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Wu S, Liang X, Cui X, Zuo D, Hong L, Chen K. Evaluating the Endometrial Hyperechoic Zone in Early Postpartum Women May Be Deceptive When Utilizing Transcutaneous Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318769029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the concordance of measurements for early postpartum endometrial thickness between magnetic resonance imaging (MRI) and transcutaneous diagnostic medical sonography (DMS) as well as its implications. The measurements of early postpartum endometrial thickness were reviewed across 51 postpartum women who underwent MRI and transcutaneous DMS. Additionally, 30 women with a normal menstrual cycle formed a control group, and their data were compared. The results indicated that the endometrial thickness at early postpartum was 4.63 ± 0.62 mm on MRI and 8.18 ± 4.70 mm on DMS, with a comparative significant difference ( P < .001). The endometrial thickness of the control group was 10.02 ± 1.71 mm on MRI and 10.17 ± 1.81 mm on DMS with no comparative significant difference ( P = .124). This cohort study questions whether the hyperechoic zone in the early postpartum uterine cavity represents the actual endometrial thickness. Care should be taken by sonographers in labeling the hyperechoic zone in the early postpartum stage as endometrium.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xian Liang
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaojing Cui
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Dongsheng Zuo
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Lian Hong
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kailiang Chen
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Munro MG. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J 2013; 18:55-70. [PMID: 24377427 DOI: 10.7812/tpp/13-072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postmenopausal uterine bleeding is defined as uterine bleeding after permanent cessation of menstruation resulting from loss of ovarian follicular activity. Bleeding can be spontaneous or related to ovarian hormone replacement therapy or to use of selective estrogen receptor modulators (eg, tamoxifen adjuvant therapy for breast carcinoma). Because anovulatory "cycles" with episodes of multimonth amenorrhea frequently precede menopause, no consensus exists regarding the appropriate interval of amenorrhea before an episode of bleeding that allows for the definition of postmenopausal bleeding. The clinician faces the possibility that an underlying malignancy exists, knowing that most often the bleeding comes from a benign source. Formerly, the gold-standard clinical investigation of postmenopausal uterine bleeding was institution-based dilation and curettage, but there now exist office-based methods for the evaluation of women with this complaint. Strategies designed to implement these diagnostic methods must be applied in a balanced way considering the resource utilization issues of overinvestigation and the risk of missing a malignancy with underinvestigation. Consequently, guidelines and recommendations were developed to consider these issues and the diverse spectrum of practitioners who evaluate women with postmenopausal bleeding. The guideline development group determined that, for initial management of spontaneous postmenopausal bleeding, primary assessment may be with either endometrial sampling or transvaginal ultrasonography, allowing patients with an endometrial echo complex thickness of 4 mm or less to be managed expectantly. Guidelines are also provided for patients receiving selective estrogen receptor modulators or hormone replacement therapy, and for an endometrial echo complex with findings consistent with fluid in the endometrial cavity.�
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Affiliation(s)
- Malcolm G Munro
- Chair of the Southern California Permanente Medical Group's Abnormal Uterine Bleeding Working Group, Director of Gynecological Services for the Los Angeles Medical Center in California, and a Professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at the University of California Los Angeles.
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Steiner E, Juhasz-Bösz I, Emons G, Kölbl H, Kimmig R, Mallmann P. Transvaginal Ultrasound for Endometrial Carcinoma Screening - Current Evidence-based Data. Geburtshilfe Frauenheilkd 2012; 72:1088-1091. [PMID: 25278620 DOI: 10.1055/s-0032-1328070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The value of transvaginal ultrasound in gynaecological examinations is beyond dispute. But it is of particular forensic importance that the validity of this type of imaging with regard to the reliable detection of early-stage malignancy is properly understood. Vaginal ultrasound screening in asymptomatic patients for the early detection of endometrial carcinoma is not useful from a medical point of view, nor is it cost-efficient. However, even though the validity of transvaginal ultrasound for screening has currently not been proven, the method should still be an integral part of gynaecological examinations.
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Affiliation(s)
- E Steiner
- Department of Obstetrics and Gynaecology, GPR Clinical Centre Ruesselsheim
| | - I Juhasz-Bösz
- Department of Obstetrics and Gynaecology, University of Saarland
| | - G Emons
- Department of Obstetrics and Gynaecology, Georg-August-University of Goettingen
| | - H Kölbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna
| | - R Kimmig
- Department of Obstetrics and Gynaecology, University of Duisburg-Essen
| | - P Mallmann
- Department of Obstetrics and Gynaecology, Cologne University
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Menzies R, Wallace S, Ennis M, Bennett A, Jacobson M, Yip G, Wolfman W. Significance of abnormal sonographic findings in postmenopausal women with and without bleeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:944-51. [PMID: 21923992 DOI: 10.1016/s1701-2163(16)35020-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We sought to determine the incidence of cancer and to compare pathologic outcomes in bleeding and non-bleeding postmenopausal patients who underwent hysteroscopy. METHODS We conducted a retrospective chart review of 294 postmenopausal women with abnormal uterine bleeding and 142 postmenopausal women without symptoms who underwent hysteroscopy. An 11 mm cut-off for asymptomatic women was applied to determine whether this endometrial thickness threshold would differentiate women with and without endometrial cancer in the asymptomatic group. RESULTS In symptomatic patients, 14 were found to have endometrial cancer and 10 were found to have endometrial hyperplasia. In the asymptomatic group, two women (1.4%) were found to have endometrial cancer with average thickness 17.5 mm, and one (0.71%) was found to have endometrial hyperplasia. Logistic regression models showed the risk of a bleeding patient developing endometrial cancer at an endometrial thickness of 4 mm was the same as the risk in a non-bleeding patient at a thickness of 15 mm. CONCLUSION Asymptomatic postmenopausal women have a low risk of having significant endometrial pathology. Cancer was approximately four times more prevalent in women with bleeding than in women with no bleeding.
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Affiliation(s)
- Rebecca Menzies
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
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Ochi J, Hayakawa K, Moriguchi Y, Urata Y, Yamamoto A, Kawai K. Uterine changes during tamoxifen, toremifene, and other therapy for breast cancer: evaluation with magnetic resonance imaging. Jpn J Radiol 2010; 28:430-6. [PMID: 20661693 DOI: 10.1007/s11604-010-0446-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We have performed pelvic magnetic resonance imaging (MRI) in patients undergoing breast cancer surgery before and after adjuvant drug therapy. Our purpose was to detect any radiographic uterine changes induced by various types of adjuvant therapy on pre- and postmenopausal patients by evaluating prospectively performed MRI. MATERIALS AND METHODS Between September 2004 and December 2007, a total of 41 women with breast cancer (11 premenopausal, 30 postmenopausal) were enrolled. All underwent MRI of the pelvis before and after drug therapy, and uterine changes were evaluated. Postoperative drugs used were selective estrogen receptor modulators (SERMs) including tamoxifen and toremifene (n = 18), aromatase inhibitors (n = 13), and anticancer drugs (n = 10). RESULTS Only the postmenopausal patients receiving SERMs showed a significant increase in endometrial thickness: from 2.4 +/- 0.4 mm before therapy to 4.5 +/- 2.6 mm after therapy (P = 0.0485). No statistically significant endometrial change was evident in postmenopausal patients treated with aromatase inhibitors (P = 0.573) or anticancer drugs (P = 0.754). Also, in premenopausal patients treated with SERMs or anticancer drugs, the change in endometrial thickness was not statistically significant (P = 0.958, 0.370). CONCLUSION This prospective study using MRI has demonstrated that uterine changes associated with adjuvant drugs for breast cancer occur exclusively in postmenopausal patients receiving SERMs.
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Affiliation(s)
- Junko Ochi
- Department of Radiology, Kobe City Medical Center General Hospital, 4-6 Minatojimanakamachi, Chuo-ku, Kobe, 650-0046, Japan.
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Radiological Reasoning: Algorithmic Workup of Abnormal Vaginal Bleeding with Endovaginal Sonography and Sonohysterography. AJR Am J Roentgenol 2008; 191:S68-73. [DOI: 10.2214/ajr.07.7067] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Algorithmic Workup of Abnormal Vaginal Bleeding with Endovaginal Sonography and Sonohysterography:Self-Assessment Module. AJR Am J Roentgenol 2008; 191:S74-8. [DOI: 10.2214/ajr.07.7114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Buccoliero AM, Fambrini M, Gheri CF, Castiglione F, Garbini F, Barbetti A, Degl’Innocenti DR, Moncini D, Taddei A, Bargelli G, Scarselli G, Marchionni M, Taddei GL. Surveillance for Endometrial Cancer in Women on Tamoxifen: The Role of Liquid-Based Endometrial Cytology – Cytohistological Correlation in a Population of 168 Women. Gynecol Obstet Invest 2008; 65:240-6. [DOI: 10.1159/000113047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 07/11/2007] [Indexed: 11/19/2022]
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Pastore AR. O valor da ultra-sonografia na avaliação das alterações endometriais em pacientes portadoras de câncer de mama e tratadas com tamoxifeno. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000600001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Irregular vaginal bleeding is a common symptom of women seeking gynecologic care. Etiologies of irregular vaginal bleeding can be classified into the following categories: pregnancy related (retained products of conception, threatened or missed abortion, or ectopic pregnancy), hormonal (disorders of ovulation, menopause, or hormonal contraceptive use), structural (polyps, myomas, or arteriovenous malformation), neoplasm (endometrial cancer), and infection (endometritis). After the history and physical examination, the initial evaluation of irregular vaginal bleeding has traditionally involved an endometrial biopsy. Transvaginal ultrasound has revolutionized the evaluation of the gynecologic ultrasound examination by providing a minimally invasive means to determine the etiology for the bleeding. Transvaginal ultrasound assessment of the endometrial cavity allows treatment to be tailored to the specific cause of irregular vaginal bleeding, thus saving women time, money, and exposure to unnecessary interventions. The purpose of this article is to give the clinician critical information regarding the capabilities of ultrasound to evaluate women with irregular vaginal bleeding.
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Koyama T, Tamai K, Togashi K. Staging of carcinoma of the uterine cervix and endometrium. Eur Radiol 2007; 17:2009-19. [PMID: 17219142 DOI: 10.1007/s00330-006-0555-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 09/10/2006] [Accepted: 11/28/2006] [Indexed: 11/29/2022]
Abstract
Carcinoma of the uterine cervix and endometrium are common gynecologic malignancies. Both carcinomas are staged and managed by means of the International Federation of Gynecology and Obstetrics (FIGO) staging system. In uterine cervical cancer, the FIGO staging system is determined preoperatively by limited conventional procedures. Although this system is effective for early stage disease, it has inherent inaccuracies in advanced stage diseases and does not address nodal involvement. CT and MR imaging are widely used as comprehensive imaging modalities to evaluate tumor size and extent, and nodal involvement. MR imaging is an excellent modality for depicting invasive cervical carcinoma and can provide objective measurement of tumor volume, and provides high negative predictive value for parametrial invasion and stage IVA disease. In contrast, endometrial cancer is surgically staged. Beside recognition of the important prognostic factors, including histologic subtype and grade, accurate assessment of the tumor extent on preoperative MR imaging is expected to greatly optimize surgical procedure and therapeutic strategy. Contrast-enhanced MR imaging can offer "one stop" examination for evaluating the depth of myometrial invasion cervical invasion and nodal metastases. Evaluation of myometrial invasion on MR imaging may be an alternative to gross inspection of the uterus during the surgery.
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Affiliation(s)
- Takashi Koyama
- Department of Diagnostic Radiology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Buccoliero AM, Gheri CF, Castiglione F, Garbini F, Fambrini M, Bargelli G, Barbetti A, Pappalardo S, Taddei A, Boddi V, Scarselli GF, Marchionni M, Taddei GL. Liquid-based endometrial cytology in the management of sonographically thickened endometrium. Diagn Cytopathol 2007; 35:398-402. [PMID: 17580351 DOI: 10.1002/dc.20655] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Liquid-based cytology represents an opportunity to re-evaluate endometrial cytology. We evaluated the accuracy of liquid-based endometrial cytology as compared to biopsy in 670 women scheduled for histeroscopy because of thickened endometrium (>4 mm), as evaluated by transvaginal sonography. Endometrial biopsy detected pathology in 41 (6%) of cases (21 of which were adenocarcinomas). Cytologic study found pathology in 62 (9%) cases (19 of which were adenocarcinomas). Two hundred ninety-one biopsies (43%) and 28 (4%) cytologies were inadequate. The sensitivity and the specificity were estimated, respectively, at 95% and 98%; the positive and negative predictive values were estimated, respectively, at 83% and 99%. Cytology provided sufficient material more often than biopsy (P < 0.01). We consider endometrial cytology an efficacious diagnostic opportunity. It could be usefully applied in association with transvaginal sonography. The combination of these procedures might reduce more invasive and expensive diagnostic procedures.
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Affiliation(s)
- Anna M Buccoliero
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy.
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Sherer DM, Gorelick C, Hellmann M, Lee YC, Angus S, Zinn H, Kheyman M, Abulafia O. Transvaginal sonographic findings of endometrial metastases of mammary ductal carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:917-20. [PMID: 16798904 DOI: 10.7863/jum.2006.25.7.917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- David M Sherer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, New York 11203-2098, USA.
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Fishman M, Boda M, Sheiner E, Rotmensch J, Abramowicz J. Changes in the sonographic appearance of the uterus after discontinuation of tamoxifen therapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:469-73. [PMID: 16567436 DOI: 10.7863/jum.2006.25.4.469] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the duration of sonographically detected changes in the endometrium of women with a history of tamoxifen use. METHODS Patients with breast cancer who had a history of tamoxifen use and documented pelvic sonographic studies were identified by means of clinic databases in both the Section of Gynecological Oncology and the Section of Obstetrical and Gynecological Ultrasound, University of Chicago, between January 1, 1996, and March 30, 2004. Of the 99 patients who met study criteria, 34 had discontinued tamoxifen use before the sonographic evaluation. Each patient's age, gravity and parity, weight, ethnicity, duration and dose of drug use, interval from drug discontinuation until sonographic evaluation, and uterine pathologic findings were reviewed. Endometrial thickness as assessed by pelvic sonography was examined in relation to duration of tamoxifen use and time from discontinuation of the drug. Statistical analysis was performed with linear regression and mixed effect linear regression models. RESULTS Endometrial thickness increased with increasing duration of tamoxifen use at a rate of 0.75 mm/y. The mean endometrial thickness after approximately 5 years of tamoxifen use was 12 mm (range, 6-21 mm). After discontinuation of tamoxifen, endometrial thickness decreased by 1.27 mm/y. CONCLUSIONS Endometrial thickness as measured by pelvic ultrasound examination increases with the duration of tamoxifen use. After discontinuation of the drug, the measured thickness decreases but at a very slow rate.
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Affiliation(s)
- Mindy Fishman
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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