3/27/2023 0 Comments Transvaginal sonogram![]() Additionally, these cutoffs do not consider personal risk factors for endometrial cancer, such as obesity, diabetes, family history, or genetic conditions that may raise one’s suspicion for endometrial cancer despite a thin endometrial lining. However, endometrial cancer can present with thin endometrium in rare cases, so recurrent or persistent postmenopausal bleeding should prompt pathologic evaluation. Thus, it is clear that transvaginal ultrasound is not ideal for predicting disease, and so women with postmenopausal bleeding and thickened endometrium on imaging should undergo sampling. ![]() calculated 61% specificity, and at 3mm, Timmermans calculated only a 35.4% specificity. However, both these studies and others found that endometrial thickness is not very specific for detecting endometrial cancer: at 5mm, Smith-Bindman et al. They were able to find that using a 5mm cutoff to define abnormally thick endometrium was 96% sensitive for detecting endometrial cancer and 92% sensitive for detecting any endometrial disease (including polyps and hyperplasia). Other studies, such as Timmermans et al., found that a 3mm cutoff was ideal, having a sensitivity of 97.9% for detecting endometrial cancer. At varying endometrial thicknesses from 3mm to 10mm, the mean weighted pooled estimates for sensitivity and specificity were calculated. conducted a meta-analysis of 35 studies including 5,892 women to endorse this cut-off value. With an endometrial thickness of 4mm or less, the negative predictive value for endometrial cancer is greater than 99%. Through multicenter trials and retrospective meta-analyses, an endometrial thickness of 4mm has been well established as the threshold above which endometrial sampling should be considered. Transvaginal ultrasound measuring endometrial thickness is a reasonable first non-invasive step in evaluating a patient with postmenopausal bleeding. Thus, it is important to quickly and accurately diagnose or exclude neoplasia in patients presenting with postmenopausal bleeding. Even though the most common cause of postmenopausal bleeding is atrophy of the vagina and/or endometrium due to decreased estrogen, it is the presenting symptom for nearly 90% of women with endometrial cancer. Postmenopausal bleeding is a common indication for ultrasound evaluation of the postmenopausal pelvis. Some of the common indications for a pelvic ultrasound in postmenopausal women include postmenopausal bleeding, pelvic pain, history of ovarian cysts, abdominal bloating, increasing abdominal girth, or pelvic pressure. Similarly to the uterus, the ovaries can continue to decrease in volume through menopause. Because of this, it can be common not to visualize the ovaries on ultrasound in a postmenopausal woman, and this should not lead to concern. Postmenopausal ovaries will also appear smaller and more homogenous, with occasional small hypoechoic follicles on ultrasound compared to those found in reproductive-age women. The normal postmenopausal endometrium should be thin and appear atrophic. Additionally, there is a reduction in the corpus-cervix ratio in postmenopausal women such that it returns to a configuration more similar to that seen in the pediatric or prepubescent uterus. ![]() The uterus can continue to decrease in size throughout menopause. It is important to be aware of ultrasound changes after menopause due to normal hormonal changes.Įxcluding pathologies such as fibroids or adenomyosis, the postmenopausal uterus tends to be smaller in overall size (as measured by uterine length, uterine height, and uterine width) compared to the reproductive age uterus. ![]() In general, the same principles apply when imaging the postmenopausal pelvis in terms of anatomy. ![]()
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