TV sonographic assessment in postmenopausal asymptomatic women

The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women without symptoms. The study involved 750 postmenopausal women aged 52-65 (mean 58.5). None of them were on hormone replacement therapy and all had had amenorrhea for more than two years. Transvaginal sonography was performed in 750 women. An endometrium of < 5 mm and non-measurable (627 women) was not investigated further. The 627 cases of this group were reassessed one year later. In the remaining 123 postmenopausal women with suspicious endometrium > 5 mm, 19 endometrial polyps (7.13%), one cervical polyp with extension in the cavity (0.8%), 90 endometrial atrophies (73.17%), ten atrophic endometritis (8.13%), two simple hyperplasias (1.62%), and one hyperplasia with atypia (0.8%) were found. Transvaginal sonography is an efficient and acceptable noninvasive method for the early detection of endometrial pathology in postmenopausal asymptomatic women.

Transvaginal ultrasound; Endometrial thickness; Postmenopausal asymptomatic women

[1] Gambacciani M., Monteleone P., Ciaponi M., Sacco A., Genazzani A.R.: "Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women". Maturitas, 2004, 48, 421.

[2] Parker S.L., Tong T., Bolden S., Wingo P.A.: "Cancer statistics". C.A. Cancer J. Clin., 1996, 46, 5.

[3] Endometrial Cancer Mortality Rate "Climbs Sharply", Statistics Show Daily Reproductive Health Report, Reproductive Health Services; 24 September 2001.

[4] Platz C.E., Benda J.A.: "Female genital tract cancer". Cancer, 1995, 75 (suppl.), 270.

[5] Gerber B., Krause A., Millier H., Reimer T., Kiilz T., Kundt G., Friese K.: "Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic ad vantage over symptomatic disease discovered by uterine bleeding". 2001, 37, 64.

[6] Bourne T., Hamberger L., Hahlin M., Granberg S.: "Ultrasound in gynecology: endometrium". Int. J. Gynecol. Obstet., 1997, 56, 115.

[7] Tsuda H., Nakmura H., Takeshi I., Kawamura N., Adachi K., Bandera C.: "Transvaginal ultrasonographyof the endometrium in postmenopausal Japanese women". Gynecol. Obstet. Invest., 2005, 60,218.

[8] An-Foraker S.H., Kawada C.Y., Mc Kinney D.: "Endometrial asp卜 ration studies on Isaacs cell sampler with cytohistologic correlation". Acta Cytol., 1979, 23, 303.

[9] Koss L.G., Schreiber K., Oberlander S.G., Moukhtar M., Levine H.S., Mousouri H.S.: "Screening of asymptomatic women for endometrial cancer". Cancer J. Clin., 1981, 31, 300.

[10] Fleischer A.C., Kalimeris G.C., Machin J.E. et al.: "Sonographic depiction of nomal and abnormal endometrium with histopathologic correlation". J. Ultrasound Med., 1986, 5,445.

[11] Fleischer A.C., Wheeler J.E, Lindsay I., Hendrix S.L., Grabill S., Kravitz B., MacDonald Brian: "An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms". Am. J. Obstet. Gynecol., 2001, 184, 70.

[12] Granberg S., Karlsson B., Wikland M., Gull B.: "Transvaginal sonography of uterine and endometrial disorders". In Fleischer A.C., Manning F.A., Jeantry P., Romero R. (eds.): "Sonography in Obstetrics and Gynecology: Principles & Practice", 5" edition, Stamford, CT, Appleton & Lange, 1996, 851.

[13] Fleischer A., Applebaum M., Parsons A.: "Transvaginal sonography of the normal endometrium". In Fleischer A., Kurjak A., Granberg S. (eds.): "Ultrasound and the Endometrium", Progress in Obstetric and Gynecological Sonography Series, New York, Parthenon, 1997, 1.

[14] Warming L., Ravn P., Skouby S., Christiansen C.: "Measurement precision and normal range of endometrial thickness in a postmenopausal population by transvaginal ultrasound". Ultrasound Obstet. Gynecol., 2002, 20, 492.

[15] Sit A.S.Y., Modugno F.，Hill M.L., Martin J., Weissfeld J.L "Transvaginal ultrasound measurment of endometrial thickness as a biomarker for estrogen exposure". Cancer Epidemiol Biomarkers Prev., 2004, 13, 1459.

[16] Koss L.G., Schreiber K., Oberland S.G., Mousouris H.F., Lesser M.: "Detection of endometrial carcinoma and hyperplasia in asymptomatic women". Obstet. Gynecol., 1984, 164, 1.

[17] J.E, Laippala P.J., Gronroo M., Salmi T.A.: "Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography". Br. J. Obstet. Gynaecol., 1999, 106, 14.

[18] Gull B., Karlson B., Milson I., Wikland M., Granberg S "Transvaginal sonography of the endometrium in a representative sample of postmenopausal women". Ultrasound Obstet. Gynecol., 1996, 7, 322.

[19] Tsuda H., Kawabata M., Kawabata K., Yamamoto K., Hidaka A., Umesaki N., Sachio Ogita: "Differences between Occidental and Oriental postmenopausal women in cutoff level of endometrial thickness for endometrial cancer screening by vaginal scan". Am. J. Obstet. Gynecol., 1995, 172, 1494.

[20] Tsuda H., Kawabata M., Yamamoto K., Inoue T., Umesaki N "Prospective study to compare endometrial cytology and transvaginal ultrasonography for identification of endometrial malignancies". Gynecol. Oncol., 1997, 65, 383.

[21] Randelzhofer B., Prompeler H.J., Sauerbrei W., Madjar H., G. Emons: "Value of sonomorphological criteria of the endometrium in women with postmenopausal bleeding: a multivariate analysis". Ultrasound Obstet. Gynecol., 2002, 19, 62.

[22] Osmers R.G.W., Osmers M., Kuhn W.: "Prognostic value of transvaginal sonography in asymptomatic endometrial cancers". Ultrasound Obstet. Gynecol., 1995, 6, 103.

[23] Fleischer A.C., Arthur B., Stephens D., Stephen S., Entman D. et al.: "Myometrial invasion by endometrial carcinoma, sonographic assessment". Rad., 1987, 162, 307.

[24] Forrest T.S.，Eiyaderani M.K., Muilenburg M.I., Bewtra C., Kable W.T., Sullivan P.: "Cyclic endometrial changes: Ultrasound assessment with histologic correlation". Radiology, 1988, 167, 233.

[25] Auslender R., Bornstein J., Dirnfeld M., Kogan O., Atad J., Abramovici H.: "Vaginal ultrasonography in patients with postmenopausal bleeding". Ultrasound Obstet. Gynecol., 1993, 3426.

[26] Bakos O., Smith P., Heimer G.: "Transvaginal ultrasonography for indentifying endometrial pathology in postmenopausal women" Maturitas, 1994, 20, 181.

[27] Karlsson B., Granberg S., Wik.land M, Ylostalo P., Torvid K., Marsal K., Valentin L.: "Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding a Nordic multicenter study". Am. J. Obstet. Gynecol., 1995, 172, 1488.

[28] Grimes D.A.: "Diagnostic dilation and curettage: a reappraisal" Am. J. Obstet. Gynecol., 1982, 142, 1.

[29] Mac Kenzie L.Z., Bibby J.H.: "Critical assessment of dilatation and curettage in 1029 women". Lancet, 1978, 2, 566.

[30] Osmers R.G., Kuhn W.: "Endometrial cancer screening". Curr. Opin. Obstet. Gynecol., 1994, 6, 75.

[31] Nasri M.N., Shepherd J.H., Setchell M.E., D.G. Lowe, T. Chard et al "The role of vaginal scan in measurement of endometrial thickness in postmenopausal women". Br. J. Obstet. Gynecol., 1991, 98,470.

[32] Fleischer A.C., Gordon A.N., Entman S.S., Kepple D.M "Transvaginal scanning of the endometrium". Clin. Ultrasound, 1990, 18, 337.

[33] Ferrazzi E., Torri V., Trio D., Zannoni E., Filiberto S., Dordoni D.: "Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study". Ultrasound Obstet. Gynecol., 2003, 7,315.

[34] Pri:impeler H.J., Madjar H., Wilhelm C., Pfleiderer A.: "Vaginal sonographie am endometriums in der postmenopause". Arch Gynecol. Obstet., 1993, 245, 746.

[35] Pri:impeler H.J., Madjar H., Du Bois A., Lattermann U., Wilhelm C., Kommoss F., Pfleiderer A. Acta Obstet. Gynecol. Scand., 1994, 73,343.

[36] Granberg S., Wik.land M., Karlsson B. et al.: "Endometrial thickness as measuremed by endovaginal ultrasonography for indentifying endometrial abnormality". Am. J. Obstet. Gynecol., 1991, 164, 47.

[37] Archer D.F., Mcintyre-Seltman K., Wilborn W.W. Jr., Dowlmg E.A., Cone F., Creasy G.W., Kafrissen M.E.: "Endometrial morphology in asymptomatic postmenopausal women". Am. J. Obstet. Gynecol., 1991, 165, 317.

[38] Zacchi V., Zini R., Canino A.: "Transvaginal sonography as a screening method for the identification of patients at risk of postmenopausal endometrial pathology". Minerva Ginecol., 1993, 45, 339.