Re: TVS & endometrial Ca
From: art fougner, md (evsono@pipeline.com)
Wed Jan 13 13:31:15 1999
Jim,
if a woman can't handle the pipelle, she probably couldn't handle
sonohysterogram either. the earlier lit re: eb involved vabra or novak.
since pipelle became the rage, our tumor board discusses more than a few
cases in which the pipelle missed the cancer.
Art
At Wed, 13 Jan 1999, James S Smeltzer MD wrote:
>
>Art,
>
>I thought that the sensitivity of pipelle before hysterectomy was over 90%
>(90-98%) sensitive for detecting endometrial ca.
>
>Grimes DA AJOG 1982;142:1-6
>Kaunitz am & al J. Reprod Med. 1988;56:2256-63
>Chambers JT, SK Clin Obstet Gynecol 1992;35:28-39.
>in Lurain JA. Uterine Cancer in Berek JS & al Novak's Gynecology, 12th ed 1996
>
>I also can not remember an endometrial cancer that was missed by either
>method (US or sampling) in my less than extensive experience. How would
>you diagnose chronic endometritis of an atrophic endometrium by US? How
>about Nocardiosis?
>Tissue diagnosis is still the gold standard, IMHO. I have also not had a
>woman who could not tolerate the musually minimal discomfort of a pipelle
>without anesthesia, but I probably will find one before I die.
>
>Jim S
>
>At 12:03 PM 1/13/1999 -0600, you wrote:
>>Yup! that's why the sensitivity is only in the mid-90's, not 100%. still
>>apparently better than blind biopsy.
>>
>>again nice scan!
>>
>>Art
>>
>>At Wed, 13 Jan 1999, Ozren Mamula wrote:
>>>
>>>Yes it was a polyp, but that's not the point. The point is that without
>>>hystology
>>>you can't be sure. Without saline infusion only thing you can see is 4 mm
>>>endometrial thickness and everything can look normal.
>>>
>>>Ozren,
>>>
>>>At 14:06 1999.01.12 -0600, you wrote:
>>>
>>>>dunno. looks like a small polyp. since cancers can exist in a polyp,
>>>>in a woman with postmenopausal bleeding, this should be removed and
>>>>handed to the pathologist for exam. i take it this was done. what did
>>>>the path report show?
>>>>all the article says is that compared with blind biopsy, TVS performed
>>>>better as a screening test. TVS obviously still missed some cancers.
>>>>out of curiosity, was saline infused to obtain this image or was this
>>>>fluid already present within the cavity? Good case! have seen a few of
>>>>these myself.
>>>>
>>>>Art
>>>>
>>>>At Tue, 12 Jan 1999, Ozren Mamula wrote:
>>>>>
>>>>>O.K. Then tell me is this endometrial polyp or cancer ?
>>>>>Please take a look at:
>>>>>
>>>>>http://www.obgyn.net/US/_uploads/POLIP.JPG
>>>>>
>>>>>Ozren,
>>>>>
>>>>>At 08:17 1999.01.12 -0600, you wrote:
>>>>>
>>>>>>This just in -
>>>>>>A simple ultrasound scan may be better at detecting cancer of the uterus
>>>>>>than the traditional biopsy method, researchers reported.
>>>>>>This is compared with 85% to 95% discovered through biopsy.
>>>>>
>>>>>>"The cancers I've seen have all occurred in women with [lining]
>>>>>>thickness in excess of 5 mm," said Morris Wortman, M.D., a clinical
>>>>>>associate professor at the University of Rochester and director of the
>>>>>>Center for Menstrual Disorders and Reproductive Choice, both in
>>>>>>Rochester, N.Y.
>>>>>>
>>>>>>thought you'd all like to know.
>>>>>>
>>>>>>Art
>>>>>>
>>>>>>--
>>>>>>art fougner, md
>>>>>>SonoScan/Genetic Sciences
>>>>>>forest hills, ny
>>>>>>evsono@pipeline.com
>>>>>
>>>>>--
>>>>>Ozren Mamula , MD
>>>>>Ozren.Mamula@public.srce.hr
>>>>>KBC Rijeka
>>>>>Kresimirova 7
>>>>>Croatia
>>>>>Tel : ++ 385 51 213 342
>>>>>
>>>>--
>>>>art fougner, md
>>>>SonoScan/Genetic Sciences
>>>>forest hills, ny
>>>>evsono@pipeline.com
>>>>
>>>--
>>>Ozren Mamula , MD
>>>Ozren.Mamula@public.srce.hr
>>>KBC Rijeka
>>>Kresimirova 7
>>>Croatia
>>>Tel : ++ 385 51 213 342
>>>
>>--
>>art fougner, md
>>SonoScan/Genetic Sciences
>>forest hills, ny
>>evsono@pipeline.com
>>
--
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
