ULTRASONOGRAPHY FOR PREDICTIVE DIAGNOSIS AND TREATMENT CONTROL OF ENDOMETRIAL HYPERPLASIA IN FERTILE AGE WOMEN
Goncharenko V.M.1, Bubnov R.V.1, Melnychuk O.P.2, Abdullaiev R.Y.3, Strokan A.M.1
1 Clinical Hospital “Pheophania” of State Affairs Department, Kyiv
2Bogomolets National Medical University, Kyiv
3Kharkiv Medical Academy of Postgraduate Education
Introduction.
Endometrial hyperplasia may cause endometrial cancer in up to 50% of cases [1]. The incidence of endometrial adenocarcinoma, which ranks first among genital malignancies, not only has remained high but in recent years has tended to significantly increase in many countries. Ultrasound (US) diagnosis has been successfully used for diagnosis of endometrial hyperplasia (EH) [1], sonoelastography capabilities for assessment of EH still were not sufficiently studied.
The Aims were to evaluate the capabilities of ultrasonography and sonoelastography (SEG) for diagnosis of endometrial hyperplasia and control treatment.
Materials and methods.
We included 318 women (38,0 ± 2,3 years), assessed to: group 1 (n = 112) with glandular-cystic EH; group 2 - endometrial polyps (n = 98); group 3 (n = 103) - atypical EH; 82 women, who underwent hysteroscopy before in vitro fertilization due to tubal origin infertility, were controls. All patients underwent clinical examination, and transvaginal ultrasound scanning including SEG, Doppler, 3D/4D at 1, 3, 6 and 12 months after hysteroresectoscopy. All patients underwent clinical examination, transvaginal ultrasound scanning including sonoelastography and 3D / 4D technology 1, 3, 6 and 12 months after hysteroresectoscopy we evaluated endometrium structure, thickness, margins with myometrium within TV US diagnostic protocol. Ultrasound scanning using transvaginal probes 5-8 MHz frequency of ultrasound scanner HITACHI 7500 was carried out before, immediately after, one and six months after the intervention. We used transvaginal probes to define sonoelastography patterns. We used the modified Tsukuba classification for evaluation sonoelastography data. 3D US imaging was performed on Siemens Elegra. The uterus was scanned in the coronal and longitudinal projections. The thickest anteroposterior diameter of the endometrial stripe was measured in the sagittal plane.
Results.
The ultrasound symptoms were identified as follows: non-homogenous and irregular margins were significantly higher in atypical EH than in both groups (P <0.01). Hypoechoic areas hypervascularity on Doppler and stiffnes were more specific for AEH than for glandular-cystic hyperplasia (P <0.01, P <0.01, P <0.01 respectively). Fluid in uterine cavity and sonoelastography blu-green-red artifact was found specific for AEH (P <0.01); BGR (blue-green-red) artifact correlated to presence of fluid in uterine cavity (r>0.97). Mean M-echo thickness was found non significant. In 241 patients (75.7%) after hysteroresection US showed normalization of endometrial structure, smooth margins with myometrium, in 76 patients (23.8%) the fibrotic lesions and rough margins with myometrium were revealed. Ultrasound symptoms of EH are presented on Table 1.
In all patients hysteroresection was successful with no early complication diagnosed. In 241 patients (75.7%) US showed normalization of endometrial structure, smooth margins with myometrium. 76 patients (23.8%) the fibrotic lesions and rough margins with myometrium were revealed. Endometrial pathology recurrence after 6 month was revealed in 7 patients (2.2 %), malignancy - in 9 (2.8%) respectively. In 19 patients (5.9%) no US data were found while clinical symptoms (e.g., uteral bleeding) urged for intervention. False negative US results were noted in 6 patients (2.8%).
Conclusions.
Ultrasound has sensitivity, specificity, as 96%, 85% respectively for early detection of endometrial hyperplasia and prediction outcome of intervention; SEG has sensitivity, specificity, as 91%, 83% respectively for polyp diagnosis.
References
Table 1. Ultrasound symptoms of EH
US symptom | Glandular-cystic hyperplasia | Endometrial polyps | Atypical hyperplasia |
Non-homogenous and irregular margins | 22 % | 27 % | 72% |
Mean M-echo thickness | 21 ± 2.1 mm | 17 ± 1.8 mm | 22 ± 2.2 mm |
Hypoechoic areas | 32% | 44% | 60% |
fluid in uterine cavity | 25 | 15 | 38 % |
hypervascularity on Doppler | 15% | 42% | 57% |
RI | 0,58 | 0,7 | 0,62 |
Prevalence stiff (compared to myometrium) | 45% | 92 % | 65 % |
Prevalence isoelastic (compared to myometrium) | 35% | 8 % | 27% |
Prevalence of soft (compared to myometrium) | 30 | - | 7 |
BGR | 12% | - | 45% |