Measurement Of Endometrial Thickness Research Articles

Performance of transvaginal ultrasound in evaluation of endometrioid versus non-endometrioid cancers.

401 Background: Measurement of endometrial thickness by transvaginal ultrasound (TVUS) is the standard of care for evaluation of patients with postmenopausal bleeding, the most common presenting symptom of endometrial cancer. However, the sensitivity of TVUS has not been clearly established in the setting of non-endometrioid histology, which is more aggressive and does not arise from endometrial hyperplasia. This study aims to evaluate the endometrial stripe (EMS) detection rate and sensitivity of TVUS in non-endometrioid compared to endometrioid endometrial cancers. Methods: In this retrospective cohort study, we included endometrial cancer cases diagnosed at a single institution from 01/01/2019 to 04/01/2024 who were enrolled in the Discovery and Evaluation of Testing for Endometrial Cancer in Tampons (DETECT) study who had TVUS during their initial clinical evaluation. Demographic characteristics and results from TVUS reports were obtained from the electronic medical record. Endometrial stripe thickness of less than 5mm is considered a negative result, whereas endometrial thickness of 5mm or greater (5mm+) is considered positive. The primary outcomes were the ability to measure EMS and the sensitivity of TVUS at a cutoff of 5mm+ for endometrial cancer detection, overall and by race and histology. We assessed differences using chi-squared tests. Results: Of the 349 patients included in our analysis, 247 (71%) had endometrioid histology, and 102 (21%) had non-endometrioid histology. There were 98 (28%) Black patients (49% non-endometrioid) and 242 (69%) White patients (22% non-endometrioid). The EMS was adequately measured in 98% of patients with endometrioid histology compared to 91% of patients with non-endometrioid histology (p=0.001). When stratified by race, EMS was visualized in 100% of Black patients with endometrioid histology but 89% of Black patients with non-endometrioid histology (p=0.02). This difference was seen but not significant in White patients with 98% measurable endometrial stripes in endometrioid cancer and 92% in non-endometrioid cancer (p=0.05). The ability to measure EMS was not different when compared by race alone. The sensitivity of TVUS (EMS of 5mm+) was higher in patients with endometrioid histology (99%) than patients with non-endometrioid histology (94%; p=0.03). Conclusions: In one of the largest and most diverse studies of TVUS performance in endometrial cancer patients to date, TVUS was more effective at visualizing the EMS and had higher sensitivity in patients with endometrioid compared to non-endometrioid endometrial cancers. While performance did not vary by race, the prevalence of non-endometrioid cancers was twice as high among Black compared to White patients. Our findings suggest that TVUS may be less accurate for diagnosing non-endometrioid endometrial cancer, which disproportionately affects Black women.

A multicentre, randomized, double-blind, placebo-controlled trial of topical oestradiol gel for endometrial regeneration after induced abortion.

Is topical oestradiol gel effective in promoting endometrial regeneration after a surgical abortion? Topical oestradiol gel is effective in promoting endometrial regeneration after a surgical abortion with few side-effects. Oestrogen is effective in promoting endometrial regeneration. Transdermal oestrogen has been widely used in clinical practice for endometrial regeneration after induced abortion, but high-level evidence is limited. We conducted a multicentre, superiority, randomized, double-blind, placebo-controlled trial. Between 9 March 2022 and 21 February 2023, 200 women were assigned in a 1:1 ratio to receive either oestradiol gel (treatment) and or oestradiol gel simulant (control) for 28 days. The participants were scheduled to have their endometrial thickness (mm) measured by ultrasonographic scan at 21-23 days post-abortion. The trial was blinded for participants, investigators, medical staff, and statistical analysts until final unblinding. Participants were women undergoing induced abortion within 10 weeks of gestation. A total of 200 participants were enrolled, with 100 in each group. Eighty-eight (88%) in the treatment group and 82 (82%) in the control group completed the study as per the protocol and were included in the per-protocol set (PPS). The intent-to-treat (ITT) analysis included all participants randomized to the study groups and used inverse probability weighting to account for loss to follow-up. The ITT analysis showed revealed significantly greater endometrial thickness in the treatment group (mean 8.1 ± 2.5 mm) compared to the control group (mean 6.9 ± 2.1 mm) 21-23 days postabortion (mean difference 1.2 mm, 95% CI 0.7 to 1.9; P < 0.001). The median time to menstrual return was shorter in the treatment group (34 days, inter-quartile range [IQR] 30-38) than in the control group (35 days, IQR 32-42), with a difference of -1 day (95% CI -2.3 to -0.9; P = 0.036). No differences were observed in the timing or volume of bleeding in the first post-abortion cycle. The PPS analysis mirrored the ITT findings. Adverse events were minimal (6% versus 8%), and the blood profile, liver, kidney and coagulation test results were comparable between groups (all P > 0.05). Loss to follow-up was 11% in the treatment group and 15% of controls, with no significant difference (P > 0.05). Inconsistencies in the timing of the ultrasonographic scans may have affected the accuracy of endometrial thickness measurements. Our findings suggest that topical oestrogen supplementation immediately after abortion within the first 10 weeks of gestation improves endometrial regeneration and growth, thereby potentially increasing the chances of a successful subsequent pregnancy. Clinical application of these findings may improve endometrial health management practices and provide a perspective on fertility treatment and women's reproductive health. This study was supported by a grant (FW-HKKT2021111501900) from Jianmin Pharmaceutical Group Co., Ltd (JMPG), Wuhan, Hubei, China. Both the oestradiol gel and the simulant were provided by JMPG. The funding source had no role in the study. X.Y.L. reports JMPG grant funding paid to their institutions. All other authors declare no competing interests. CHiCTR2100053565. 24 November 2021. 9 March 2022.

Does the Uterine Ozone Therapy Alter the Transcript Profile of Anti- and Proinflammatory Genes in Mares With Endometritis?

This study aimed to evaluate the localised effects of intrauterine ozone therapy on endometrial recovery in mares with endometritis. Our investigation assessed changes in gene expression profiles of anti-inflammatory (IL-1RA and IL-10), proinflammatory (IL-R1B3i and TNFα) and pleiotropic (IL-6) cytokines, along with detailed histological measurements of epithelial and endometrial thickness and the glandular area ratio. Twenty mares were assigned to a 2 × 2 factorial design based on endometritis diagnosis and treatment (control or 42 μg/mL ozone insufflation), resulting in four groups: NC (negative for endometritis/control), NO (negative/ozone), PC (positive/control) and PO (positive/ozone). Oestrus was induced with 2 mg of oestradiol benzoate on Days -1, 1 and 3, plus 1 mg on Day 5. Day 0 marked the initial uterine treatment, followed by insufflations on Days 1 and 2 with O3 (ozone) or O2 (control). Uterine biopsies were taken before treatment on Day 0 and Day 6 for histological analysis and gene expression assessment. Data were analysed using a statistical model that included endometritis status, treatment type, biopsy times (D0 and D6) and their interactions, analysed with Proc Glimmix. Regardless of treatment or endometritis status, significant biopsy effects (p < 0.01) indicated increased epithelial height and endometrial thickness in Day 6 samples. Analysis of IL-1 and TNFα revealed a significant interaction (p < 0.05) among endometritis, treatment and biopsy, with higher IL-1B3i expression on Day 6 in the PC group. The treatment effect (p < 0.04) showed a higher frequency (p < 0.01) of animals with positive modulation in the PC group (66.7%) versus the PO group (0.0%). An interaction effect (p = 0.08) between endometritis and treatment resulted from higher IL-1RA expression on Day 6 in the PC group compared to the PO group. Biopsy effect was significant for IL-10 (p < 0.01), indicating higher values in the second sample associated with tissue repair. In the short-term evaluation, ozone therapy did not influence endometrial morphology and may modulate cytokine expression, specifically the reduction in IL-1 and TNFα levels. Therefore, this therapy appears to be a safe and potentially effective treatment for modulating the inflammatory response in mares with endometritis.

Medical treatment of miscarriage using misoprostol—a retrospective study

PurposeThe treatment of early miscarriage with medication is effective and low in side effects. Nevertheless, no uniform dosage regimen has yet been established, nor has it been possible to determine whether previous pregnancies and births with their respective modes of delivery play a role in the effectiveness of Misoprostol. This study aimed to find predictive parameters for successful treatment with Misoprostol in early miscarriage.MethodsIn a retrospective study at the Otto von Guericke University Women’s Hospital, records of patients with early miscarriage and medical treatment using Misoprostol from 2018 to 2021 were reviewed for this purpose. The need for a curettage subsequent to treatment was scored as a parameter of failure. The data were analyzed using Statistical Package for the Social Science Version 28.0. The significance level was set to 0.050.ResultsWe found that successful therapy with misoprostol was seen in 86% (n = 114). 14% (n = 20) of the patients had curettage after taking Misoprostol as advised. Out of 134 women, 16% (n = 21) reported mild side effects, with nausea as the leading one (9.2% (n = 12)). Significance was found comparing the measurement of double endometrial stripe thickness after the second cycle of Misoprostol in women with and without curettage after medical treatment (exact value two-sided 0.035 at p < 0.05). A cutoff value at 8.8 mm was calculated using ROC Analysis.ConclusionsOur results indicate that the treatment of early miscarriage in the first trimester with Misoprostol is effective and has few side effects. The measurement of the endometrial stripe thickness after the second cycle of Misoprostol via transvaginal ultrasound could present a predictive marker during therapy.

The Role of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding

Background: Endometrial cancer is currently the most common malignancy of the female genital tract. Most of the women with endometrial cancer initially present with postmenopausal bleeding (PMB) and may be assessed initially with either endometrial biopsy or transvaginal ultrasonography. Objective: The objective of this study was to evaluate transvaginal ultrasound (TVS) measurement of endometrial thickness (ET) in diagnosing endometrial cancer in women with postmenopausal bleeding. Materials and method: This was a prospective study. Transvaginal ultrasonography and Papanicolaou smear were performed in 291 women presenting with postmenopausal bleeding aged &gt;50 years and were followed up for one year in BIRDEM General Hospital from September 2017 to August 2018. Results: One hundred and seventeen women had an endometrial thickness ≤4 mm and one endometrial cancer (0.85%) was diagnosed in this group. Endometrial biopsy was performed in women who had recurrent bleeding. But in women with an endometrial thickness of ≥5mm (174 out of 291 women), endometrial cancer was diagnosed in 9.77%, atypical hyperplasia in 5.17%, ovarian malignancy in 1.72% and total malignancy was 17.8%. Conclusion: Transvaginal ultrasonography using a ≤4 mm cut-off has high sensitivity for detecting endometrial cancer and can identify women with PMB who are highly unlikely to have endometrial cancer, thereby avoiding more invasive endometrial biopsy. Delta Med Col J. Jan 2021;9(2): 91-95

Endometrial Thickness as Diagnostic Triage for Endometrial Cancer Among Black Individuals

Poor performance of the transvaginal ultrasonography triage strategy has been suggested as a contributor to racial disparity between Black individuals and White individuals in endometrial cancer (EC) stage at diagnosis in population-level simulation analyses. To examine the false-negative probability using ultrasonography-measured endometrial thickness (ET) thresholds as triage for EC diagnosis among Black individuals and assess whether known risk factors of EC modify ET triage performance. This retrospective diagnostic study of merged abstracted electronic health record data and secondary administrative data (January 1, 2014, to December 31, 2020) from the Guidelines for Transvaginal Ultrasound in the Detection of Early Endometrial Cancer sample assessed Black individuals who underwent hysterectomy in a 10-hospital academic-affiliated health care system and affiliated outpatient practices. Data analysis was performed from January 31, 2023, to November 30, 2023. Pelvic ultrasonography within 24 months before hysterectomy. Ultrasonography performed before hysterectomy as well as demographic and clinical data on symptom presentation, endometrial characterization, and final EC diagnosis were abstracted. Endometrial thickness thresholds were examined for accuracy in ruling out EC diagnosis by using sensitivity, specificity, and negative predictive value. False-negative probability was defined as 1 - sensitivity. Accuracy measures were stratified by risk factors for EC and by factors hypothesized to influence ET measurement quality. A total of 1494 individuals with a uterus (median [IQR] age, 46.1 [41.1-54.0] years) comprised the sample, and 210 had EC. Fibroids (1167 [78.1%]), vaginal bleeding (1067 [71.4%]), and pelvic pain (857 [57.4%]) were the most common presenting diagnoses within 30 days of ultrasonography. Applying the less than 5-mm ET threshold, there was an 11.4% probability that someone with EC would be classified as not having EC (n = 24). At the 4-mm (cumulative) threshold, the probability was 9.5%, and at 3 mm, it was 3.8%. False-negative probability at the 5-mm threshold was similar among EC risk factor groups: postmenopausal bleeding (12.4%; 95% CI, 7.8%-18.5%), body mass index greater than 40 (9.3%; 95% CI, 3.1%-20.3%); and age 50 years or older (12.8%; 95% CI, 8.4%-18.5%). False-negative probability was also similar among those with fibroids on ultrasonography (11.8%; 95% CI, 6.9%-18.4%) but higher in the setting of reported partial ET visibility (26.1%; 95% CI, 10.2%-48.4%) and pelvic pain (14.5%; 95% CI, 7.7%-23.9%). These findings suggest that the transvaginal ultrasonography triage strategy is not reliable among Black adults at risk for EC. In the presence of postmenopausal bleeding, tissue sampling is strongly recommended.

Association between proliferative-to-secretory endometrial compaction and pregnancy outcomes after embryo transfer: a systematic review and meta-analysis.

Does the change in endometrial thickness (EMT) from the end of the follicular/estrogen phase to the day of embryo transfer (ET) determine subsequent pregnancy outcomes? Endometrial compaction from the late-proliferative to secretory phase is not associated with live birth rate (LBR) and other pregnancy outcomes. Endometrial compaction has been suggested to be indicative of endometrial responsiveness to progesterone, and its association with ET outcome has been investigated but is controversial. A systematic review with meta-analysis was carried out. PubMed, EMBASE, and Web of Science were searched to identify relevant studies from inception to 18 November 2022. The reference lists of included studies were also manually screened for any additional publications. Cohort studies comparing ET pregnancy outcomes between patients with and without endometrial compaction were included. A review of the studies for inclusion, data extraction, and quality assessment was performed by two independent reviewers. The effect size was synthesized as odds ratio (OR) with 95% CI using a random-effects model. Heterogeneity and publication bias were assessed by the I2 statistic and Egger's test, respectively. The primary outcome was LBR. Secondary outcomes included biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), miscarriage rate (MR), ongoing pregnancy rate (OPR), and ectopic pregnancy rate (EPR). Seventeen cohort studies involving 18973 ET cycles fulfilled the eligibility criteria. The pooled results revealed that there were no significant differences between endometrial compaction and non-compaction groups in LBR (crude OR (cOR) = 0.95, 95% CI 0.87-1.04; I2 = 0%; adjusted OR (aOR) = 1.02, 95% CI 0.87-1.19, I2 = 79%), BPR (cOR = 0.93, 95% CI 0.81-1.06; I2 = 0%; aOR = 0.88, 95% CI 0.75-1.03, I2 = 0%), CPR (cOR = 0.98, 95% CI 0.81-1.18; I2 = 70%; aOR = 0.86, 95% CI 0.72-1.02, I2 = 13%), MR (cOR = 1.09, 95% CI 0.90-1.32; I2 = 0%; aOR = 0.91, 95% CI 0.64-1.31; I2 = 0%), and EPR (cOR = 0.70, 95% CI 0.31-1.61; I2 = 61%). The OPR was marginally higher in crude analysis (cOR = 1.48, 95% CI 1.01-2.16; I2 = 81%) among women with compacted endometrium, but was not evident in adjusted results (aOR = 1.36, 95% CI 0.86-2.14; I2 = 84%). Consistently, the pooled estimate of LBR remained comparable in further subgroup and sensitivity analyses according to the degree of compaction (0%, 5%, 10%, 15%, or 20%), type of ET (fresh, frozen, or euploid only), and endometrial preparation protocol (natural or artificial). No publication bias was observed based on Egger's test. Although the number of included studies is sufficient, data on certain measures, such as EPR, are limited. The inherent bias and residual confounding were also inevitable owing to the observational study design. Furthermore, inconsistent definitions of pregnancy outcomes may affect the accuracy of our pooled analysis. Given the lack of prognostic value, assessing endometrial compaction or repeated EMT measurement on the day of ET may not be necessary or warranted. This work was supported by Natural Science Foundation of Jiangxi Province (20224BAB216025), National Natural Science Foundation of China (82260315), and Central Funds Guiding the Local Science and Technology Development (20221ZDG020071). The authors have no conflicts of interest to declare. CRD42022384539 (PROSPERO).

Reliability Of Transvaginal Ultrasound Measured Endometrial Thickness In Diagnosis Of Endometrial Cancer In Postmenopausal Women

Abstract Objective: Dilatation and curettage have been replaced by ultrasound measurement of uterine endometrial thickness (ET) especially by Transvaginal ultrasound (TVS) as a first step in the workup of women with postmenopausal bleeding for many years. Still, there is no unanimity for endometrial thickness cut-off value to define abnormality. We used an endometrial thickness of 4mm as a cut-off value in this study. Methods: This cross-sectional validation study included 120 patients who presented with postmenopausal bleeding in OPD of POF hospital from 01-12-2017 to 1-06-2018.TVS measured endometrial thickness ≥4mm was assumed positive for malignancy and ˂ 4 mm was taken negative for malignancy. The TVS findings of patients were compared with the histopathology report of endometrial sampling, which was performed in OPD by manual vacuum aspirator (MVA). Histopathology report was taken as a reference standard to confirm or refute the diagnosis of transvaginal ultrasound. Results: On TVS, 54 patients had ≥ 4mm endometrial thickness (taken positive for malignancy) while 66 patients had &lt;4 mm endometrial thickness (taken negative for malignancy). Histopathology of the endometrium (reference standard) revealed that 47 (39.17%) patients had malignancy and 73(60.83%) patients did not have malignancy. The reliability of transvaginal ultrasound (TVS) using 4mm cut-off point ET in detecting endometrial malignancy in patients presenting with uterine bleeding after menopause, keeping histopathological findings as a reference standard showed 89.36% sensitivity, 83.56%, specificity, 92.42% negative predictive value and 77.78% positive predictive value &amp; 85.83% accuracy rate. Conclusion: We concluded that there was a low probability of endometrial malignancy in women with ˂ 4 mm transvaginal ultrasound (TVS)measured endometrial thickness (ET).TVS may replace invasive endometrial sampling in cases of postmenopausal bleeding with ˂ 4mm ET.

#113 : Transdermal Oestrogen (GEL) for Endometrial Preparation in Frozen-Thawed Embryo Transfer

Background and Aims: Frozen-thawed embryo transfer (FET) requires a synchronization between endometrium and embryo. Pregnancy and live birth rates are proven to be significantly higher with FET due to better endometrial receptivity. In this study, we look at effectiveness oftwo oestrogen preparations in hormone replacement therapy (HRT) FET cycle on the pregnancy outcomes. Method: This is a retrospective analysis of 200 HRT FET cycles from 1st Jan 2020-31st December 2021, divided into 2 groups. Group 1 (n=100) received T Progynova 6 mg/day and Group 2 (n=100) received Oestrogel 6 mg/day (17B oestradiol 0.06% gel Besins France) starting on day 1 of menses, without GnRH agonist pituitary downregulation. The oestrogen dose was adjusted accordingly to achieve endometrial thickness (ET) of minimum 8 mm, prior to initiation of vaginal progesterone. The pregnancy outcomes (biochemical pregnancy, clinical pregnancy, ongoing pregnancy, early pregnancy loss and ectopic pregnancy rates), duration of oestrogen usage and endometrial thickness measurement prior to embryo transfer were analysed. Results: The biochemical pregnancy rate in this study was 39%, with a clinical pregnancy rate of 31%. Comparing both preparations, the biochemical pregnancy rate (p=0.562), clinical pregnancy rate (p=0.705), ongoing pregnancy rate (p=0.623), and early pregnancy loss rate (p=0.705) were not statistically significant. The duration required to achieve optimal endometrial thickness (p=0.212), and endometrial thickness measurement prior to vaginal progesterone commencement (p=0.335) were comparable. Conclusion: Oestrogel is a non-inferior option to oestradiol valerate for endometrial preparation in HRT FET cycles, especially for patients with high risk of venous thromboembolism due to its safety profile.

Thick endometrium is associated with hypertensive disorders of pregnancy in programmed frozen-thawed embryo transfers: a retrospective analysis of 2,275 singleton deliveries

To investigate whether endometrial thickness (EMT) acts as a contributing factor to adverse perinatal outcomes in programmed frozen-thawed embryo transfer (FET) cycles. Retrospective cohort study. University-based reproductive medical center. The study included singleton live births resulting from programmed FET cycles that took place between January 2017 and April 2022 (N = 2,275 cycles). The EMT measurement conducted on the day of progesterone initiation was utilized. Programmed FET cycles with EMT <7 mm were excluded from consideration. All included subjects were divided into 4 groups on the basis of the 10th, 50th, and 90th percentiles of EMT: group Ⅰ (EMT ≤8 mm, n = 193), group Ⅱ (EMT = 8.1-10 mm, n = 1,261), group Ⅲ (EMT = 10.1-12 mm, n = 615), and group Ⅳ (EMT >12 mm, n = 206). After adjusting for patient demographics and FET parameters, logistic regression analysis and restricted cubic spline were used to investigate the relationship between EMT and perinatal outcomes. The group Ⅱ (EMT = 8.1-10 mm) served as a reference. The primary outcome measure was the hypertensive disorders of pregnancy (HDP). Secondary outcomes included gestational diabetes mellitus, cesarean delivery, placenta previa, premature rupture of membrane, birthweight, preterm birth, low birthweight, macrosomia, small for gestational age, large for gestational age and neonatal morbidity. The incidence of HDP was substantially elevated in group Ⅳ when compared with the other groups (5.7% vs. 4.1% vs. 5.7% vs. 9.7% for groups Ⅰ-Ⅳ, respectively). In addition, group I displayed a higher incidence of cesarean deliveries, whereas both group I and group IV exhibited an elevated prevalence of placenta previa. After adjusting for confounding factors, patients in group IV exhibited a significantly increased risk of HDP (adjusted odds ratio [OR] = 2.03, 95% confidence interval [CI] 1.13-3.67) as compared with patients in the reference group. The restricted cubic spline model revealed a nonlinear association between EMT and the odds of HDP on continuous scales. In comparison to women with an EMT of 9.5 mm, there was no significant change in the risk of HDP in women with EMT between 7 and 11 mm, as indicated by adjusted ORs of 1.37 (95% CI 0.41-4.52), 1.34 (95% CI 0.73-2.47), 1.13 (95% CI 0.79-1.62), 1.04 (95% CI 0.87-1.25), and 1.46 (95% CI 0.81-2.65), respectively. However, the risk of HDP was significantly higher in women with EMT ranging from 12 to 15 mm, with adjusted ORs of 1.86 (95% CI 1.03-3.35), 2.33 (95% CI 1.32-4.12), 2.92 (95% CI 1.52-5.60), and 3.62 (95% CI 1.63-8.04), respectively. This study demonstrated a noteworthy association between EMT and adverse perinatal outcomes during the programmed FET cycles. Specifically, a thick endometrium (EMT >12 mm) was independently associated with an increased risk of developing HDP, whereas the optimal EMT for reducing the risk of HDP was at around 9-10 mm.

Evaluation of visceral adipose tissue thickness in precocious puberty.

Although there is a relationship between earlier onset of puberty and increased adiposity tissue. Publications in the literature on adiposis in patients with central precocious puberty (CPP) and visceral fat thickness (VFT) have conflicting results. So, in this study, we aimed to evaluate the relationship between sexual maturation and obesity in the development of early puberty and to examine their relationship with pelvic sonographic parameters. A total of 126 girls [patients - premature thelarche (PT) and CPP - and controls] were included in this study. Anthropometric and ultrasonographic evaluations were made by the same pediatric endocrinologist and pediatric radiologist, respectively. Pubertal stages were made according to the Tanner stages. Height, weight, and body mass index were measured as anthropometric measurements, and visceral, subcutaneous, and transabdominal fat thicknesses were measured in sonographic evaluation. The study population was divided into three groups: 44 healthy subjects to Group 1, 23 patients with PT to Group 2, and 59 patients with CPP to Group 3. When we evaluated the anthropometric and ultrasonographic parameters according to pubertal status, significant differences, especially between Group 1 and Group 3, were observed in all data. In the multiple logistic regression analysis, the endometrial thickness (OR = 7.521, p < 0.001) and VFT (OR = 1.530, p < 0.001) were found to be independent predictors of precocious puberty. It has been found that VFT and endometrial thickness measurements, which are evaluated quickly and accurately by USG, are important predictors of prepubertal precociousness.

Endometrial thickness is a prognostic factor in endometrial carcinoma

Background: Ultrasonography is a method that is commonly used today to measure endometrial thickness. It is useful as the initial step to detect endometrial hyperplasia or cancer in women with abnormal uterine bleeding. This study seeks to explore the predictive role of endometrial thickness in the development of endometrial cancer and identify the variables that affect endometrial thickness. Methods: This study is a cross sectional retrospective analytical study of women with a history of endometrial cancer who underwent transabdominal ultrasonography or transvaginal ultrasonography (TVS) followed by complete surgical staging between January 2019 and December 2021 at Dr. Kariadi General Hospital Semarang. Patients were categorized by endometrial thickness into ≤8 mm and &gt;8 mm. In order to compare the endometrial thickness and clinicopathology traits, a bivariate analysis was done. The study proceeded with multivariate analysis and logistic regression if more than one bivariate analysis revealed a significant correlation (p&lt;0.25). Results: This study involved 55 participants who had endometrial thickness measurements taken. Endometrial thickness was used to divide the patient population into two groups: ≤8 mm (n=28) and &gt;8 mm (n=27). Tumor differentiation grading showed a significant difference between the two groups (p&lt;0.001). The thickness of the endometrium is a significant prognostic of endometrial carcinoma based on the degree of tumor differentiation (p&lt;0.001). With each millimeter increase in the endometrium, the likelihood of endometrial carcinoma increases significantly by 1,25 [p&lt;0.001; 95%CI =1.112-1.404] times. Conclusion: As a result, the degree of tumor differentiation on post-operative histological analysis is correlated with the thickness of the endometrium. The endometrium's thickness considerably increased as the tumor differentiation level deteriorated. These findings highlight the significance of endometrial thickness as a possible predictor of tumor differentiation and prognosis in endometrial cancer.

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.

P-162 Numeric Embryo Quality Scoring Index (NEQsi) is Predictive of IVF Cycle Outcome at any Endometrial Thickness

Abstract Study question Is it possible to use NEQsi to determine the statistical contributions of embryo quality and endometrial thickness (ET) to IVF cycle outcome? Summary answer Yes. Analytics revealed that the likelihood of pregnancy is reliably predicted by the quality of the embryo at any endometrial thickness. What is known already ET is widely utilized to assess the quality of endometrial preparation in IVF cycles. The connection between endometrial thickness and cycle outcome is divided in the literature; studies report correlation between ET and cycle outcome while others find no link between the two. Regardless, the statistical interactions between ET and embryo quality remain understudied. NEQsi was recently developed as a method for converting Gardner embryo grades to interval variables for use in statistical modeling. The combination of NEQsi scores and endometrial thickness measurements provides an opportunity to assess the contributions of embryo quality and ET on IVF cycle outcomes. Study design, size, duration We conducted a retrospective analysis including IVF cycles conducted at a Canadian multi-clinician fertility care centre (n = 1623). Data were acquired from a chart review of deidentified patient files from 2014 – 2021. Participants/materials, setting, methods Participants were all patients who underwent single embryo transfer and had endometrial thickness measurements, Gardner embryo grading, and ultrasound based endometrial receptivity testing (usER) as part of their care program. No interventions were made. Gardner embryo grades on file were created using EmbryoScope (Vitrolife, Göteborg Sweden) and converted to NEQsi scores. We conducted multivariate statistical modelling analysis to determine the combined contribution of embryo grade and endometrial thickness on IVF cycle outcome. Main results and the role of chance NEQsi scores ranged from 3 – 11 (mean 8.32 ± 1.78 SD). Endometrial thicknesses ranged from 3.1 mm to 20.2 mm (mean 9.69 ± 2.23 SD). A positive linear relationship was observed between NEQsi score and probability of pregnancy. Multivariate logistical regression determined that embryo grade was a highly significant predictor of cycle outcome (p &amp;lt; 0.0001). Endometrial thickness was not a statistically significant predictor of cycle outcome (p = 0.585). Limitations, reasons for caution We acknowledge that the single centre design is a limitation of this study. Future investigation with more cycles and multiple centres will strengthen the study and interpretation of the data. Wider implications of the findings The application of NEQsi was simple and this work confirms the utility of the NEQsi in conducting statistical analyses with embryo quality as a covariate. In addition, our findings imply that cancellation of embryo transfers based on ET measurements may not be warranted. Trial registration number Not applicable

P-355 Thin endometrium is associated to higher risk of having a displaced window of implantation (WOI)

Abstract Study question Is thin endometrium (&amp;lt;6 mm) associated to an abnormal receptivity status? Summary answer Thin endometrium (&amp;lt;6 mm) is significantly associated with a displaced WOI. What is known already The measurement of endometrial thickness by 2D vaginal ultrasound (US) is a routine practice in Assisted Reproduction Techniques (ART). Thin endometrium (&amp;lt;6 mm) is associated with poor reproductive outcome; however, the potential reason is unknown. Study design, size, duration Retrospective cohorts study including 25,888 patients in which endometrial lining was measured by 2D US the day before progesterone supplementation in HRT cycles for frozen embryo transfers and Endometrial Receptivity Analysis (ERA) was performed after 5 days of progesterone administration. Endometrial thickness was classified as &amp;lt; 6 mm, 6-12 mm, or &amp;gt; 12 mm; ERA results were considered as receptive or displaced WOI (Pre-receptive, post-receptive, proliferative, and late-receptive) that needs a personalized embryo transfer (pET). Participants/materials, setting, methods Endometrial thickness was measured from one endometrial layer to the other on a longitudinal transvaginal scan at the site of maximum thickness evidenced by 2D US. For ERA analysis, RNA was extracted and sequenced by NGS. Then, the ERA computational predictor obtained the diagnosis as standard or displaced WOI. Main results and the role of chance RA results reveal that women with thin endometrium (&amp;lt;6mm) present significantly higher incidence of displaced WOI (47.49%) than 6-12mm (38.20%) (p = 0.0038), and &amp;gt;12mm (39.75%) (p = 0.026). No other differences were found. *Significant different against other two groups. Global Chi-square test for association P = 0.002. Limitations, reasons for caution This is a retrospective study, having innate limitations of its nature. Wider implications of the findings Thin endometrium (&amp;lt;6mm) is associated to a higher displaced WOI compared to normal lining or hypertrophic endometrium. Normal endometrial thickness (6-12 mm) considered as “receptive” does not preclude a transcriptomic receptivity status in 38.20% of the cases. This finding should be considered when embryo transfer is planned. Trial registration number Not applicable

Endometrial thickness after dilation and evacuation: A retrospective cohort study

AbstractObjectiveTo evaluate endometrial thickness 1–2 h after dilation and evacuation (D&amp;E).MethodsWe used a deidentified single‐institution database to retrospectively evaluate endometrial thickness measurements obtained as part of routine care 1–2 h postprocedure using transabdominal ultrasonography from 17 March 2020 to 16 October 2020. From this database, we extracted measurements, procedural outcomes and postoperative bleeding interventions. We assessed our primary outcome of endometrial thickness and the relationship between endometrial thickness and the need for bleeding‐related interventions within 4 h postprocedure.ResultsWe performed 213 endometrial thickness evaluations at a mean gestational age of 19.2 ± 2.8 weeks with median quantitative intraoperative blood loss of 150 mL (10–2000 mL). We found a median endometrial thickness of 12.2 mm (interquartile range [IQR]: 9.1–16 mm) performed 89.6 ± 19.3 min after the D&amp;E. Eleven (5.2%) patients needed further interventions for bleeding during recovery, with all but one having bleeding issues before or at the same time as the ultrasound examination. Patients with and without bleeding issues had median endometrial thicknesses of 20.3 mm (IQR: 12.5–29.2 mm, range: 1.2–42 mm) and 12.2 mm (IQR: 9.0–15.8 mm, range: 2.1–43 mm), respectively, p = 0.008.ConclusionEndometrial thickness 1–2 h after D&amp;E can vary widely but 75% of patients have a measurement &lt;16 mm. Although patients with bleeding complications have slightly thicker endometrial linings, these patients typically present clinically and endometrial assessment does not predict the need for intervention.

Features of ovarian steroidogenesis and endometrial hypertrophy during adjuvant therapy with tamoxifen in premenopausal patients with hormone-dependent breast cancer

Background. Difficulties in the prevention and treatment of endometrial pathology in hormone-positive breast cancer are associated with the lack of an unambiguous understanding of the mechanisms of the effect of tamoxifen on target tissues and the development of possible hyperestrogenism.Aim. To study the effect of ovarian steroidogenesis on the endometrium during adjuvant therapy with tamoxifen in pre-menopausal patients with hormone-dependent breast cancer.Materials and methods. All patients at inclusion in the study had intact menstrual function and received adjuvant therapy with tamoxifen. Group 1 included 42 patients without chemotherapy, group 2 included 41 patients with chemotherapy. Depending on the safety of the menstrual function, each group was divided into 2 subgroups. At the control points (3, 6 and 9 months from the start of tamoxifen therapy) patients underwent transvaginal ultrasound with measurement of endometrial thickness, and also determined the content of follicle-stimulating hormone and estradiol in peripheral blood. When menstruation persisted, blood sampling and measurement of endometrial thickness were performed on days 5-8 of the menstrual cycle.Results. In subgroups 1A and 2C, patients with preserved menstrual function showed a trend towards higher values of estradiol levels and endometrial thickness, compared with subgroups 1B and 2D of patients with amenorrhea. Against this background, the absence of statistically significant intergroup differences in the content of follicle-stimulating hormone in patients receiving tamoxifen with a preserved menstrual cycle (1A and 2C) and amenorrhea (1B and 2D) attracts attention. An intragroup analysis of follicle-stimulating hormone dynamics in patients with amenorrhea without chemotherapy in subgroup 1C shows an increase in its content by 162 %, without statistically significant changes in endometrial thickness and estradiol concentration. The statistically significant increase in endometrial thickness by 25 % and the proportion of patients with increasing endometrial wall thickness in 63.3 % in the 2D subgroup in patients receiving tamoxifen, with amenorrhea and previous chemotherapy treatment are cause for concern.Conclusion. The results of the study indicate a possible additive effect of such factors as intact menstrual function before the start of treatment for hormone-positive breast cancer, chemotherapy, and the development of amenorrhea on the progressive increase in endometrial thickness when using tamoxifen in premenopausal patients.

Uterine artery Doppler and endometrial blood flow in frozen embryo transfer: A cohort study.

The implantation rate after assisted reproductive technology depends on 2 important factors, good quality embryo and endometrial receptivity. Endometrial receptivity is mainly assessed by ultrasound measurement of endometrial thickness and morphology. This study aimed to investigate the relationship between uterine artery Doppler indices/endometrial perfusion and pregnancy rate. This cohort study was done on 250 women who were candidates for frozen embryo transfer from January to July 2022. For assessing endometrial receptivity, we performed a Doppler ultrasound of the uterus before embryo transfer with apparently desirable endometrium (endometrial thickness 7 mm and 3 line endometrial pattern). In addition, the women were divided into 2 groups according to assisted reproductive technology outcome (clinical pregnancy), group I positive clinical pregnancy, and group II negative clinical pregnancy, and uterine artery indices and endometrial perfusion were compared between these groups. Uterine artery Doppler showed that the pulsatility index was significantly different between positive and negative clinical pregnancy groups, but resistance index and peak systolic velocity (PSV) did not have statistically significant differences. Also, endometrial perfusion was significantly different between the 2 groups of clinical pregnancy. Endometrial perfusion was significantly better in positive clinical pregnancy groups. Doppler ultrasound can help to assess endometrial receptivity.

Endometrial Thickness Measurement as Predictor of Endometrial Hyperplasia and Cancer in Perimenopausal Uterine Bleeding: Cross-Sectional Study.

Endometrial thickness (ET) measurement was an alternative method for predicting abnormal endometrial pathology in postmenopausal bleeding. Cut-off value of ET measurement could not be use in perimenopausal bleeding. Aim of this study was to investigate appropriate ET cut-off value for perimenopause women with abnormal uterine bleeding (PEMB) and abnormal endometrial histopathology. This was a cross-sectional study. PEMB at Bhumibol Adulyadej Hospital between July 2018 and June 2022 were recruited. Subjects who met inclusion criteria underwent ET measurement and endometrial biopsy via endometrial aspirator. Participants who had histopathology report of endometrial hyperplasia and more were classified as the study group. The Control group were subjects with no endometrial hyperplasia or cancer. Demographic and clinical character data were included. Correlation of ET and endometrial histopathology were calculated for statistical significance. A total of 304 cases were included. After exclusion, 254 subjects were recruited for this study. There were 22 and 232 cases in the study and control groups, respectively. The mean age and body mass index (BMI) of participants were 44.7 years old and 27.5 kg/m2, respectively. Prevalence of endometrial hyperplasia and cancer in perimenopausal uterine bleeding were 7.5 (19/254) and 1.2 (3/254) percent, respectively. Endometrial thickness equal to and more than 8 mm was associated with abnormal endometrial histopathology with statistical significance. Age, BMI, nulliparity, anovulatory bleeding history, hypothyroidism, diabetes mellitus and anovulation state of both groups were comparable. Endometrial thickness equal or more than 8 mm were significantly associated with endometrial hyperplasia or more among perimenopausal women with abnormal uterine bleeding.

Artificial intelligence for prediction of endometrial intraepithelial neoplasia and endometrial cancer risks in pre- and postmenopausal women

The current approach to endometrial cancer screening requires that all patients be able to recognize symptoms, report them, and carry out appropriate interventions. The current approach to endometrial cancer screening could become a problem in the future, especially for Black women and women from minority groups, and could lead to disparities in receiving proper care. Moreover, there is a lack of literature on artificial intelligence in the prediction and diagnosis of endometrial intraepithelial neoplasia and endometrial cancer. This study analyzed different artificial intelligence methods to help in clinical decision-making and the prediction of endometrial intraepithelial neoplasia and endometrial cancer risks in pre- and postmenopausal women. This study aimed to investigate whether artificial intelligence may help to overcome the challenges that statistical and diagnostic tests could not. This study included 564 patients. The features that were collected included age, menopause status, premenopausal abnormal bleeding and postmenopausal bleeding, obesity, hypertension, diabetes mellitus, smoking, endometrial thickness, and history of breast cancer. Endometrial sampling was performed on all women with postmenopausal bleeding and asymptomatic postmenopausal women with an endometrial thickness of at least 3 mm. Endometrial biopsy was performed on premenopausal women with abnormal uterine bleeding and asymptomatic premenopausal women with suspected endometrial lesions. Python was used to model machine learning algorithms. Random forest, logistic regression, multilayer perceptron, Catboost, Xgboost, and Naive Bayes methods were used for classification. The synthetic minority oversampling technique was used to correct the class imbalance in the training sets. In addition, tuning and boosting were used to increase the performance of the models with a 5-fold cross-validation approach using a training set. Accuracy, sensitivity, specificity, positive predictive value, and F1 score were calculated. The prevalence of endometrial or preuterine cancer was 7.9%. Data from 451 patients were randomly assigned to the training group, and data from another 113 patients were used for internal validation. Of note, 3 of 9 features were selected by the Boruta algorithm for use in the final modeling. Age, body mass index, and endometrial thickness were all associated with a high risk of developing precancerous and cancerous diseases, after fine-tuning for the multilayer computer to have the highest area below the receiver operating characteristic curve (area under the curve, 0.938) to predict a precancerous disease. The accuracy was 0.94 for predicting a precancerous disease. Precision, recall, and F1 scores for the test group were 0.71, 0.50, and 0.59, respectively. Our study found that artificial intelligence can be used to identify women at risk of endometrial intraepithelial neoplasia and endometrial cancer. The model is not contingent on menopausal status or symptoms. This may be an advantage over the traditional methodology because many women, especially Black women and women from minority groups, could not recognize them. We have proposed to include patients to provide age and body mass index, and measurement of endometrial thickness by either sonography or artificial intelligence may help improve healthcare for women in rural or minority communities.