Typical ultrasound features of various endometrial pathology described using the International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding.
Van den Bosch T., Verbakel JY., Valentin L., Wynants L., De Cock B., Pascual MA., Leone FPG., Sladevicius P., Alcazar JL., Votino A., Fruscio R., Lanzani C., Van Holsbeke C., Rossi A., Jokubkiene L., Kudla M., Jakab A., Domali E., Epstein E., Van Pachterbeke C., Bourne T., Van Calster B., Timmerman D.
OBJECTIVE: To describe the ultrasound features of different endometrial and other intracavitary pathologies in pre- and postmenopausal women presenting with abnormal uterine bleeding using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: Prospective observational multicenter study of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced ultrasonography with color Doppler was performed in all cases and fluid instillation sonography in 1857. Endometrial sampling was performed according to each center's local protocol. In 2216 women, endometrial histology was available, and these were defined as the study population. The histological endpoints were cancer, atypical endometrial hyperplasia, endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, and intracavitary leiomyoma. For fluid instillation sonography the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint we report typical ultrasound features using the IETA terminology. RESULTS: Median (range) age was 49 years (19-92), median parity 2 (0-10) and median body mass index 24.9 (16.0-72.1). Of the study population 38% (n=843) were postmenopausal. Endometrial polyps were diagnosed in 751 women (33.9%), intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None of 66 women with endometrium < 3mm (0%; 95% CI 0.0-5.5%) had endometrial cancer (or atypical hyperplasia/endometrioid intraepithelial neoplasia, EIN). Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 endometria with a three-layer pattern (1.1%; 95% CI 0.4-3.1%), and in three of 459 endometria with a linear endometrial midline (0.7%; 95% CI 0.2-1.9%) and in five of 337 cases with a single vessel without branching on unenhanced ultrasound (1.5%; 95% CI 0.6-3.4). CONCLUSIONS: The paper describes the typical ultrasound features of endometrial cancer, polyps, endometrial hyperplasia and endometrial atrophy using IETA terminology. Some easy to assess IETA-features (i.e. endometrial thickness < 3mm, triple layer pattern, linear midline and single vessel without branching) make endometrial cancer unlikely. This article is protected by copyright. All rights reserved.