectively. Transvaginal ultrasonography is an excellent first-step diagnostic method of excluding the endometrial abnormalities in women with postmenopausal bleeding but is of limited use in premenopausal women with irregular bleeding. Ultrasonography may reduce the number of invasive endometrial investigations by approximately 40%.

The sensitivity and specificity of vaginal sonography in detecting endometrial abnormalities in women with postmenopausal bleeding

To evaluate the sensitivity and specificity of vaginal sonography in the detection of endometrial abnormalities in patients with postmenopausal bleeding (PMB). In a prospective study, 54 patients with PMB were examined with vaginal ultrasonography prior to dilatation and curettage. The mean endometrial thickness was compared with the histopathological results. A cutoff value of 5 mm was prospectively chosen to evaluate the sensitivity and specificity of this method. The calculated sensitivity for the measurement of endometrial thickness as a predictor of endometrial pathology was 89%, and the specificity was 83%. We found carcinoma associated with an endometrial thickness of 6 mm. Although its sensitivity was high, we feel that an endometrial thickness > 5 mm should constitute a cause for concern but not a definitive indication of pathology. Thus we believe that, at this point, the role of vaginal sonography as an aid in determining which women with PMB should undergo curettage has yet to be determined.

Transvaginal sonography of the endometrium in women with postmenopausal bleeding.

The purpose of this study was to determine the value of screening transvaginal ultrasonography for the evaluation of endometrial abnormalities in women with postmenopausal bleeding. 250 women with postmenopausal bleeding underwent transvaginal ultrasonographic examinations before undergoing dilatation and curettage. Women who had any pelvic symptoms or were on hormone replacement therapy were excluded. In 151 women, the histologic diagnosis was atrophic endometrium. In these patients, the mean endometrial thickness was 3.4 +/- 1.2 mm. In 24 patients with endometrial carcinoma, the mean endometrial thickness was 16.5 +/- 6.2 mm. The measurement included both endometrial layers (i.e. double layer). Thirty six cases of other pelvic pathologic conditions were discovered on ultra sonography. We believe that is reasonable to have a cutoff limit for normal postmenopausal endometrium at 5 mm. Endovaginal ultrasound is a valuable diagnostic instrument, as sensitive as dilatation and curettage, for detecting pathological conditions in the uterine mucosa.

The sensitivity and specificity of vaginal sonography in detecting endometrial abnormalities in women with postmenopausal bleeding

Objective To evaluate the sensitivity and specificity of vaginal sonography in the detection of endometrial abnormalities in patients with postmenopausal bleeding (PMB). Methods In a prospective study, 54 patients with PMB were examined with vaginal ultrasonography prior to dilatation and curettage. The mean endometrial thickness was compared with the histopathological results. A cutoff value of 5 mm was prospectively chosen to evaluate the sensitivity and specificity of this method. Results The calculated sensitivity for the measurement of endometrial thickness as a predictor of endometrial pathology was 89%, and the specificity was 83%. We found carcinoma associated with an endometrial thickness of 6 mm. Conclusions Although its sensitivity was high, we feel that an endometrial thickness > 5 mm should constitute a cause for concern but not a definitive indication of pathology. Thus we believe that, at this point, the role of vaginal sonography as an aid in determining which women with PMB should undergo curettage has yet to be determined. © 1996 John Wiley & Sons, Inc.