Sonohysterography-Guided Biopsy of Focal Endometrial Lesions: Value of Four-dimensional Ultrasonography

PURPOSE: To assess the usefulness of four-dimensional (4D) ultrasonographic guidance in sonohysterographyguided biopsy of focal endometrial lesions. MATERIALS AND METHODS: Endometrial biopsies were performed prospectively under 4D ultrasound guidance in 24 consecutive patients with focal endometrial lesions detected on baseline sonohysterography. A single slice view in three orthogonal planes, a sagittal surface-rendered image, and multislice views in the sagittal plane were used for real-time guidance during the procedure. We evaluated feasibility based on the technical success rates and the number of "diagnostic" specimens obtained for histological diagnosis, and we correlated the biopsy results with the pathological diagnosis determined through the surgical procedure. RESULTS: Four-dimensional sonohysterography-guided biopsy was successfully performed in 21 (87.5%) of 24 patients without any significant complication. The biopsy specimens were diagnostic in 19 (90.5%) of 21 patients. Thirteen of 19 patients (68.4%) patients underwent surgery, and the diagnoses obtained using cytology correlated well with the pathology. CONCLUSION: Four-dimensional ultrasonography-guided biopsy is technically feasible and may be useful in the diagnosis of focal endometrial lesions.

MR Imaging of Endometrial Cancer that Occurs After Radiation Therapy for Cervix Cancer

PURPOSE: We wanted to describe the MR imaging findings of endometrial cancer in patients with a history of prior radiation therapy for cervical cancer (ECRT) and we compare them to the MR imaging findings of patients with spontaneously occurring endometrial cancer (SEC). MATERIALS AND METHODS: Twenty-two patients with endometrial cancer that was diagnosed by operation or endometrial biopsy were included in the study. The patients were divided into two groups according to the presence of past RT for cervical cancer: ECRT (n = 4) and SEC (n = 18). The MR images were retrospectively analyzed by consensus of two experienced radiologists. The MR imaging findings were analyzed by the size, shape and signal intensity of the mass, distension of the uterine cavity, the presence of cervical stenosis and the nature of the fluid collection. RESULTS: For the mass shape, all the ECRT lesions were polypoid masses. However, the SEC patients had 5 polypoid masses and 13 wall thickenings. The maximal diameter, signal intensity and enhancement pattern of the masses were not different between the ECRT and SEC patients. The width of the endometrial cavity varied between 3.9 cm in the ECRT patients and 0.4 cm in the SEC patients (p =0.002). All the ECRT patients had cervical stenosis. However, none of the SEC patients had cervical stenosis. CONCLUSION: MR imaging of ECRT patients demonstrated prominent distension of their uterine cavity and cervical stenosis, which may be the result of radiation fibrosis in the uterus.

Sonohysterography-Guided Biopsy of Focal Endometrial Abnormalities: Technical Feasibility and Diagnostic Accuracy

PURPOSE: To assess the feasibility and diagnostic accuracy of a sononohysterography-guided biopsy in an evaluation of focal endometrial lesions. MATERIALS AND METHODS: Sixty-five consecutive patients with focal endometrial lesions detected on baseline sonohysterography were enrolled prospectively. The biopsy was performed under real-time sonohysterography guidance, using a 3.1 mm Pipelle endometrial sampler as the primary biopsy device. The feasibility was evaluated from the technical success rates and the number of "diagnostic" specimen for the histological diagnosis. The diagnostic accuracy was assessed by comparing the biopsy results with the final pathological diagnosis obtained by the surgical procedure. RESULTS: Sonohysterography-guided biopsy was performed successfully in 59(90.8%) out of 65 patients. The reasons for failure in 6 patients were a failure to pass through the cervix (n=3); failure to target a focal lesion (n=2); and inadequate uterine distension (n=1). The biopsy specimen was "diagnostic" in 49 (83.1%) out of 50 patients, and "non-diagnostic" in 10 patients with insufficient tissue (n=6) and indeterminate cellular features for a histological diagnosis (n=4). The cytology results of the sonohysterographically-guided biopsy correlated well with the pathological diagnosis in 35 (92.1%) out of 38 patients who underwent subsequent surgical procedures. CONCLUSION: Sonohysterography-guided biopsy is technically feasible and can be an accurate method for diagnosing focal endometrial lesions. It could be considered to be a reliable office triage as an alternative to hysteroscopic biopsy in patients with focal endometrial abnormalities.

Comparison of Transvaginal Ultrasonography with Hysterosonography as a Screening Method in Patients with Abnormal Uterine Bleeding

OBJECTIVE: To assess the utility of hysterosonography (HS) as a screening method in patients with abnormal uterine bleeding. MATERIALS AND METHODS: We retrospectively reviewed transvaginal ultrasonography (TVS) and HS for 105 patients whose diagnosis was confirmed pathologically. All 105 patients were initially evaluated on the same day with both TVS and HS. On TVS and HS examination, endometrial cavitary lesions were classified as diffuse hyperplasia, endometrial polyp, endometrial cancer, uterine synechia and submucosal leiomyoma. Hysteroscopy with biopsy (n=35), curettage (n=60) or hysterectomy (n=10) was performed, and the results of TVS and HS examination were correlated with the pathological findings. RESULTS: The sensitivity and specificity were 79.0% and 45.8% for TVS, and 95.1% and 83.3% for HS, respectively. The positive and negative predictive values were 83.0% and 39.3% for TVS, and 95.1% and 83.3% for HS, respectively. Twenty-seven showed a discrepancy between the TVS and HS, and eight cases showed a discrepancy between HS and the pathologic diagnosis. CONCLUSION: TVS is a sensitive method to evaluate the endometrial cavitary lesions, but it often does not provide the physician with sufficient diagnostic information. With its higher sensitivities, specificities and positive and negative predictive values, HS can be better used than TVS in evaluating those patients with abnormal uterine bleeding.

Endometrial Carcinoma Occuring from Polycystic Ovary Disease: A Case Report

Endometrial carcinoma usually occurs in postmenopausal women ; less than 5% occurs in women under the age of40. Up to one quarter of endometrial carcinoma patients below this age have PCO(polycystic ovary disease, Stein-Leventhal syndrome). The increased incidence of endometrial carcinoma in patients with PCO is related to chronic estrogenic stimulation. We report MR imaging in one case of endometrial carcinoma occuring in a 23 yearold woman with PCO and had complained of hypermenorrhea for about three years. On T2-weighted MR image the endometrial cavity was seen to be distended with protruded endometrial masses of intermediate signal intensity, and the junctional zone was disrupted beneath the masses. Both ovaries were best seen on T2-weighted MR imagingand showed multiple small peripheral cysts and low signal-intensity central stroma.