![]() Especially in the last case, switching on the colour/power Doppler may help the orientation by visualising the vascularisation of the myometrium stopping at the basal layers of the endometrium. If the endometrium is not visible on unenhanced ultrasound, this may be due to distortion of the uterine cavity, to shadowing by overlying (calcified) fibroids or because the endometrium has (almost) the same echogenicity as the surrounding myometrium. If 3D acquisition is not available, the endometrial thickness should NOT be measured (it should be reported as ‘not measurable’, together with a short explanation of the reason why). ![]() In these cases, minimal manipulation of a 3D volume usually enables the sonographer to achieve the correct section. Sometimes the uterus is twisted laterally, precluding the visualisation of a proper mid‐sagittal view. In case the endometrium is not readily visible at first glance, it can usually be traced starting from the endocervical canal and then moving up. The whole uterus should be scanned from right to left and from fundus to cervix. ![]() The ultrasound examination should start with the acquisition of a proper midsagittal section of the uterus, followed by the measurement of the endometrium. Both unenhanced ultrasound (without FIS) and enhanced ultrasound (FIS) are discussed ( ). On how to perform an ultrasound examination of the endometrium and of the uterine cavity and on the terms and definitions to be used to report the ultrasound findings. In an attempt to standardise the ultrasound examination of the endometrium and the uterine cavity, the International Endometrial Tumor Analysis (IETA) group, consisting of an international panel of physicians with a special interest in endometrial ultrasound wrote a consensus paper an endometrial polyp with the typical presence of a pedicle artery on colour Doppler an intracavitary fibroid irregular and highly vascularised endometrium highly suspicious for malignancy). Although every ultrasound examination should still start with a correct measurement of the endometrium, especially in those with a thickened endometrium the above mentioned ultrasound applications should be used to reach a more precise diagnosis (e.g. With the advent of higher resolution vaginal probes, colour and power Doppler imaging and 3D ultrasound, together with the use of fluid instillation sonography (FIS), the diagnostic potential of ultrasound examination of the endometrium and of the uterine cavity has increased substantially. In those women, the ultrasound examination should therefore be performed early in the menstrual cycle just after (or at the end of) the menses/withdrawal bleeding days. Before menopause and during hormone replacement therapy (especially with sequential schemes), the endometrium changes with time and is, on average, thicker than after menopause, affecting the test's specificity. a blood clot in the cavity or the presence of small subendometrial cysts as seen in women on tamoxifen therapy).įinally, most studies on endometrial thickness, included only postmenopausal women who were not on hormone replacement therapy. A thickened endometrium can be caused by an endometrial polyp, endometrial proliferation associated or not with hyperplasia, an intracavitary fibroid or by an artifact (e.g. ![]() In case the endometrium is not (or not entirely) visible it should be recorded as “not measurable”.Ī second limitation of the endometrial thickness measurement is its rather low specificity: a ‘thick’ endometrium does not equal endometrial cancer. It has to be stressed that the endometrial thickness may not be recorded if the entire endometrium is not clearly visible from the right to the left corneal region and from the fundus to the isthmus of the uterus. due to cavity distortion or a stretched uterine position) the test is inconclusive. If the endometrium cannot be visualised (e.g. In a patient with a clearly visible, thin and regular endometrium, further tests such as endometrial sampling, hysteroscopy or curettage are therefore not indicated unless symptoms persist.Ĭalculated that using endometrial thickness measurement as first step evaluation in postmenopausal bleeding, would save further, more invasive diagnostic tests in about half of patients.Īlthough, due to its high sensitivity, the measurement of the endometrial thickness has proven its value in the exclusion of endometrial malignancy, the test has some limitations. If the endometrial thickness measured in the midsagittal plane is thin, the risk for endometrial cancer is very low. ![]() The use of ultrasound in the diagnosis of endometrial and intracavitary pathology was introduced in the late 1980s and early 1990s: ![]()
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