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Cantalogo LR, Jammal MP, Gomes MKO, Murta EFC, Nomelini RS. Management of ultrasonographic endometrial thickness in postmenopausal asymptomatic women. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:417-421. [PMID: 35442374 DOI: 10.1590/1806-9282.20210929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Letícia Rodrigues Cantalogo
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Millena Prata Jammal
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Mariana Kefalás Oliveira Gomes
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Eddie Fernando Candido Murta
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Rosekeila Simões Nomelini
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
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Carugno J, Marbin SJ, LaganÀ AS, Vitale SG, Alonso L, DI Spiezio Sardo A, Haimovich S. New development on hysteroscopy for endometrial cancer diagnosis: state of the art. Minerva Med 2021; 112:12-19. [PMID: 33438376 DOI: 10.23736/s0026-4806.20.07123-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometrial cancer (EC) is the most common gynecologic cancer diagnosed in developed countries and represents the second most frequent gynecologic cancer-related cause of death following ovarian cancer. There are 2 subtypes of EC. Type I tumors (endometrioid adenocarcinoma) representing 85-90% of the cases. They are likely to be low-grade tumors and are thought to have a link to estrogen exposure. Type II tumors represent 10-15% of EC. They are characterized as high-grade carcinomas, with serous or clear cell histology type, and carry poor prognoses. The benefits of hysteroscopy in achieving a targeted endometrial biopsy under direct visualization over blind biopsy techniques are widely accepted. Hysteroscopic endometrial biopsy is performed under direct visualization and is the only technique that allows for the selective biopsy of targeted areas of the endometrium. There is no screening protocol for the early detection of EC. Among the general population, advanced age, obesity, nulliparity and the use of exogenous hormones are known as risk factors for EC. There are additional situations that portend an increased risk of EC that deserve special consideration such as in patients diagnosed with Lynch Syndrome, using tamoxifen, obese, or the young patient with a desire for future fertility. We presented a narrative review of the current role of hysteroscopy for the diagnosis of endometrial cancer.
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Affiliation(s)
- Jose Carugno
- Miller School of Medicine, Unit of Minimally Invasive Gynecology, Division of Obstetrics, Department of Gynecology and Reproductive Sciences, University of Miami, Miami, FL, USA -
| | - Staci J Marbin
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Antonio S LaganÀ
- Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy
| | - Salvatore G Vitale
- Unit of Obstetrics and Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Luis Alonso
- Unit of Gynecology Endoscopy, Gutenberg Center, Malaga, Spain
| | | | - Sergio Haimovich
- Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Technion, Israel
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Li H, Ran L, Wu H, Xu Z, Wu K, Kong L. A population‐based study of the relationship between endometrial thickness and prevalence of breast mass in postmenopausal women. Int J Gynaecol Obstet 2019; 145:306-311. [PMID: 30927444 DOI: 10.1002/ijgo.12814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/01/2018] [Accepted: 03/28/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Hao Li
- Department of Endocrine and Breast SurgeryThe First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Liang Ran
- Department of Physical ExaminationThe First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - He Wu
- Department of Endocrine and Breast SurgeryThe First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Zhou Xu
- Department of Endocrine and Breast SurgeryThe First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Kai‐Nan Wu
- Department of Endocrine and Breast SurgeryThe First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Ling‐Quan Kong
- Department of Endocrine and Breast SurgeryThe First Affiliated Hospital of Chongqing Medical University Chongqing China
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Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium: data from the FAME-Endo study: an observational register study. Arch Gynecol Obstet 2018; 298:813-820. [PMID: 30182190 DOI: 10.1007/s00404-018-4885-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/22/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the risk for endometrial cancer (EC) in a large series of asymptomatic patients with thickened endometrium at ultrasound examination based on previously published data of a theoretical cohort. METHODS In a prospective register study, a total of 1024 women with thickened endometrium in ultrasound examination undergoing histological diagnosis by dilation, hysteroscopy and curettage were evaluated. 124 patients were excluded due to current medication with tamoxifen and/or presence of HNPCC leaving 900 patients for further analysis. RESULTS Mean [standard deviation (SD)] age of patients was 65.6 (8.6) years. Mean (SD) endometrial thickness was 11.9 (5.8) mm. 32 and 6 cases of EC and complex endometrial hyperplasia with atypia were found, respectively. In the univariate analysis, a statistically significant association between endometrial thickness, current use of antihypertensive medication, number of deliveries, and the presence of endometrial fluid in preoperative vaginal ultrasound (p < 0.05) with EC was found. A multivariate logistic regression model incorporating these parameters showed a statistically significant independent association of endometrial thickness, number of deliveries, and the presence of endometrial fluid in preoperative vaginal ultrasound (p < 0.05), but not current use of antihypertensive medication, with EC. Using a cut-off of the endometrial thickness of > 11 mm, the risk for "EC alone" and "EC and complex endometrial hyperplasia with atypia combined" was found to be 6.7% and 7.9%, respectively. CONCLUSIONS Our data compare favorably to a theoretical cohort suggesting a clinically reasonable cut-off of > 11 mm endometrial thickness to discriminate between "normal" and "pathological". The data regarding "risk for endometrial cancer" can be used for counseling affected women.
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Abstract
OBJECTIVE The aim of the study was to evaluate clinical predictive factors for endometrial polyps in postmenopausal women compared with postmenopausal women without polyps. METHODS In this cross-sectional study, 132 Brazilian women with a histopathological diagnosis of endometrial polyps were compared with 264 women without endometrial alterations (control). The study group included women aged at least 45 years with amenorrhea for at least 12 months, who underwent hysteroscopic polypectomy. The control group consisted of women aged at least 45 years with amenorrhea for at least 12 months, without postmenopausal bleeding and endometrial thickness less than 5 mm by transvaginal ultrasonography. Clinical, anthropometric (body mass index and waist circumference), laboratory, and ultrasonographic data were collected to evaluate predictive factors for endometrial polyps. The Student's t test, χ test, and logistic regression (odds ratio [OR]) were used for statistical analysis. RESULTS A higher percentage of women with polyps were obese (72%) when compared with control (39%) (P < 0.0001). Waist circumference was greater among women with polyps (P = 0.0001). The incidence of diabetes, hypertension, and dyslipidemia was higher among women with endometrial polyps (P < 0.0001). According to the diagnostic criteria of the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III), 48.5% of the women with polyps and 33.3% of the controls were classified as having metabolic syndrome (MetS) (P = 0.004). The risk of endometrial polyps was higher in women with body mass index at least 25 kg/m (OR = 4.66; 95% CI 2.16-10.05); glucose at least 100 mg/dL (OR = 2.83; 95% CI 1.36-5.90); dyslipidemia (OR = 7.02; 95% CI 3.70-13.32); diabetes (OR = 2.58; 95% CI 1.05-6.32); and MetS (OR = 2.76; 95% CI 1.18-6.46) when compared with control, adjusted for age, and time since menopause. CONCLUSIONS In postmenopausal women, obesity, dyslipidemia, hyperglycemia, and the presence of MetS were predictive factors for endometrial polyps.
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Balica A, Wald-Spielman D, Schertz K, Egan S, Bachmann G. Assessing the thickness of the vaginal wall and vaginal mucosa in pre-menopausal versus post-menopausal women by transabdominal ultrasound: A feasibility study. Maturitas 2017; 102:69-72. [DOI: 10.1016/j.maturitas.2017.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/16/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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Sarvi F, Alleyassin A, Aghahosseini M, Ghasemi M, Gity S. Hysteroscopy: A necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness. Turk J Obstet Gynecol 2016; 13:183-188. [PMID: 28913119 PMCID: PMC5558290 DOI: 10.4274/tjod.66674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023] Open
Abstract
Objective: To investigate the histologic and hysteroscopic findings of post-menopausal women with uterine bleeding and asymptomatic women with increased endometrial thickness equal or more than 5 mm. Materials and Methods: This cross-sectional study was performed between May 2014 and June 2015 on 110 post-menopausal women aged 40-82 years. The women were divided into two groups: Women with abnormal uterine bleeding (AUB group) and asymptomatic women with increased endometrial thickness (asymptomatic group). Results: Among the participants, 67 women had AUB and 43 women were asymptomatic. In the AUB group sensitivity, specificity, and positive and negative predictive values of hysteroscopy for normal findings were 98%, 100%, 100% and 90%, respectively. In the asymptomatic group, the same parameters were 98%, 100%, 100% and 85%, respectively. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for polyps and myomas were 100%. Also, the sensitivity, specificity, and positive and negative predictive values were 100% in hyperplasia cases found during hysteroscopy in both groups. Conclusion: Increased endometrial thickness in postmenopausal women with or without AUB is mostly due to benign lesions such as polyps and submucosal myomas. Hysteroscopy is a safe and reliable method for evaluating and treating these lesions.
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Affiliation(s)
- Fatemeh Sarvi
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
| | - Ashraf Alleyassin
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
| | - Marzieh Aghahosseini
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
| | - Marzieh Ghasemi
- Zahedan University of Medical Sciences, Pregnancy Health Research Center, Department of Obstetrics and Gynecology, Zahedan, Iran
| | - Sima Gity
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
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Abstract
The purpose of this pictorial review is to describe the normal appearance of the endometrium and to provide radiologists with an overview of endometrial pathology utilizing case examples. The normal appearance of the endometrium varies by age, menstrual phase, and hormonal status with differing degrees of acceptable endometrial thickness. Endometrial pathology most often manifests as either focal or diffuse endometrial thickening, and patients frequently present with abnormal vaginal bleeding. Endovaginal ultrasound (US) is the first-line modality for imaging the endometrium. This article will discuss the endometrial measurements used to direct management and workup of symptomatic patients and will discuss when additional imaging may be appropriate. Three-dimensional US is complementary to two-dimensional ultrasound and can be used as a problem-solving technique. Saline-infused sonohysterogram is a useful adjunct to delineate and detect focal intracavitary abnormalities, such as polyps and submucosal fibroids. Magnetic resonance imaging is the preferred imaging modality for staging endometrial cancer because it best depicts the depth of myometrial invasion and cervical stromal involvement. Unique imaging features and complications of endometrial ablation will be introduced. At the completion of this article, the reader will understand the spectrum of normal endometrial findings and will understand the workup of common endometrial pathology.
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Goldberg Y, Lavie O, Mandel R, Kaufman Y, Segev Y, Auslender R. Two-Dimensional Sonographic Evaluation of Endometrial Polyps - Parameters That Are Reassuring. Gynecol Obstet Invest 2016; 81:359-62. [PMID: 27255414 DOI: 10.1159/000441779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
AIMS To assess intra-endometrial lesions according to five two-dimensional sonographic parameters for predicting malignancy. MATERIAL AND METHODS This is a retrospective analysis of stored digital images from consecutive pathological reports of patients with benign endometrial polyps and stage 1 endometrial carcinoma. Five sonographic parameters were evaluated: heterogeneous or complex echogenicity of the lesion, presence of a 'bright edge sign,' regular endometrial-myometrial junction, the presence of a normal endometrium adjacent to the lesion, and detection of small intralesional cysts. The sensitivity, specificity, PPV, and NPV of these parameters were calculated, as well as combinations of pairs of parameters. RESULTS Seventy-nine patients were eligible for the current study, 26 with benign endometrial polyps and 53 with stage 1 endometrial carcinoma. The sonographic appearance of numerous small intralesional cysts (cystic formation) was highly related to benign polyp; the presence of a lesion with heterogeneous echogenicity had sensitivity and specificity for malignancy of 63.5 and 88.5%, respectively. CONCLUSIONS We have shown that asymptomatic endometrial lesions, which are homogenous, have bright edges, and small intralesional cysts are likely to be benign Determining these parameters during sonographic evaluation can assist in identifying patients who will benefit from a follow-up strategy instead of an unnecessary surgical intervention.
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Affiliation(s)
- Yael Goldberg
- Unit of Gynecological Ultrasonography, Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Loiacono RMR, Trojano G, Del Gaudio N, Kardhashi A, Deliso MA, Falco G, Sforza R, Laera AF, Galise I, Trojano V. Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium: hysteroscopic and histological results. Gynecol Obstet Invest 2015; 79:210-6. [PMID: 25765014 DOI: 10.1159/000371758] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/26/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compares hysteroscopic and histopathological results in postmenopausal women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. MATERIALS AND METHODS This is a retrospective study of 570 cases hysteroscopically examined between January 2008 and July 2012. The patients were followed up at the Istituto Tumori 'Giovanni Paolo II', Bari, Italy. RESULTS A total of 320 of the 570 cases were selected. The inclusion criteria were transvaginal ultrasound, hysteroscopy and endometrial biopsy. In the AUB group, if the hysteroscopy results were normal, a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100, 95, 71 and 100%, respectively, were achieved, while in the asymptomatic group these values were 100, 97, 90 and 100%, respectively. For both the group with polyps and that with myomas, the sensitivity, specificity, PPV and NPV were 100%. For endometrial hyperplasia, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 81, 96, 87 and 93%, respectively, in the AUB group, while in the asymptomatic group, the sensitivity was 60%, the specificity and PPV were 100%, and the NPV was 98%. The sensitivity of hysteroscopy for endometrial cancer was 63%, the specificity 97%, the PPV 77%, and the NPV 95%. CONCLUSIONS In postmenopausal women with a thickened endometrium with or without AUB, hysteroscopy allows for an accurate diagnosis in benign endometrial pathology. Hysteroscopy also allows directed biopsies of suspicious lesions, which is useful in malignant endometrial pathology.
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Affiliation(s)
- Rosalia Maria Rita Loiacono
- Division of Gynaecologic Oncology, Apulian Cancer Registry, National Cancer Research Centre, Istituto Tumori 'Giovanni Paolo II', Bari, Italy
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Otify M, Fuller J, Ross J, Shaikh H, Johns J. Endometrial pathology in the postmenopausal woman - an evidence based approach to management. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/tog.12150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mohamed Otify
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
| | - Joanna Fuller
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
| | - Jackie Ross
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
| | - Hizbullah Shaikh
- Kings College Hospital Histopathology Department; Denmark Hill London SE5 9RS UK
| | - Jemma Johns
- Suite 8, Golden Jubilee Wing; King's College Hospital; Denmark Hill London SE5 9RS UK
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Paradisi R, Rossi S, Scifo MC, Dall'O' F, Battaglia C, Venturoli S. Recurrence of Endometrial Polyps. Gynecol Obstet Invest 2014; 78:26-32. [DOI: 10.1159/000362646] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022]
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Corbacioglu Esmer A, Akbayir O, Goksedef BPC, Gunduz N, Kisacık S, Dagdeviren H, Guraslan B, Ark C. Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding? Gynecol Obstet Invest 2013; 77:40-4. [PMID: 24334971 DOI: 10.1159/000356959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 11/04/2013] [Indexed: 11/19/2022]
Abstract
AIM To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). METHODS Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. RESULTS Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. CONCLUSION There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.
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Affiliation(s)
- Aytul Corbacioglu Esmer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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