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Re: liability of US Endometrial ThicknessFrom: H.Fehmi Yazıcıoğlu (hfy@turk.net)Sun Mar 26 15:36:20 2000
At Tue, 21 Mar 2000, Joanne Bulley, MD wrote: > >New case >71yo woman, thin on NO HRT, with a brownish stain to vaginal secretions, >to me suspicious for endometrial source. Ultrasoound - transabdominal >and transvaginal, showed an endometrail stripe, double thickness, of 9.7 >mm. Since this was over the 5mm and therefore compatiable for a >possible hyperpalsia or worse, and her cervical os was tight as can be, >yeailding scant cells for PAP, I did a hysteroscopy and fractional D&C >today. > >H/S showed easily visualized atrophic appearing endometrial cavity with >nothing at all suspicious. D&C resulted in scant fragments of tissue - >both endocervical and endometrial. > >What was the reason it looked 9.7 mm by US?? > Dear Joanne, Here are my explanations for a discrepancy between the US and HS results in a 70 yo postmenopausal patient: 1.Use of Tamoxifen (Typically produces subendometrial hyperplasia undetectable by HS and/or D&C 2.Calcification of the arcuate arteries in this age group may produce an image which may be mistaken as a thickening of the endometrium 3.Sometimes in cases with a stenotic os intern one may easily produce a subendometrial false cavity with the tip of the hysteroscope and then consider the hysteroscopic image to represent an endometrial cavity with an atrophic endometrial lining.
My advice: Repeat vaginal US (Preferably using a device with Power
Doppler capacity)İf you still continue to see a thickened endometrium
and/or vascularisation, then repeat HS this time under real time
guidance of a good transabdominal US Probe.And if you don't see anything
suspicious then don't forget to take random hysteroscopic biopsies which
may reveal some pathology especially in Tamoxifen users.
>
-- H.Fehmi Yazıcıoğlu, Clinical Chief of Staff, Süleymaniye Maternity Hospital Istanbul,Turkey
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