Endometrial polyps: sonohysterographic evaluation

Preoperative Imaging Evaluation of Endometrial Cancer in FIGO 2023

The staging of endometrial cancer is based on the International Federation of Gynecology and Obstetrics (FIGO) staging system according to the examination of surgical specimens, and has revised in 2023, 14 years after its last revision in 2009. Molecular and histological classification has incorporated to new FIGO system reflecting the biological behavior and prognosis of endometrial cancer. Nonetheless, the basic role of imaging modalities including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography, as a preoperative assessment of the tumor extension and also the evaluation points in CT and MRI imaging are not changed, other than several point of local tumor extension. In the field of radiology, it has also undergone remarkable advancement through the rapid progress of computational technology. The application of deep learning reconstruction techniques contributes the benefits of shorter acquisition time or higher quality. Radiomics, which extract various quantitative features from the images, is also expected to have the potential for the quantitative prediction of risk factors such as histological types and lymphovascular space invasion, which is newly included in the new FIGO system. This article reviews the preoperative imaging diagnosis in new FIGO system and recent advances in imaging analysis and their clinical contributions in endometrial cancer. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.

Likelihood ratio of sonohysterographic findings for discriminating endometrial polyps from submucosal fibroids

OBJECTIVES

The purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids.

METHODS

This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial-myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings.

RESULTS

The LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial-myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial-myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity.

CONCLUSIONS

A combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.

Sonohysterography: the utility of diagnostic criteria sets

OBJECTIVE

The objective of our study was to determine whether applying specific diagnostic criteria to the interpretation of sonohysterography would improve the diagnostic accuracy of the interpretation.

MATERIALS AND METHODS

This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure that resulted in a positive pathologic diagnosis. The initial interpretation (reader 1) was performed at the time of the examination. Subsequently, a reviewer with limited expertise (reader 2) interpreted the sonohysterograms masked to both the original medical imaging report and the final pathologic diagnosis. Reader 2 used a set of standardized diagnostic criteria to aid in arriving at one of the following diagnoses: normal, endometrial polyp, endometrial hyperplasia, endometrial carcinoma, submucosal fibroid, adenomyosis, adhesions, or clots. These results were compared with the initial diagnostic report (reader 1) and the final pathologic findings.

RESULTS

Overall agreement with pathology findings was 76.7% for reader 1 and 84.9% for reader 2. Comparison of the readers' interpretations using the pathologic diagnosis as the reference standard showed that reader 2's interpretations, which were established using the diagnostic criteria set, were uniformly better than those of reader 2.

CONCLUSION

The application of standardized diagnostic criteria may enhance the diagnostic accuracy of sonohysterography.

Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps

AIMS

To evaluate the diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps.

METHODS

Thirty-two women whose preliminary transvaginal ultrasound suggested endometrial abnormality underwent sonohysterography. The findings were then compared with histopathological results.

RESULTS

The sonohysterographic diagnosis was fibroid in seven patients, endometrial polyp in 23 patients and simple hyperplasia in two patients. Histopathological findings confirmed our diagnosis in all except three patients with endometrial polyps, who had normal secretory endometrium. Sonohysterography was found to have a sensitivity of 100%, a positive predictive value of 90% and diagnostic accuracy of 90.6%.

CONCLUSION

Sonohysterography is a useful, minimally invasive and accurate technique to evaluate the pathologies involving endometrium and uterine cavity.