21st World Congress on Ultrasound in Obstetrics and Gynecology
P31.06
Endometrial thickness measurement for detection of
endometrial cancer in premenopausal and postmenopausal
Taiwanese women
B. Cheng, F. Kung
Obstetrics and Gynecology, Chang Gung Memorial Hospital,
Kaohsiung Medical Center, Chang Gung University College
of Medicine, Kaohsiung, Taiwan
Objectives: The goal of this study was to estimate the accuracy of
endometrial thickness measurement in the detection of endometrial
cancer among women before and after menopause.
Methods: Endometrial cancer (EMCA) was confirmed by patho-
logical examinations, and the thickness of the endometrium was
measured by trans-vaginal ultrasound (TVUS). Patients with both
pathology and TVUS records available from January 2006 to Febru-
ary 2011 were included in this study. Patients in the control group
were those who had dysfunctional uterine or postmenopausal bleed-
ing but had no EMCA, sub-mucosal polyps, or myoma. A receiver
operating characteristic (ROC) curve was constructed to determine
the best cutoff values for predicting the risk of EMCA.
Results: A total of 114 women, aged 31–81 years, with EMCA
and 460 age-matched women without EMCA were studied. These
patients were divided into two age groups: older or equal and
younger than 51 years old. In the older group, the mean endometrial
thickness for patients with EMCA was 11.3 mm (SD ± 7.5 mm)
and was 5.89 mm (SD ± 2.56 mm) for those without EMCA.
In the younger group, the mean endometrial thickness for those
with EMCA was 16.5 mm (SD ± 10.5 mm) and was 9.17 mm (SD
± 4.31 mm) for those without EMCA. In the ROC analyses, the area
was 0.745 (95% CI, 0.68–0.82) for those without EMCA in the
older group and was 0.754 (95% CI, 0.65–0.86) for those without
EMCA in the younger group. Based on these results, a cutoff value
of 5.0 mm was determined for the older group. This value had a
sensitivity of 88% and specificity of 49% in estimating patients with
EMCA. In the younger group, the cutoff value was 8.6 mm with
a sensitivity of 79% (95% CI, 65–85) and specificity of 50% for
estimation of patients with EMCA.
Conclusions: The thickness of the endometrium can be used as an
index to predict the risk of EMCA. An endometrial thickness less
than or equal to 5.0 mm in women older than 51 years old and
8.6 mm in those younger than 51 years old indicates a low risk for
developing EMCA.
P31.07
Bleeding in postmenopause - one day clinic evaluation
I. Ceausu1,2 , H. Rahimian2 , I. Briceag2 , D. Hudita1,2
1
‘Dr. I. Cantacuzino’ Ob-Gyn Department, Carol Davila
University of Medicine and Pharmacy, Bucharest, Romania;
2
Ob-Gyn Ultrasound Unit, ‘Dr. I. Cantacuzino’ Hospital,
Bucharest, Romania
Objectives: The aim of this study was to compare the efficacy of
blind endometrial biopsy by Pipelle with that of hysteroscopy biopsy
with biopsy forceps under direct view and the safeties of transvaginal
ultrasound measurements.
Methods: The study included 23 postmenopausal women in the
gynecology department of the ‘Dr. I. Cantacuzino’ Hospital selected
for endometrial biopsy because of persistent and repetitive irregular
bleedings in menopause, with endometrial thickness less than 5 mm
by ultrasound. All women were between 50 and 65 years, at
least after one year without any menstrual bleedings and without
hormonal therapy.
Results: All women undergo biopsy with Pipelle and in 12 cases the
results indicated endometrial hyperplasia, 9 with atrophy, 1 polyp
and 1 case with insufficient tissue sample. The hysteroscopy was
performed after 4 weeks from the first biopsy, and enabled a selective
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Poster abstracts
biopsy of the areas of visualized endometrium. The results were
14 hyperplasia, 4 polyps and 5 atrophic endometrium. The rate of
confirmation rate for polyps by Pipelle was 1 to 4, the rest of 3 polyps
were initially considered atrophy (2 cases) or hyperplasia without
atypia (1 case). Also, 3 cases of initially considered atrophy were
discovered with simple hyperplasia without athypia, and in 3 cases of
simple hyperplasia it was discovered a complex hyperplasia without
athypia. The conformity rate calculated by analysis between blind
and under direct visual control biopsy for hyperplasic endometrium
was 84.61%.
Conclusions: Transvaginal ultrasound in postmenopausal women
with persistent bleeding is a routine first choice investigation, but
hysteroscopic biopsy under visual control is necessary at least for
the patients with any hyperplasic changes at the blind biopsy.
P31.08
Transvaginal ultrasound evaluation of long-term endometrial
thickness evolution in patients treated with tamoxifen
L. Hereter, M. Pascual, B. Graupera, R. Di Paola,
M. Fernández-Cid, R. Fàbregas
Department Obstetrics, Gynecology and Reproduction,
Institut Universitari Dexeus, Barcelona, Spain
Objectives: To analyse the evolution of endometrial thickness in a
cohort of breast cancer patients on tamoxifen after 5 years from
their first control with transvaginal ultrasound.
Methods: Retrospective study of 41 breast cancer patients treated
with tamoxifen. Transvaginal ultrasound was performed twice for
each patient: during treatment with tamoxifen and 5 years after the
first ultrasound evaluation. Patients with endocavitary pathologies
such as polyps or submucous myomas were not included in the
study.
Results: The mean age of the women at their first evaluation
was 63.1 ± 8.3 years-old and the average duration of tamoxifen
therapy was 1.7 ± 0.8 years. Endometrial thickness observed on first
control was 6.0 ± 4.5 cm while on second control was 5.9 ± 3.7 cm.
The difference between mean values of endometrial thickness
was 0.12 95% CI [−1.5, 1.7]. The analysis was made with a
multiple linear regression model to correlate the last ultrasound
endometrial measurement with further parameters investigated at
first control: patient’s age, endometrial thickness, duration of
tamoxifen treatment and time intercoursed until second evaluation.
The age of the woman was the only parameter that demonstrated
a positive association with the endometrial thickness (β = 0.162,
P = 0.022), increasing with patient’s age.
Conclusions: Endometrial thickness was unchanged when compared
to the duration of tamoxifen treatment and to the time intercoursed
between the first and the last ultrasound evaluation, while the
only one value associated with a modification was the age of the
patient. It was observed that endometrial thickness as measured by
transvaginal ultrasound increased with the age of the patient.
P32: UROGYNECOLOGY AND PELVIC
FLOOR
P32.01
Prevalence of major abnormalities of levator ani in women
with moderate symptomatic prolapse
K. Dlouha, L. Krofta, M. Krcmar, M. Otcenasek, P. Velebil,
J. Feyereisl
Institute for the Care of the Mother and Child, Prague, Czech
Republic
Objectives: Our aim was to assess morphological characteristics of
levator ani muscle in patients referred for symptomatic POP Q st. II
prolapse.
Ultrasound in Obstetrics & Gynecology 2011; 38 (Suppl. 1): 168–281