DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180852

Do we need more than ultrasound endometrial thickness to predict malignancy?

Adly N. Al Fattah, Tricia D. Anggraeni, Bella Aprilia, Muhammad Ikhsan

Abstract


Endometrial thickness (ET) ultrasound measurement has high diagnostic performance for detection of endometrial cancer in symptomatic postmenopausal women. Identified clinical risk factors, Doppler or 3D ultrasound parameters to predict endometrial malignancy had been proposed in several studies. We compared the accuracy of ultrasound endometrial thickness with scoring system/index involving both of clinical and ultrasound parameters to predict endometrial malignancy. Eight eligible diagnostic studies were appraised to assess the accuracy of ultrasound ET and/or ultrasound-based index to predict malignancy. The incidence of endometrial malignancy confirmed by histopathology examination was ranging from 10.5 to 58% from 8 studies. Ultrasound-based index to predict endometrial malignancy had good accuracy (AUC 75% - 98%). The addition of endometrial volume/uterine corpus volume ratio (EV/UCV) and Doppler to clinical parameters had increased the prediction accuracy of the index. While ultrasound ET alone has also high sensitivity, respectively 90.6% and 96.9% using the cut-off 4 mm and 3 mm with low accuracy. Ultrasound-based index to predict endometrial malignancy had better accuracy compared to ultrasound ET alone. Combination of ultrasound including Doppler parameters and clinical parameters had increased the prediction accuracy of the endometrial malignancy prediction index.


Keywords


Clinical, Doppler, Endometrial cancer, Ultrasound

Full Text:

PDF

References


Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. The Lancet. 2005 Aug;366(9484):491–505. https://doi.org/10.1016/S0140-6736(05)67063-8

Breijer MC, Van Doorn HC, Clark TJ, Khan KS, Timmermans A, Ben W J Mol, et al. Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies. Eur J Obstet Gynecol. Elsevier Ireland Ltd; 2012 Jul 1;163(1):91–6. https://doi.org/10.1016/j.ejogrb.2012.03.025

Dijkhuizen FPHLJ, Mol BWJ, Br lmann HAM, Heintz APM. Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding. Maturitas. 2003 Aug;45(4):275–82. https://doi.org/10.1016/S0378-5122(03)00152-X

Mihajlovic S, Vasiljevic M, Jurisic A, Kisic-Tepavcevic, Dimitrijevic D, Nejkovic L. Predictive value of transvaginal ultrasound score for detection of endometrial malignancy. 2016 Oct 30;:1–6.

Clark TJ. Outpatient hysteroscopy and ultrasonography in the management of endometrial disease. Curr Opin Obstet Gynecol. 2004 Aug;16(4):305–11. https://doi.org/10.1097/01.gco.0000136491.26463.c2

Seckin B, Cicek MN, Dikmen AU, Bostanc EI, Muftuoglu KH. Diagnostic value of sonography for detecting endometrial pathologies in postmenopausal women with and without bleeding. J Clin Ultrasound. 2016 Feb 9;44(6):339– https://doi.org/46. 10.1002/jcu.22329

Mansour GM, El-Shalakany A. Endometrial/uterine corporeal volume ratio (EV/UCV) as predictor of malignancy in women with postmenopausal bleeding. Arch Gynecol Obstet. 2nd ed. 2011 Aug 24;285(3):831–8. https://doi.org/10.1007/s00404-011-2035-2

Burbos N, Musonda P, Duncan TJ, Crocker SG, Morris EP, Nieto JJ. Estimating the Risk of Endometrial Cancer in Symptomatic Postmenopausal Women. Int J Gynecol Cancer. 2011 Apr;21(3):500–6.

Opolskiene G, Sladkevicius P, Valentin L. Prediction of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness > 4.5 mm. Ultrasound Obstet Gynecol. 2011 Jan 19;37(2):232–40. https://doi.org/10.1002/uog.8871

Dueholm M, M ller C, Rydbjerg S, Hansen ES, rtoft G. An ultrasound algorithm for identification of endometrial cancer. Ultrasound Obstet Gynecol. 2014 May 2;43(5):557–68. https://doi.org/10.1002/uog.13205

Dueholm M, Christensen JW, Rydbjerg S, Hansen ES, rtoft G. Two- and three-dimensional transvaginal ultrasound with power Doppler angiography and gel infusion sonography for diagnosis of endometrial malignancy. Ultrasound Obstet Gynecol. 2015 Jun 2;45(6):734–43. https://doi.org/10.1002/uog.13421

Burbos N, Musonda P, Giarenis I, Shiner AM, Giamougiannis P, Morris EP, et al. Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: the Norwich DEFAB risk assessment tool. British Journal of Cancer. Nature Publishing Group; 2010 Mar 30;102(8):1201–6. https://doi.org/10.1038/sj.bjc.6605620

Patel V, Wilkinson EJ, Chamala S, Lu X, Castagno J, Rush D. Endometrial Thickness as Measured by Transvaginal Ultrasound and the Corresponding Histopathologic Diagnosis in Women With Postmenopausal Bleeding. International Journal of Gynecological Pathology. 2017 Jul;36(4):348–55.

Sorosky JI. Endometrial Cancer. Obstet Gynecol. 2008 Jan 11;111:1–12.

Jacobs I, Burnell M, Manchanda R, Singh N, Sharma A, et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncology. Elsevier Ltd; 2010 Dec 18;12(1):38–48. https://doi.org/10.1016/S1470-2045(10)70268-0