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Sonographic endometrial three-layer pattern in symptomatic first-trimester pregnancy: not diagnostic of ectopic
1Department of Radiology, University Hospital and New Jersey Medical School, Newark 07103, USA.
Purpose:
We evaluated a recent report that suggested that a "3-layer" appearance of the endometrium on sonography is diagnostic of ectopic pregnancy in symptomatic pregnant patients.
Methods:
We reviewed the log of pelvic sonograms performed to rule out ectopic pregnancy in women presenting with first-trimester bleeding and/or pain during a 29-month period. Medical records and sonograms of patients without sonographic evidence of intrauterine pregnancy were reviewed to determine final diagnoses and whether the 3-layer pattern was present.
Results:
One hundred twenty patients with available follow-up had no sonographic evidence of intrauterine pregnancy. Fifty-nine (49%) had ectopic pregnancy. An endometrial 3-layer pattern was noted sonographically in 15 patients (13%), of whom 6 (40%) had ectopic pregnancy. As a diagnostic sign of ectopic pregnancy, the endometrial 3-layer pattern had a sensitivity of 10.2%, specificity of 85.2%, positive predictive value of 40%, negative predictive value of 50.5%, and accuracy of 49.2%.
Conclusions:
The endometrial 3-layer pattern is neither sensitive nor specific for the diagnosis of ectopic pregnancy.