[The value of ultrasonography in diagnosis of atypical endometrial hyperplasia in postmenopausal women]

Abstract

There is no agreement if an incorrect endometrial ultrasound image without clinical symptoms or postmenopausal bleeding despite normal ultrasound results are the indications for histopathological diagnosis of endometrium to exclude its pathological hyperplasia.

Objectives: The aim of the study was a comparison the compatibility of ultrasound results with histopathological examination of uterine scrapings in postmenopausal women.

Material and methods: The study included 659 postmenopausal women aged 41-85 (mean 61.5). They were divided into three groups. The first one counted 186 women (28.22%) with metrorrhagia and normal endometrial ultrasound image. The second one counted 293 women (44.46%) with only changes in ultrasound examination and the third one counted 180 women (27.31%) with metrorrhagia and incorrect ultrasound image of endometrium. As an incorrect ultrasound images the endometrial thickness above 5 mm, especially with non-homogenous structure, polyps and fluid in uterine cavity, were assumed. Each examined women had a D&C with consecutive histopathological evaluation of the tissue material.

Results: The endometrial cancer was the most frequent in the third group--in 29 examined women (16.11%) and was significantly rare in the first and second groups: 9 women (4.84%) and 2 women (0.68%), respectively. The most frequent (in 19 from 107 women--17.75%) the cancer was recognized in cases of endometrial hyperplasia, especially when ultrasound image of endometrium was non-homogenous and irregular, and the rarest was in the cases of affirmed fluid in uterine cavity (1 from 22 examined women--4.5%).

Conclusions: The endometrial cancer is the frequent in women with postmenopausal bleeding and endometrial hypertrophy in ultrasound examination, especially when endometrial image is non-homogenous and irregular. However, the rarest endometrial cancers were affirmed in postmenopausal women with ultrasound image of fluid in uterine cavity with thin endometrium.