Evaluation Of Endometrial Thickness Research Articles

Evaluation of Endometrial Thickness by Transvaginal Sonography in Postmenopausal Women with Bleeding: A Cross-sectional Study

Introduction: Abnormal Uterine Bleeding (AUB), occurring atleast one year after menopause, is one of the most concerning complaints among gynaecological patients. Endometrial atrophy is the most common endometrial finding in women with Postmenopausal Bleeding (PMB), approximately 10-15% of whom have endometrial carcinoma. Earlier studies suggested that obesity, Type 2 diabetes mellitus, and hypertension are risk factors for endometrial hyperplasia. Diabetes mellitus, obesity, and hypertension form the triad of endometrial cancer. Aim: To assess endometrial thickness by Transvaginal Sonography (TVS) and compare it with histopathological findings in women with PMB, evaluating whether an endometrial thickness of <4 mm on TVS is more suggestive of malignancy. Materials and Methods: The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at King George Hospital, Vishakapatnam, Andhra Pradesh, India, from January 2022 to December 2022, comprising n=100 subjects. After routine necessary investigations for PMB, a transvaginal ultrasound examination was carried out to calculate endometrial thickness and compare it with the results of histopathological diagnosis of the endometrium. The parameters assessed were endometrial thickness and appearance, Type 2 Diabetes Mellitus (T2DM), hypertension, and Body Mass Index (BMI). The data was compiled and compared using the Chi-square test, with a p-value of ≤0.05 considered highly significant. Results: The results showed normal atrophic and thickened endometrium in 36% of subjects each, and abnormal endometrium such as hyperplasia, carcinoma, and polyps were recorded in 14%, 8%, and 6% (n=6) of cases, respectively. The histopathological results showed normal endometrium such as atrophic, secretory, and proliferative endometrium in 49%, 6%, and 19% of subjects, respectively. Abnormal endometrial findings such as endometrial hyperplasia, carcinoma, and polyps were observed in 14%, 7%, and 5% of cases, respectively. The majority of cases (58%) had endometrial thickness ≤4 mm, followed by 36% of cases with 5-10 mm and 6% of cases >11 mm, with mean and Standard Deviation (SD) values of 5.8±3. mm Statistical analysis data on the association between TVS findings and Histopathological Examination (HPE) findings was observed to be statistically significant (p<0.001). A statistically significant association was observed between T2DM, and BMI >25 kg/m2 together, DM+hypertension+BMI (Triad) and endometrial thickness, respectively. Conclusion: The TVS is easy, simple, non invasive, and involves no complications. Therefore, it can be used as the first diagnostic step in the investigations of women with PMB, combined with histopathological assessment.

Evaluation of endometrial thickness in breast cancer patients with tamoxifen treatment – Difference between 2-dimensional ultrasonography and elastosonography

ObjectiveThis study aimed to confirm the clinical significance of elastographic endometrium measurement in comparison with conventional ultrasonography for tamoxifen users with breast cancer. Materials and methodsIn this retrospective analysis, 98 women receiving tamoxifen as postoperative breast cancer treatment were included. Patient medical charts were reviewed, and related medical, obstetric, and gynecological information and histories relevant to breast cancer were evaluated. Patient clinical imaging data included endometrial thickness measurements using both conventional ultrasonography and elastography, and the differences between these two modalities in delta values were statistically analyzed along with possible influencing factors. ResultsEndometrial thickness measured using 2-dimensional ultrasonography had a mean value of 5.81 mm (standard deviation [SD] = 3.09), and elastosonography showed a mean value of 3.07 mm (SD = 1.62). A paired t-test was conducted and a significant difference between them was confirmed (P-value <0.001). Logistic regression analysis revealed that age and duration of tamoxifen treatment significantly influenced the degree of difference between endometrial thickness measurements. ConclusionsElastosonography may be a more successful and useful tool for measuring actual endometrial thickness than generalized 2-dimensional ultrasonography. In clinical cases with limited use of elastosonography and consequent inability for thorough evaluation of endometrial thickness, practitioners should exercise caution in deciding whether or not to adopt invasive diagnostic procedures, such as endometrial curettage, especially for young patients of reproductive age or those with prolonged treatment of breast cancer with tamoxifen.

Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness.

Abnormal uterine bleeding (AUB) is a common complaint in postmenopausal and perimenopausal women, caused by a range of disorders, including structural and systemic diseases. The evaluation of endometrial thickness (ET) via radiological methods, followed by a histopathological examination of the endometrium, is useful for proper diagnosis. Among systemic diseases, thyroid dysfunction, specifically hypothyroidism and hyperthyroidism, contribute significantly to AUB cases. This descriptive cross-sectional study was conducted at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India, over a period of 16 months, from May 2021 to September 2022. Patients presenting with abnormal uterine bleeding and undergoing thyroid function tests (TFTs), ultrasonography, and endometrial biopsy/hysterectomy at the gynecological outpatient department were included. Hospital records were used to obtain clinical details and investigation results. Endometrial thickness and thyroid status were recorded, and descriptive statistics were used to analyze the collected data. This study included 150 patients with abnormal uterine bleeding, with a mean age of 44 years and 80.6% of patients in the premenopausal age group. A total of 48% of patients had a deranged thyroid profile, with hypothyroidism being more common (91.6%). Structural causes of AUB were identified in 81.3% of cases, with adenomyosis (33.65%), concomitant adenomyosis and leiomyoma (31.5%), and leiomyoma (14.8%) being the most common. Endometrial polyps (4.6%) and endometrial carcinoma (0.6%) were also observed and were consistent with the final histopathology. The remaining 18 patients had no structural causes and were categorized as cases of dysfunctional uterine bleeding (DUB). Increased ET was more commonly observed in postmenopausal patients (4.3%) compared to premenopausal patients (0.7%) among those with AUB, while the reverse was true for patients with DUB. Increased ET was commonly associated with hypothyroidism in both groups. Histopathological examination of endometrial biopsies/hysterectomy specimens revealed additional findings in some patients, including hyperplasia of the endometrium with (0.7%) and without atypia (4%), leading to a more accurate diagnosis. AUB is a prevalent condition affecting women in both pre-menopausal and postmenopausal stages, frequently caused by structural anomalies. However, thyroid dysfunction, especially hypothyroidism, is also a significant contributing factor. As such, thyroid function tests (TFTs) are an effective and economical means of identifying potential underlying causes of AUB. Hypothyroidism is frequently associated with increased endometrial thickness, and histopathological examination remains the gold standard for determining the precise cause of AUB.

Comparison of transabdominal sonography and transvaginal sonography in evaluation of endometrial thickness in the setting of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a common complaint in women of reproductive age for which they consult their gynecologist and is the direct cause of a significant health-care burden for women. Imaging plays a pivotal role in diagnosing and helping the clinicians choose an appropriate management strategy at the earliest possible juncture, thus relieving patients of their symptoms and preventing complications. This tertiary care hospital-based study aims to assess the role transabdominal sonography in comparison with transvaginal sonography in evaluation of endometrial thickness in the setting of AUB in of in female population of Kancheepuram and West Chennai district of Tamil Nadu. Materials and Methods: It is a prospective study conducted in the Department of Radiology, of a tertiary care hospital in Kancheepuram district of Tamil Nadu, India. One hundred adult females who presented with complaints of abnormal bleeding per vaginum underwent both transabdominal (TAS) and transvaginal ultrasonography (TVS). In addition, they were evaluated for AUB through assessment of endometrial thickness and the presence of other uterine and adnexal pelvic pathologies. Result: The results of the present study show that TVS is superior to TAS in assessing endometrial thickness accurately and has a slightly better role in diagnosing endometrial pathologies such as endometrial polyp, hyperplasia, endometrial carcinoma, and number and location of Submucosal/intramural leiomyomas. Conclusion: TVS is superior to TAS in assessing endometrial thickness accurately and have high sensitivity and accuracy in the diagnosis of pelvic pathologies and determination of the type of pelvic mass was improved significantly when a transvaginal study was performed after TAS in cases of AUB.

Evaluation of endometrial thickness by transvaginal ultrasound and baseline risk factors as a predictor for endometrial abnormalities in postmenopausal women.

To evaluate the endometrial thickness (ET) as a predictor of endometrial abnormalities in postmenopausal women and whether consideration of baseline risk factors increases diagnostic accuracy. This is a retrospective observational study of postmenopausal women presenting with bleeding or thickened endometrium (≥4 mm) on ultrasound, between 2003 and 2012. Risk factors for endometrial abnormality were analysed using logistic regression. Of 301 women, 220 were symptomatic and 81 were asymptomatic. The median ET was 6 mm (IQR 4-9) for symptomatic women and 9 mm (IQR 6-12) for asymptomatic women. Abnormal pathology was found in 35 symptomatic (15.9%) and 6 asymptomatic women (7.4%). For each 1 mm increase in ET, the odds of an abnormal diagnosis increased by 16.3% (95% CI 9.6-23.5) for symptomatic and 19.9% (95% CI 3.1-39.3) for asymptomatic women. The Youden's index method identified an ET threshold of ≥7.1mm for symptomatic and ≥14.5mm for asymptomatic women. In symptomatic women the sensitivity was 88.6% (95% CI 72.3-96.3) and specificity 69.2% (95% CI 61.9-75.6), while in asymptomatic women the sensitivity was 50.0% (95% CI 13.9-86.1) and specificity was 89.3% (95% CI 79.5-95.0). The addition of age in the symptomatic women model reduced the sensitivity (82.9% (95% CI 65.7-92.8)) but increased the specificity (72.4% (95% CI 65.3-78.6)). ET is a significant predictor of abnormality. In the absence of risk factors, our study suggests that invasive procedures may be withheld until the ET is ≥7.1 mm with bleeding and ≥14.5 mm in asymptomatic women with no bleeding.

Relation of Endometrial Hyaluronic Acid with Female Infertility in Women Undergoing Ovarian Stimulation Protocol

A comparative prospective study was conducted in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, from September 2019 to March 2020. The aim of the study was to evaluate the level of hyaluronic acid (HA) in endometrial fluid at day of trigger in infertile women whom undergoing ovarian stimulation protocol. The study included a total of 60 women who were selected from those attended the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies. All couples subjected to a full history taking, complete general examination, complete gynecologic examination and infertility workup including: husband’s semen analysis, hormonal analysis, uterine cavity and tubal patency was performed. Different ovulation induction programs were used evaluation of endometrial thickness, pattern, size and number of mature follicles was performed by transvaginal sonography in the 2nd of menstrual cycle and cycle day 11-14 before HCG injection. In this study basal hormonal analysis were performed to the female in the 2nd or 3rd day of the menstrual cycle and study included aspiration of endometrial fluid for determination of hyaluronic acid level by ELISA technique. The study showed that mean of hyaluronic acid was elevated significantly in women received letrozole plus FSH (158.7±19.7 pg/ ml) followed by women received Clomid plus FSH (160.8±13.5 pg/ml) and the lowest mean was recorded in the control group (146.1±26.2 pg/ml). The study showedpositive correlation betweenhyaluronic acid and LH at day of triggering of ovulation in women received Clomid plus FSH (group B). The study showed positive correlation betweenhyaluronic acid and progesterone at day of triggering of ovulation in women received letrozole plus FSH. The study showed positive correlation betweenhyaluronic acid and number of follicles in women after receiving letrozole plus FSH. The study revealed that HA mean was elevated significantly (P&lt; 0.05) in women who became pregnant after stimulation protocol compared with women who failed to be pregnant (164.2 vs. 152.1 pg/ml) as shown in Figure 4). The study also revealed that HA was significantly elevated in women who became pregnant after receiving letrozole + FSH (164.2 pg/ ml) as compared with non pregnant women (152.1 pg/ml) while HA level was non significantly related with pregnancy occurrence after administration of Clomid+FSH. It was concluded that, hyaluronic acid was elevated significantly in women received ovulation simulation drugs and letrozolewas superior to clomiphene as a treatment foranovulatory infertility in women

Evaluation of Endometrial Thickness in Females with Post Menopausal Bleeding

Evaluation of Endometrial Thickness in Females with Post Menopausal Bleeding

Endometrial assessment by transvaginal ultrasonography and correlation with histopathology among post menopausal women

Background: Transvaginal ultrasonography has increased the reliability of imaging diagnosis of women with endometrial pathologies and this technique has become widely used to evaluate endometrial thickness in women with postmenopausal bleeding.&#x0D; Materials and methods: 359 women presenting with history of at least three months amenorrhea were undergone transvaginal ultrasonography with measurement of endometrial thickness and uterine size. Endometrial biopsies were taken in 69 cases (19.2%) only.&#x0D; Results: The median age of patients was 53 years with the age range of 42 years to 81 years. Abdominal pain was the commonest symptoms followed by backache. 3/69 cases with histopathological diagnoses had normal sized uterus, while 66 cases had bulky (&gt;6.0 cm) uterus. 58/69 cases showed &gt; 5 mm thick endometrium and the endometrium was abnormal in 31/69 cases. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect abnormal endometrium were 91.2%, 22.9%, 53.4% and 72.7% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect endometrial hyperplasia and carcinoma were 100%, 17.5%, 10.3% and 100% respectively.&#x0D; Conclusions: Transvaginal sonographic evaluation of endometrial thickness and uterine size is useful for exclusion of endometrial pathology and to avoid unnecessary invasive surgical procedures.

How accurately can you suspect endometrial carcinoma in PMB?

Endometlial carcmoma is the second commonest gynaecological carcinoma worldwide, which is more frequently present as postmenopausal bleeding in early stages. Evaluation of endometrial thickness by 2D and 3D transvaginal ultrasonography, saline infusion sonography, MRI, blind and hysteroscopic guided endometiial biopsy are the investigations available to evaluate postmenopausal bleeding. Many studies has been conducted to assess and compare the accuracy of each investigation and found to have differences in sensitivity, specificity and predictive values on diagnosing endometrial malignancies. Therefore, systematic analysis of symptoms, risk factors and supportive investigations will give a better prediction of endometrial carcinoma in women presenting with postmenopausal bleeding.

Comparison of pregnancy outcomes in women undergoing frozen thawed embryo transfer (FET) cycles following ultrasound for endometrial morphology with and without Doppler studies- a prospective cohort study

Introduction: There is a paucity of data evaluating role of endometrial blood flow in frozen thawed embryo transfer cycles (FET cycles) in hormone replacement treatment (HRT) cycles. Objective: To compare pregnancy outcomes in women undergoing ultrasound for endometrial morphology alone to those with endometrial morphology with blood flows in frozen embryo transfer cycles. Patients: Patients aged 23 to 38 years undergoing first two frozen thawed single blastocyst embryo transfer cycles. From August 2019 to January 2020, 163 patients undergoing hormone replacement frozen embryo transfer cycles were enrolled in the study. Patients were divided in two groups. Patients in group A (n = 92) had ultrasonographic evaluation of endometrial thickness and morphology and in group B (n = 71) patients underwent ultrasound for endometrial thickness, morphology along with Doppler blood flow studies. Outcome measures: Primary outcome was clinical pregnancy rate. Secondary outcome measures were pregnancy loss rate, ongoing pregnancy rate, and ectopic pregnancy rate. Results: Clinical pregnancy rate in group A and group B was 54.34% and 47.88%. Clinical pregnancy rate was similar between both the groups (P = 0.779). Ongoing pregnancy rate in group A and B was 48.91% and 40.84%, respectively. Pregnancy loss rate (7–13 wks) was 5.4% and 7.04% in group A and group B, respectively. There was no significant difference in ongoing pregnancy rate and pregnancy loss rate between both the groups (P = 0.756). Conclusion: Additional measurement of doppler studies do not help in improving implantation and thus seems unnecessary in improving pregnancy rates and reducing pregnancy loss rates in FET cycles.

Evaluation of endometrial thickness, follicular growth, and serum estradiol levels in spontaneous (fertile) vs induced (infertile) cycles via clomiphene or gonadotropin

Abstract&#x0D; Objectives: The current evaluating study was launched to assess endometrial thickness (ET), follicular growth (FG), and serum estradiol (SE) levels in spontaneous (fertile) vs induced (infertile) cycles via clomiphene or gonadotropin.&#x0D; Patients and methods: The work included two groups; a study group (SG) and a control group (CG). The SG contained 196 patients who suffered infertility and was divided into two subgroups according to the treatment that the patients received, clomiphene (SGC) or gonadotrophin (SGG). The CG included 130 healthy, fertile, individuals who received no treatment. Transvaginal ultrasonography (TVU) was used to evaluate the treatment effects on the ET and FG plus ovulation. The SE levels of the group members were measured using a competitive radioimmunoassay (CRIA).&#x0D; Results:A trilaminar endometrium was ultrasonically recognized in the SGC and the CGshowing three hyper-echogenic lines with inner hypo-echogenic regions. ET was significantly (p?0.05)reduced in the SGCwhen compared with that in the CG.The follicular diameter (FD) was significantly (p?0.05) larger in the SGs than that in the CG. However, the FD significantly (p?0.05) increased in the SGG in comparison to that in the CG. The SE levels were significantly (p?0.05) higher during the mid of the cycle in the SGs than those in the CG. &#x0D; Conclusion: The assessed effects of the clomiphene or gonadotropin on the endometrial features, ovulation, and serum estradiol levels provide significant prognostic information regarding the use of those treatments in infertile women.

Should we continue to measure endometrial thickness in modern-day medicine? The effect on live birth rates and birth weight.

The evaluation of endometrial thickness (EMT) is still part of standard cycle monitoring during IVF, despite the lack of robust evidence of any value of this measurement to predict little revalidation in contemporary medical practice; other tools, however, such as endocrine profile monitoring, have become increasingly popular. The aim of this study was to reassess whether EMT affects the outcome of a fresh embryo transfer in modern-day medicine, using a retrospective, single-centre cohort of 3350 IVF cycles (2827 women) carried out between 2010 and 2014. In the multivariate regression analysis, EMT was non-linearly associated with live birth, with live birth rates being the lowest with an EMT less than 7.0 mm (21.6%; P < 0.001) and then between 7.0 mm and 9.0 mm (30.2%; P = 0.008). An EMT less than 7.0 mm was also associated with a decrease in neonatal birthweight z-scores (-0.40; 95% CI -0.69 to -0.12). In conclusion, these results reaffirm the use of EMT as a potential prognostic tool for live birth rates and neonatal birthweight in contemporary IVF, namely when considered together with other ovarian stimulation monitoring methods, such as the late-follicular endocrine profile.

Predicting of successful implantation at IVF cycles

Many of the uterine infertility factors are associated with chronic endometritis. Its prevalence reaches 92.6%. Quality of endometrial transformation during the “implantation window” is the basis of successful fertility. In our retrospective comparative study of 101 in vitro fertilization (IVF) cycles, the efficacy of transvaginal Doppler ultrasound (TVDUS) in predicting successful implantation was evaluated. Inclusion criteria were as follows: age younger than 41 years and good quality of embryos. Exclusion criteria were as follows: 41 and older age, poor quality of embryos and uterine cavity lesions. The 1st group included 38 cases with the presence of endometrial blood flow (EBF). The 2nd group included 63 cases with the absence of EBF. TVDUS was performed before embryo transfer (ET). Significant differences of EBF were connected with age and duration of infertility. In women of less than 31 years old, EBF was detected in 47.4% cases versus 26.3% women of older age. EBF was not detected in 74.6% of the cases of duration of infertility for 5 years and more. Pregnancy rate was significantly higher in the 1st group (63.1% versus 39.7%) and when endometrial thickness was 8–11 mm (52.1% versus 30.0%). We offer routine evaluation of endometrial thickness and EBF with TVDUS as a very helpful approach for predicting the implantation in IVF cycles.

Evaluation of endometrial thickness in postmenopausal women by using 3.0-T MRI

Background: The accepted threshold for normal endometrial thickness is 5 mm; lesions with endometrial thickness &lt; 5 mm are considered benign, whilst those &gt; 5 mm areconsidered malignant. However, endometrium ≥ 5 mm on transvaginal ultrasonography inpostmenopausal woman is considered as asymptomatic endometrial thickening. However, recent studies suggest that asymptomatic endometrial thickness of even 8 mm – 11 mm in postmenopausal women may be normal.Objectives: The present study investigated the normal endometrial thickness range in 297 asymptomatic postmenopausal women using 3.0-T magnetic resonance imaging (MRI) T2-weighted sagittal images measured retrospectively by a single radiologist.Method: The data were classified according to patient age and postmenopausal duration, and the medical records and follow-up MR images were reviewed to assess the clinical outcome.Results: The mean endometrial thickness was 2.4 ± 0.1 mm (range: 0.1–11.6). The endometriumin 21 of 297 subjects was ≥ 5 mm thick. Follow-up MR images were obtained in 17 of these 21 women, and their endometrial thickness was found to have decreased in all of them. To date,none of the subjects has been diagnosed with endometrial cancer.Conclusion: Although 5 mm is considered the conservative threshold of normal endometrial thickness on MRI of postmenopausal women, this figure should not, to avoid excessive false-positive diagnoses, be assumed as an indication of malignancy.

Evaluation of Endometrial Thickness and Bone Mineral Density Based on CYP2D6 Polymorphisms in Turkish Breast Cancer Patients Receiving Tamoxifen Treatment

Background: Several previous studies have examined the effect of CYP2D6 gene polymorphism on the efficacy and metabolism of tamoxifen (Tamoxifen Teva, Nolvadex) in the treatment of breast cancer. In the present study, the metabolic profiles associated with various CYP2D6 genotypes were evaluated. Method: In the present study 92 Turkish breast cancer patients with early-stage hormone receptor-positive tumors treated with adjuvant tamoxifen (20 mg) were evaluated for CYP2D6 genotype and metabolic profiles. Known side effects of tamoxifen treatment, including endometrial thickening, changes in serum lipid levels and bone density, and hepatosteatosis, were evaluated according to the CYP2D6 polymorphism. Result: The distribution of metabolic characteristics in the Turkish population was as follows: 77.1% normal metabolism, 11.5% intermediate metabolism, 5.2% ultrarapid metabolism, and 2.1% poor metabolism. The CYP2D6 genotypes associated with rapid metabolism were CYP2D6 3X*1/*1 duplication (DUP) and CYP2D6 2X*1/*2, while poor metabolism was associated with the genotypes CYP2D6 *3/*4 and CYP2D6 *6/*6. There was no statistically significant relationship between metabolic characteristics and bone density or hepatosteatosis. A statistically significant difference in total cholesterol and triglycerides was detected in lipid profile analysis (p = 0.003, p = 0.02). Assessment of endometrial thickness revealed a significant association of hyperplasia and poor metabolism, and an association between atrophy and ultrarapid metabolism (p = 0.01). Conclusion: Significant development of endometrial hyperplasia was identified among individuals with poor tamoxifen metabolism. As a result, tamoxifen may be a significant predictor of endometrial thickening among individuals with poor metabolic characteristics.

The evaluation of endometrial thickness and bone mineral density based on CYP2D6 polymorphisims in Turkish breast cancer patients receiving tamoxifen treatment.

e11559 Background: The drug efficacy and metabolism of tamoxifen on the treatment of breast cancer in the presence of gene polymorphisms CYP2D6, has been investigated in many studies. In the presen...

Endometrial thickness predicts endometrial hyperplasia in patients with polycystic ovary syndrome

Body mass index is predictive of sonographic endometrial stripe thickness, which in turn is predictive of endometrial hyperplasia in patients with polycystic ovary syndrome. For every 1-mm increase in endometrial stripe, the odds ratio of hyperplasia increased by 1.48 (95% confidence interval, 1.04-2.10).

Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding

This study was undertaken to investigate cut-off value of the endometrial thickness by transvaginal ultrasonography (TvUSG), and to detect the accuracy of preoperative Pipelle biopsy in premenopausal women with abnormal vaginal bleeding. This study was included 144 premenopausal women with abnormal bleeding. Their endometrial thickness was measured by TvUSG and then Pipelle endometrial biopsy was performed. Preoperative histopathologic findings of 57 women who were operated were compared with final histolopathologic examination. Of the 144 women, 113 (78.4%) had normal and 31 (21.6%) had an abnormal endometrium. The abnormal endometrium was composed of 11.8% hyperplasia (simple + atypical complex), 4.2% endometrial polyp, and 5.5% adenocarcinoma. An optimal sensitivity and specificity (83.6 and 56.4%, respectively) and negative predictive value with 95.6% for detection of abnormal endometrium were obtained with an endometrial thickness of 8 mm. The accuracy rate of preoperative Pipelle biopsy was 94.7% in a total of 57 women. An endometrial thickness >8 mm is more likely than that of 8 mm or less to be indicated with endometrial biopsy in premenopausal uterine bleeding. Pipelle endometrial biopsy is an accurate diagnostic procedure for the detection of high-grade endometrial lesions in premenopausal women.

Evaluation of endometrial thickness in hormone receptor positive early stage breast cancer postmenopausal women switching from adjuvant tamoxifen treatment to anastrozole

Evaluation of endometrial thickness by transvaginal ultrasonography (TVUS) in postmenopausal estrogen receptor positive breast cancer patients treated with anastrozole after tamoxifen therapy. This study included 70 postmenopausal estrogen receptor positive breast cancer patients who switched to anastrozole after tamoxifen; patients had endometrial thickness >4 mm and no endometrial malignancy. Endometrial thickness was measured after anastrozole treatment. Endometrial thickness during anastrozole therapy was lower than after tamoxifen therapy ( p < 0.001); the mean reduction in endometrial thickness was 4.5 mm (±3.0). Cystic endometrial appearance was more frequent in patients under tamoxifen than in those under anastrozole ( p < 0.001). Duration of tamoxifen therapy was not correlated to the endometrial thickness at the time of its suspension. Duration of tamoxifen therapy and endometrial thickness at the time of tamoxifen suspension was correlated to the relative reduction of endometrial thickness during anastrozole therapy. Anastrozole reverses tamoxifen-induced increased endometrial thickness and sonographic endometrial cystic appearance.

Evaluation of Endometrial Urocortin Secretion for Prediction of Pregnancy after Intrauterine Insemination

Urocortin is a neuropeptide produced by the human endometrium and has biological effects putatively important for promoting blastocyst implantation. We measured urocortin concentrations in samples of endometrial wash fluid collected from women with unexplained infertility who underwent intrauterine insemination (IUI). Patients 28-42 years of age (n = 71) were consecutively enrolled after a complete clinical evaluation. Endometrial wash fluid was retrieved before IUI, at the time of ultrasound evaluation of endometrial thickness. Urocortin concentrations were assayed with a specific ELISA. After IUI, 28 patients (39%) became pregnant. Urocortin concentrations were significantly higher in women who became pregnant than in those who did not (0.38 microg/L vs 0.13 microg/L, P <0.0001). At a cutoff of 0.321 microg/L, urocortin results were positive in 61% [95% confidence interval (CI), 41%-78%] of women who had successful implantation and negative in 98% (95% CI, 88%-99.6%) of those who did not. The pregnancy rate for women with urocortin concentrations >0.32 microg/L was 94%, which differed significantly (P <0.05) from the overall pregnancy rate of 39% in the study population. Urocortin is measurable in endometrial wash fluid, and its concentrations before IUI are higher in women who subsequently achieve pregnancy. These data suggest that the probability of having a successful pregnancy-producing IUI may be better estimated by measuring urocortin in endometrial wash fluid.