WHEN THICKNESS MATTERS: THE IMPORTACE OF ENDOMETRIAL THICKNESS MEASUREMENT IN PATIENTS WITH INTRAUTERINE FLUID COLLECTION
Keywords:
intrauterine fluid collection, mucometra, endometrial thickness, malignant lesionAbstract
Numerous patients are referred by their gynecologists for a histological evaluation due to an ultrasound finding of “mucometra” (intrauterine fluid collection) without endometrial thickness being measured and reported. It seems that for a large number of doctors, intrauterine fluid collection by itself rather than the thickness of the endometrium is of significance when suspecting a possible pathology of the uterus.
The aim of this study was to assess the histological significance of intrauterine fluid collection as such versus intrauterine fluid collection accompanied by endometrial thickness.
The study was retrospective. It included 98 postmenopausal patients with sonographically confirmed mucometra that underwent dilatation and curettage. Subjects were divided in 3 groups: patients with mucometra; patients with mucometra and endometrial thickness >10 mm and patients with mucometra and endometrial thickness ≤10 mm. Data regarding histological findings were obtained from medical history.
Behind TVS finding of “mucometra” regardless of endometrial thickness presence, histopathology analysis revealed 84.6% atrophic endometrium, 12.8% benign, and 2.6% premalignant or malignant lesion.
Among patients with endometrial thickness up to 10 mm, atrophic endometrium was found in 80%, and 20% of patients had benign findings. Patients with endometrial thickness above 10 mm had premalignant or malignant lesion in 11%, benign lesion in 21%, and the remaining 68% had atrophic endometrium.
Endometrial thickness rather than intrauterine fluid accumulation itself is crucial in making the decision for further histological evaluation.
References
Granberg S, Wikland M, Karlsson B, Norström A, Friberg LG. Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol 1991; 164(1 Pt 1): 47-52. doi: 10.1016/0002-9378(91)90622-x.
Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol 1995; 172(5): 1488-1494. doi: 10.1016/0002-9378(95)90483-2.
Salakos N, Bakalianou K, Deligeoroglou E, Kondi-Pafiti A, Papadias K, Creatsas G. Endometrial carcinoma presenting as hematometra: clinicopathological study of a rare case and literature review. Eur J Gynaccol Oncol 2007; 28(3): 239-240.
Epstein E, Valentin L. Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding. Ultrasound Obstet Gynccol 2006; 28(I): 89-95. doi: 10.1002/uog.2782.
Goldstein SR. Postmenopausal endometrial fluid collections revisited: look at the doughnut rather than the hole. Obstet Gynecol 1994; 83(5 Pt 1): 738-40. PMID: 8164935.
Zalel Y, Tepper R, Choen I, Goldberger S, Beyth Y. Clinical significance of endometrial fluid collection in asymptomatic postmenopausal women. J Ultrasound Med 1996; 15(7): 513-155. doi: 10.7863/jum.1996.15.7.513.
Pardo J, Kaplan B, Nitke S, Ovadia J, Segal J, Neri A. Postmenopausal intrauterine fluid collection: correlation between ultrasound and hysteroscopy. Ultrasound Obstet Gynecol 1994; 4(3): 224-226. doi: 10.1046/j.1469-0705.1994.04030224.x.
