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. 2024 Nov;43(6):448-456.
doi: 10.14366/usg.24097. Epub 2024 Jul 20.

Diagnostic value of transvaginal contrast-enhanced ultrasound in identifying benign and malignant endometrial lesions and assessing myometrial invasion

Fang Guo  1 , Yulin Yan  1 , Chengsheng Huang  2 , Xia Wang  1 , Xing Wu  1 , Yanli Xu  2 , Tao Ying  1
Affiliations

Diagnostic value of transvaginal contrast-enhanced ultrasound in identifying benign and malignant endometrial lesions and assessing myometrial invasion

Fang Guo et al. Ultrasonography. 2024 Nov.

Abstract

Purpose: The objective of this study was to evaluate the diagnostic value of transvaginal contrastenhanced ultrasound (CEUS) in differentiating benign from malignant endometrial lesions and assessing the extent of myometrial invasion.

Methods: A total of 70 patients who underwent surgery for endometrial lesions at the authors' hospital were selected. Transvaginal ultrasound examination and CEUS were performed for quantitative and qualitative analysis. Based on the CEUS results, an International Federation of Gynecology and Obstetrics (FIGO) disease grade was assigned and compared with pathological findings.

Results: Postmenopausal vaginal bleeding is a key clinical manifestation of endometrial carcinoma. Among the patients with endometrial carcinoma, compared with normal myometrium, the lesion areas exhibited a greater rate of rise (defined as enhanced intensity divided by enhancement time) and a shorter half-clearance time (P<0.05). These findings suggest that in endometrial carcinoma, the contrast agent displays a "fast-in/fast-out/hyperenhancement" perfusion pattern. In contrast, the characteristic perfusion pattern for benign endometrial lesions is low enhancement (P<0.05). The diagnostic accuracy of CEUS in detecting myometrial invasion was 88% (22 of 25 cases).

Conclusion: Transvaginal CEUS is a practical and effective diagnostic imaging method for distinguishing between benign and malignant endometrial lesions. It can also be used to evaluate the depth of myometrial invasion in patients with early-stage endometrial carcinoma.

Keywords: Contrast-enhanced ultrasound; Endometrial benign lesions; Endometrial neoplasms; Myometrial invasion.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Fig. 1.
Fig. 1.. Cohort flowchart.
The green line represents the thickness of the normal myometrium, while the blue line denotes the extent of myometrial invasion. 2D US, two-dimensional ultrasound; IUD, intrauterine device; CEUS, contrast-enhanced ultrasound; FIGO, International Federation of Gynecology and Obstetrics. FIGO Ia indicates less than 50% myometrial invasion, while FIGO Ib signifies greater than 50% invasion.
Fig. 2.
Fig. 2.. A 67-year-old woman with intrauterine hemorrhage confirmed by hysteroscopy.
A. Two-dimensional transvaginal ultrasonography reveals a lesion occupying the uterine cavity (arrow). B. Contrast-enhanced ultrasonography demonstrates an absence of contrast agent perfusion, and the patient was diagnosed with intrauterine hemorrhage.
Fig. 3.
Fig. 3.. A 54-year-old woman with a pathology-confirmed endometrial polyp.
A. Two-dimensional ultrasound could not visualize the boundary of the lesion. B. A distinct boundary is visible between the endometrial polyp and the normal endometrial tissue (arrows), resembling an island. This feature was termed the "island sign" by the authors.
Fig. 4.
Fig. 4.. A 65-year-old woman who experienced overdiagnosis.
Contrast-enhanced ultrasound (CEUS) suggested a International Federation of Gynecology and Obstetrics (FIGO) stage Ib lesion; however, pathological examination revealed a FIGO stage Ia lesion. The massive intrauterine lesion (asterisk) and the thin myometrium (arrow) complicated the assessment of myometrial invasion depth.
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