Elastosonographic evaluation of endometrium in women using tamoxifen for breast cancer.

OBJECTIVES: A prospective case-control study was carried out to assess the value of elastosonography in identifying endometrial pathology in women using Tamoxifen (TAM) for breast cancer. MATERIALS AND METHODS: In total, 66 women using TAM for breast cancer were enrolled for the study with 61 premenopausal and 61 postmenopausal healthy controls. Ultrasonographic findings (strain ratio, endometrial thickness) were evaluated in regard to the duration of TAM usage, histopathological findings, and menopausal status. RESULTS: Patients with endometrial cancer (EC) and cystic endometrial hyperplasia (CEH) were found to have longer duration of TAM usage, increased endometrial thickness, and higher strain ratios compared with controls. A significant positive correlation was found between duration of TAM usage, endometrial thickness, and the strain ratios. Endometrial thickness and the strain ratios were significant predictors for groups under risk. Cutoff values for endometrial thickness, strain ratios, and duration of TAM usage were 12.55 mm, 2.46, and 18 months in premenopausal group and 7.75 mm, 7.70, and 32 months in postmenopausal group to predict risky population, respectively. CONCLUSION: Endometrial tissue strain ratio was found to be significantly increased in cases with endometrial pathologies. Addition of elastosonography modality to B-mode may improve the diagnostic accuracy during the follow-up of women using TAM for breast cancer.

Elastosonographic evaluation of patients with a sonographic finding of thickened endometrium.

OBJECTIVE: To evaluate if elastosonography of the endometrium can differ between normal endometrial tissue and abnormal pathology. STUDY DESIGN: One hundred and six women with a sonographic finding of thickened endometrium were enrolled in this study. All patients underwent B-mode scanning and elastosonography, performed by the same operator who was blinded to the study design. After sonographic evaluation, all patients underwent endometrial tissue sampling via dilatation and curettage. Histopathological results indicated that 22 patients had endometrial hyperplasia, 20 patients had endometrial polyps, and 64 patients had normal pathology results, with or without abnormal uterine bleeding. Groups were formed according to histopathological results, and ultrasonographic findings (strain ratio, endometrial thickness) were compared. RESULTS: Median age was 46 [interquartile range (IQR) 4] years, 37 (IQR 10) years and 36 (IQR 10) years for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively. Median age of the endometrial hyperplasia group was significantly higher compared with the endometrial polyps and normal pathology groups (p<0.001). Median parity was 3 (IQR 2), 2 (IQR 1) and 3 (IQR 1) for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively; differences between the groups were not significant (p=0.102). No differences were found between the groups in terms of endometrial thickness (p>0.05). When elastosonographic strain (B/A) ratios were compared between the groups, the endometrial hyperplasia and endometrial polyps groups had significantly lower B/A ratios (higher elasticity) than the normal pathology group (p<0.001). There was no significant difference in B/A ratios between the endometrial hyperplasia and endometrial polyps groups (p>0.05). CONCLUSION: The elasticity of endometrial tissue, measured non-invasively via elastosonography, was similar in women with endometrial polyps and endometrial hyperplasia, but differed significantly compared with women with normal pathology who had a sonographic finding of thickened endometrium and abnormal bleeding as the presenting complaint. According to these results, elastosonography cannot be used as a diagnostic tool to differentiate between endometrial hyperplasia and endometrial polyps. However, elastosonography can be used to differentiate between pathological endometrial changes and normal endometrium in patients presenting with a sonographic finding of thickened endometrium.

Is lateral localisation of placenta a risk factor for adverse perinatal outcomes?

The aim of this study was to evaluate the relationship between placental localisation and perinatal outcomes. This study was performed in a tertiary centre hospital by retrospectively analysing the medical records of patients who were followed up and underwent delivery in the same hospital. The patients were divided into two groups according to the placental locations (central and lateral) in their routine sonographic findings between the 18 and 24 weeks' gestation. Out of 1,057 patients, 87.4% (n = 919) had centrally located placentas and 12.6% (n = 133) had laterally located placentas. Preeclampsia was found to be significantly higher in the lateral placental location group (4.5% vs. 1.6%; p = 0.027). There was a significant correlation with foetal growth restriction (FGR), preterm birth rates, low Apgar scores and need for neonatal intensive care unit in the lateral placental location group (p < 0.05). The pregnant women with laterally located placentas should be followed up promptly with special care for the risk of preeclampsia and FGR, and poor neonatal outcomes.