Thin endometrial echo complex on ultrasound does not reliably exclude type 2 endometrial cancers

Area of Science:

• Gynecologic oncology
• Diagnostic imaging
• Pathology

Background:

• Type 2 endometrial cancer, including uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC), and high-grade carcinomas (HGC), presents diagnostic challenges.
• Ultrasonography is a key imaging modality for evaluating postmenopausal uterine abnormalities.

Purpose of the Study:

• To characterize the ultrasonographic features of the uterus and endometrial echo-complex (EEC) in postmenopausal patients with type 2 endometrial cancer.
• To assess the reliability of endometrial stripe thickness in diagnosing type 2 endometrial cancer.

Main Methods:

• Retrospective review of preoperative pelvic ultrasound reports and images from 52 postmenopausal patients diagnosed with type 2 endometrial cancer.
• Analysis of endometrial echo-complex (EEC) thickness, intracavitary findings, myometrial and adnexal masses, and uterine size.
• Independent re-review of ultrasound films by a gynecologic ultrasonographer.

Main Results:

• Eighty-five percent of patients presented with abnormal vaginal bleeding.
• A thickened EEC (>5 mm) was observed in 65% of cases, while 17% had an EEC <4 mm and 17% had an indistinct EEC.
• In cases with a non-thickened EEC, other abnormalities like intracavitary lesions (44%), myometrial masses (67%), enlarged uteri (72%), or adnexal masses (28%) were common.

Conclusions:

• A thin or indistinct endometrial stripe on ultrasound does not reliably exclude type 2 endometrial cancer.
• Postmenopausal vaginal bleeding necessitates endometrial sampling, irrespective of EEC thickness, particularly when accompanied by other ultrasonographic abnormalities or persistent bleeding.