Ultrasonographic Measurement Of Endometrial Thickness Research Articles

Endometrial Hiperplazi ile Komplike Obez ve Premenopozal Hastalarda Vücut Yağ Dokusu Dağılımının Etkisi

Objective: There is a close association between obesity and menstrual irregularity. This study aims to investigate lipoid tissue accumulation between overweight or obese premenopausal patients with endometrial hyperplasia and with benign pathologic lesions via using the bioimpedance method.Materials and Methods: Obese or overweight volunteers with abnormal uterine bleeding were examined. Eighty-eight volunteers meet the inclusion criteria. We obtained fat mass, fat percentage and impedance of body parts by using Multi-Frequency Body Composition Analyzer. Blood lipid profile and ultrasonographic measurement of endometrial thickness were also performed. Results: 33 volunteers were in the hyperplasia group and 55 were in the control group. 28 of the 33 volunteers (84.8%) had at least one increased fatty acid. 41 of the 55 patients (74.5%) had at least one increased fatty acid in the control group. Total cholesterol levels are higher in the hyperplasia group than in the control group (p=0.006). There was no significant difference between the groups for bioimpedance analyses. Conclusion: Hyperlipidemia remains an important factor that contributes to endometrial pathologies. Serum cholesterols were significantly high in the endometrial hyperplasia group. Rather than lipoid tissue distribution, increased cholesterol may contribute to gynecologic pathology occurrence in obese individuals complicated with endometrial hyperplasia.

Diagnostic criteria for retained products of conception-A scoping review.

IntroductionNumerous studies have been performed assessing optimal treatment regimens for evacuating (retained) products of conception from the uterus, but standardized criteria for diagnosing retained products of conception (RPOC) are still lacking. We aim to provide an overview of diagnostic criteria in current literature, used to diagnose RPOC after induced first‐trimester abortion or early pregnancy loss.Material and methodsPubmed, EMBASE, and the Cochrane library were searched systematically up until March 2020 for English articles reporting on induced abortion or early pregnancy loss. Articles not specifying diagnostic criteria used to assess completeness of treatment were excluded, as were conference abstracts, expert opinions, reviews, and case reports. Four elements of diagnostic criteria were described: diagnostic tools, parameters used within these tools, applied cut‐off values, and timing of follow up. Additionally, a meta‐analysis was performed assessing diagnostic qualities of the most often applied diagnostic tool and parameter.ResultsThe search strategy yielded 1233 unique articles, of which 248 were included, with a total of 339 517 participants. In the 79 included randomized controlled trials, six diagnostic tools to assess RPOC were identified, combined in 14 ways, with 55 different cut‐off values. In 169 observational studies, seven diagnostic tools were identified, used in 28 combinations, applying 89 different cut‐off values. Transvaginal ultrasonographic measurement of endometrial thickness with a cut‐off value of at least 15 mm indicating RPOC, was used most frequently. In the timing of follow‐up there was great variation, with 55 and 107 different combinations in randomized controlled trials and observational studies, respectively. Assessment of treatment success was scheduled most often around 2 weeks after treatment. Diagnostic qualities of endometrial thickness of 15 mm or more was not adequately assessed.ConclusionsThere is wide variation in the way RPOC are assessed, and the criteria used to define RPOC following induced abortion and early pregnancy loss; ultrasonographic measurement of endometrial thickness, with a cut‐off of 15 mm or more 2 weeks after primary treatment is the most widely used diagnostic approach. A meta‐analysis on diagnostic accuracy of endometrial thickness of 15 mm or more did not lead to solid results. These findings can be a first step to develop a workable standard of establishing RPOC after induced abortion or early pregnancy loss.

Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women.

ObjectiveTo assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+).MethodsThis retrospective cohort study included 29,995 consecutive women who underwent transvaginal ultrasonography (TVS) for an incidental finding of a thickened endometrium at the health screening and promotion center at Asan Medical Center between 2006 and 2010. Among 959 patients with endometrial abnormalities, 92 patients were included in this study. A total of 867 patients were excluded: 416 were lost to follow-up; 263 did not undergo endometrial biopsy; 155 had endometrial polyps; 17 had submucosal myomas; and 16 had insufficient tissue samples. Endometrial histology was the reference standard for calculating accuracy.ResultsOf the 92 patients, 78 (84.8%) had normal pathology, while 14 (15.2%) had endometrial pathology (EH+), including 5 patients (35.7%) with simple hyperplasia without atypia, 3 (21.4%) with complex hyperplasia, and 6 (42.9%) with endometrial carcinoma, all stage Ia. The area under the receiver-operating characteristic curve was 0.75 (95% confidence interval [CI], 0.593–0.906). The cut-off value for ET was 8 mm, indicating that TVS ET had a fair accuracy in diagnosing carcinoma, had a sensitivity of 100% (95% CI, 62.9–100.0%) and a specificity of 24.3% (95% CI, 15.2–36.3%).ConclusionTVS is useful for detecting EH+, with a cut-off value for ET of 8 mm having a high sensitivity for detecting endometrial pathologies and the ability to identify women highly unlikely to have EH+, thereby avoiding more invasive endometrial biopsy.

Importance of Serum Copper and Vascular Endothelial Growth Factor (VEGF-A) Levels in Postmenopausal Bleeding

The main aim of this study is association of serum copper and vascular endothelial growth factor (VEGF-A) in postmenopausal bleeding (PMB) patients. Blood samples were collected from female patients suffering with postmenopausal bleeding (n=50) as well as healthy females as controls (n=50). Serum copper levels were estimated by spectrophotometric method and serum VEGF-A by ELISA technique and compared with ultrasonographic measurement of endometrial thickness in both patients and controls. A significant increase in serum copper levels and an almost twofold increase in serum VEGF-A was observed in DUB patients when compared with controls. Correlation (r) between serum VEGF-A levels and endometrial thickness was 0.96. Odds ratio for copper, VEGF-A and combination of copper and VEGF-A was 0.0426, 0.0947 and 0.0313 respectively, in all these cases odds ratio was <1. The abnormal angiogenesis in PMB could be due to increased serum copper levels,which in turn stimulates factors like VEGF-A, thereby causing an increase in endometrial growth.

Serum Copper and Vascular Endothelial Growth Factor (VEGF-A) in Dysfunctional Uterine Bleeding

Over the past 20 years there has been an upsurge of interest proper cause of abnormal angiogenesis of DUB. This study particularly focused on the association of serum copper and vascular endothelial growth factor (VEGF-A) in patients with Dysfunctional Uterine Bleeding (DUB). Blood samples were collected from female patients suffering with DUB (n = 50) as well as healthy females as controls (n = 50). Serum copper levels were estimated by spectrophotometric method and serum VEGF-A by ELISA technique and compared with ultrasonographic measurement of endometrial thickness in both patients and controls. A significant increase in serum copper levels and an almost two fold increase in serum VEGF-A was observed in DUB patients when compared with controls. Correlation(r) between serum VEGF-A levels and endometrial thickness was 0.97. Odd Ratio for copper, VEGF-A and combination of copper and VEGF-A was 0.0426, 0.0947 and 0.0313, respectively, in all these cases odds ratio was less than one. The abnormal angiogenesis in DUB could be due to increased serum copper levels, which in turn stimulates factors like VEGF-A, thereby causing an increase in endometrial growth.

Endometrial Thickness and Serum β-hCG as Predictors of the Effectiveness of Oral Misoprostol in Early Pregnancy Failure

ObjectiveTo evaluate ultrasonographic measurement of endometrial thickness and serum levels of chorionic gonadotropin (β-hCG) as predictors of failure to abort completely in patients designated for uterine evacuation using oral misoprostol. MethodsWomen attending an obstetric outpatient clinic who complained of residual vaginal bleeding 15 days or more after taking oral misoprostol for medical induction of abortion for early pregnancy failure were evaluated by transvaginal ultrasound scan and assay of serum β-hCG. They subsequently underwent dilatation and curettage under general anaesthesia. According to the results of histopathological examination of uterine contents, the study cohort was divided into women with incomplete abortion (19 cases, 19.6%) and cases with complete abortion (78 cases, 80.4%). The results of the ultrasound scan and the assay of serum β-hCG were correlated with the histopathological results to determine the accuracy of these markers in predicting complete abortion. ResultsBaseline characteristics for both groups were similar. The endometrial thickness in the two groups ranged from 11.2 ± 3.9mm in the complete abortion group to 14.6 ± 6.1mm in the incomplete abortion group, a statistically significant difference (P = 0.003). Serum β-hCG levels were statistically different in the two groups (complete abortion 73.9 ± 23.9 IU/L vs. incomplete abortion 109.4 ± 68.4 IU/L, P < 0.001). Measured endometrial thickness ≥ 12mm predicted incomplete abortion with a sensitivity of 88.5%, a specificity of 73.7%, a positive predictive value (PPV) of 93.2%, and a positive likelihood ratio (LR+ve) of 85.6. A serum β-hCG ≥-100 IU/L predicted incomplete abortion with a sensitivity of 87.2%, a specificity of 78.9%, a PPV of 94.4%, and a LR+ve of 85.6. ConclusionQuantitative assay of serum β-hCG and ultrasound measurement of endometrial thickness are clinically useful measures for predicting late failure of medical abortion, but should be used as supplements to clinical assessments.

Transvaginal Ultrasound Measurement of Endometrial Thickness as a Biomarker for Estrogen Exposure

Abstract Objective: In clinical settings, transvaginal ultrasound has been used to evaluate abnormal vaginal bleeding. Because the endometrium responds to estrogens, endometrial thickness may constitute a biomarker of estrogen status in postmenopausal women. This study aimed to validate the transvaginal ultrasonographic measurement of endometrial thickness as an estrogen biomarker in asymptomatic, postmenopausal women by demonstrating an association between endometrial thickness and risk factors known to be associated with estrogen exposure. Method: Endometrial thickness was measured in 1,271 women ages 55 to 74 years who underwent transvaginal ultrasound screening as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. A questionnaire, completed before screening, provided risk factor information, including reproductive and hormone use histories. Results: Endometrial thickness measurements ranged from 1 to 32 mm (median 3.0 mm). The frequencies of thicker endometrium (≥3.0 mm), according to body mass index (BMI) quartile, were 55.2%, 66.1%, 69.7%, and 76.7% (P &amp;lt; 0.0001). The frequencies of thicker endometrium were 57.8%, 58.3%, and 82.6% among never users, ex-users, and current users of hormone replacement therapy (HRT), respectively (P &amp;lt; 0.0001). Other factors associated with thicker endometrium included age, marital status, history of uterine fibroids, years since menopause, and history of hypertension. Statistically significant associations were not seen in analyses limited to current HRT users (n = 461). In multiple variable analysis (R2 = 0.08), current HRT use (P &amp;lt; 0.0001) and higher BMI (P &amp;lt; 0.0001) were independently associated with thicker endometrium. Conclusion: In postmenopausal women, factors reflecting exogenous (current HRT use) and endogenous (BMI) estrogen exposure were associated with increased endometrial thickness as measured during screening transvaginal ultrasound. Practical limitations related to screening transvaginal ultrasound include measurement variability, lack of information regarding type or dose of HRT, and problems of differentiating true endometrial thickening from unrecognized endometrial polyps or fluid accumulations. Constrained by these limitations, these results partially validate a transvaginal ultrasound measurement of endometrial thickness as a potential biomarker related to estrogen status.

Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding

Objective: To compare the diagnostic accuracy of ultrasonographic endometrial thickness and outpatient hysteroscopy, to establish the most appropriate exam for the diagnosis of endometrial cancer in postmenopausal women with abnormal uterine bleeding (AUB). The secondary aim was to develop a multivariable approach considering clinical history as an added value for these diagnostic procedures. Methods: This prospective study was conducted on 220 consecutive postmenopausal patients with AUB, who underwent ultrasonographic evaluation of endometrial thickness, outpatient hysteroscopy and endometrial biopsy. Evaluation of sensitivity, specificity, positive and negative predictive value was performed. Receiver operator characteristic curve (ROC) was calculated to assess the global performance of ultrasonographic measurement of endometrial thickness and diagnostic hysteroscopy as tests for detecting endometrial cancer and atrophy. Results: Histological findings for <4 mm level revealed that atrophy was present in 48 (65%) and in 2 cases (2.7%) endometrial cancer was found; for ≥4 mm values polyps and myomas were present in 86 (59%) and there were 11 (7.5%) endometrial cancer. Sensibility and specificity for trans-vaginal ultrasound, with a cut-off value ≥4 mm, was 55.6% and 49.7% while positive predictive value was 83.3% and negative predictive value 98.1% (ROC curve 0.597). Hysteroscopy revealed sensitivity 100%, specificity 49.6%, positive predictive value 81.3% and negative predictive value 100% (ROC curve 0.993). Conclusions: In conclusion, endometrial thickness <4 mm can miss malignancies but trans-vaginal ultrasound remains the first line diagnostic procedure in postmenopausal women without AUB, because it is not invasive and has high sensitivity for detecting endometrial cancer and other endometrial disease; according to our experience, outpatient hysteroscopy with biopsy is mandatory in all postmenopausal women with AUB.

Prediction of pituitary down-regulation by evaluation of endometrial thickness in an IVF programme

The aim of this retrospective study was to determine whether pituitary down-regulation after gonadotrophin-releasing hormone analogue (GnRHa) administration can be accurately predicted by transvaginal ultrasonographic measurement of endometrial thickness in the presence of menstruation. All cycles of an IVF/intracytoplasmic sperm injection programme in which a long protocol of GnRHa was used for ovarian stimulation were analysed. Overall, 209 patients underwent 223 treatment cycles. Using a serum oestradiol concentration of 50 pg/ml as a cut-off point, the sensitivity, specificity, predictive value and false positive and false negative values were calculated for prediction of pituitary down-regulation from endometrial thickness measurements. Pituitary down-regulation was achieved in 223 treatment cycles in 180 patients (80%). The best combination of the highest specificity (71.7%) and sensitivity (62.5%) is achieved with a linear appearance of the endometrium. Therefore, ultrasonographic measurement of endometrial thickness should be used in combination with serum oestradiol concentration in estimating pituitary down-regulation after GnRHa. In conclusion, the linear appearance of endometrium can be as reliable as serum oestradiol concentration in prediction of pituitary down-regulation after GnRHa.

Transvaginal ultrasonographic measurement of endometrial thickness: an intra-observer and interobserver reproducibility study

Purpose: To assess reproducibility of transvaginal sonographic measurement of endometrial thickness.Methods: Thirty consecutive asymptomatic volunteers (all female; mean age: 46.9 years, SD: 9.5, range: 24–66 years) were entered in the study. In all cases, endometrial thickness was measured in a sagittal plane of the uterus at the level of the maximum estimated thickness, using transvaginal ultrasonography. All patients were examined by the two authors, one experienced (JLA) and the other inexperienced (AZ). Both examiners were blind to each other’s measurements. Two measurements were made by each examiner and intra- and interobserver reproducibility were tested by analysis of variance, using the intraclass correlation coefficient (rI).Results:Endometrial thickness could be measured by the two examiners in all cases. Both intra-observer reproducibility (rI=0.974 and rI=0.961 for examiners one and two, respectively) and interobserver reproducibility (rI=0.954) were high.Conclusion: Transvaginal sonographic measurement of endometrial thickness is highly reproducible.

R-176. The correlation between histopathological evaluation of endometrium and transvaginal ultrasonographic measurement of endometrial thickness in peri- and postmenopausal bleeding

R-176. The correlation between histopathological evaluation of endometrium and transvaginal ultrasonographic measurement of endometrial thickness in peri- and postmenopausal bleeding

Measurement of endometrial thickness with transvaginal ultrasonography: is it reproducible?

To assess the intraobserver and interobserver variability of transvaginal ultrasonographic measurement of endometrial thickness, two investigators (M.V., M.-F. D.) independently evaluated two successive measurements in 55 patients with a 5.0 MHz transvaginal transducer. Each observer was blinded to his or her own and to the other's results. Measurements were taken at the maximal thickness in the longitudinal uterine axis. The intraclass coefficients evaluating the agreement between two measures of a same observer were 94% and 97%; the coefficient was 94% between the two investigators. Intraobserver kappa values (agreement on endometrium < or = 5 mm and > 5 mm) were 0.70 and 0.81, respectively; the interobserver kappa value was 0.74. Transvaginal sonographic measurement of endometrial thickness has excellent intraobserver and good interobserver agreement. However, in clinical practice, an endometrial thickness measuring +/- 1 mm of a cut-off value should be interpreted with caution, especially when this may modify the clinical management.

Prospective Evaluation of Endometrial Thickness as a Predictor of Pituitary Down-Regulation after Gonadotropin-Releasing Hormone Analogue Administration in an In Vitro Fertilization Program

Objective: To determine whether pituitary down-regulation after gonadotropin-releasing hormone analogue (GnRH-a) administration can be accurately predicted by transvaginal ultrasonographic measurement of endometrial thickness. Design: Prospective study. Setting: An IVF unit of an academic medical center. Patient(s): One hundred eighty-one patients undergoing 265 IVF-ET treatment cycles using GnRH-a in the long protocol. Main Outcome Measure(s): Serum concentrations of E 2 were determined, and endometrial thickness was measured by transvaginal sonography. The accuracy of endometrial thickness for predicting pituitary down-regulation was calculated. Result(s): Pituitary down-regulation, defined as a serum E 2 concentration of ≤55 pg/mL, was achieved in 77% (204 of 265) of the cycles. An endometrial thickness of ≤6 mm was found in 92.2% (188 of 204) of cycles in which down-regulation was achieved. An estradiol level of ≤55 pg/mL was present in 95.9% (188 of 196) of cycles with endometrial thickness of ≤6 mm. Conclusion(s): A state of relative hypoestrogenism after GnRH-a administration, indicative of pituitary down-regulation, can be predicted with a high degree of accuracy by ultrasonographic measurement of endometrial thickness. Thus, routine testing for serum E 2 concentration may be safely omitted. This may allow further simplification of IVF protocols and increase both cost-effectiveness and patients’ convenience.

Transvaginal ultrasonographic measurement of endometrial thickness in postmenopausal women receiving estrogen replacement therapy

OBJECTIVE: This study was undertaken to evaluate endometrial thickness by transvaginal ultrasonography in asymptomatic postmenopausal women receiving estrogen replacement therapy. The endometrial thickness in this study group was compared with endometrial thickness measurements in a group of women who had abnormal postmenopausal bleeding. The recent literature was reviewed. STUDY DESIGN: Asymptomatic postmenopausal women receiving estrogen replacement, seen for routine examination during the 1-year period from Jan. 1, 1994, to Dec. 31, 1995, had the endometrium evaluated by transvaginal ultrasonography. Women with abnormal postmenopausal bleeding were likewise evaluated and their measurements compared with those of the study group. RESULTS: Twenty-seven different estrogen and estrogen-progestin combinations in 327 asymptomatic women were studied. Additionally, 24 women who were bleeding, not receiving estrogen, and 46 women with abnormal bleeding on estrogen therapy underwent ultrasonography of the endometrium. Endometrial thickness ranged from 1 to 15 mm in women on a regimen of combined estrogen-progestin therapy, 1 to 14 mm in women using sequential estrogen-progestin, and 3 to 15 mm for women receiving unopposed estrogen in the study group. For women with abnormal bleeding not using estrogen, the endometrium measured an average of 12.3 mm (range 2 to 29 mm), with unopposed estrogen 8.3 mm (range 4 to 13 mm), and for estrogen with progestin 6.5 mm (range 2 to 15 mm). Significant pathologic features were found in those women who had bleeding and endometrial measurements between 5.0 and 29 mm. CONCLUSION: There was no significant difference between endometrial thickness measurements in women receiving various combinations of estrogen replacement. In general, expected endometrial measurements can range from 1 to 15 mm. In women with postmenopausal bleeding, however, significant pathologic features may exist with an endometrium measuring as little as 5 mm. (Am J Obstet Gynecol 1997;176:1334-9.)

The variation of endometrial response to a standard hormone replacement therapy in women with premature ovarian failure. An ultrasonographic and histological study

The endometrial response to a standard hormone replacement therapy in 18 women with premature ovarian failure was examined by serial ultrasonographic measurement of endometrial thickness and histological study of endometrial biopsy taken on day 19 of the cycle. Women with idiopathic ovarian failure (n = 10) had significantly better response than women with Turner's syndrome (n = 4), whereas women with premature ovarian failure associated with previous chemotherapy (n = 4) had an intermediate response. These observations suggest that the endometria of women with Turner's syndrome responded suboptimally to steroid hormones. However, all endometrial biopsies studied revealed secretory changes. Overall, the results of histological dating of endometrial biopsy were found to be positively correlated with endometrial thickness on day 19 of the cycle (r = 0.72, P less than 0.01). The plasma concentration of oestradiol on days 15, 19 and 29 of the artificial cycle were found to be significantly higher than those on the corresponding days of the natural cycle.

REVIEW

The values of various methods used to evaluate the luteal phase, including basal body temperature, measurement of progesterone (P), endometrial biopsy, ultrasonographic measurement of endometrial thickness, and measurement of endometrial proteins, are reviewed. Luteal phase defect (LPD) is a controversial entity. The diagnosis of this condition is best based on a histological study of the endometrium. Methods to improve the accuracy of the diagnosis are discussed. LPD is more likely to be a result of an abnormal response of the endometrium to P, than to a subnormal production of P by the corpus luteum. Many methods of treatment for LPD have been proposed but none is based on a properly controlled clinical trial. Treatment designed to improve the response of the endometrium to P may be more rewarding than P supplementation.