OP24.01: Ultrasound features of atypical endometrial hyperplasia

To describe ultrasound features of atypical endometrial hyperplasia in postmenopausal women. Retrospective study. 495 postmenopausal women with vaginal bleeding and endometrium ≥5mm were examined with transvaginal gray-scale and power Doppler ultrasound by an experienced ultrasound examiner. Endometrium was assessed according IETA terms, definitions and measurements. Final histological diagnosis was gold standard for selecting this particular group of patients. Out of 495 women, 19 women had atypical endometrial hyperplasia at final histological diagnosis. Demographic data of those women is expressed as median (range): age 65 (53-83) years, age at menopause 51 (43-61) years, length of menopause 12 (1-33) years, BMI 30 (23-39). Ten (53%) women had hypertension and four (21%) women had diabetes. Endometrial thickness was 10.9 (5.1 – 29.4) mm. Saline installation sonography was attempted in all women and successfully performed in 15 women. Out of those, 14 women had endometrium with 1 to 4 focal lesions and only two of them had focal lesions with irregular surface. Most common ultrasonographic features in the endometrium with atypical hyperplasia were: heterogeneous with regular or irregular cysts (37%), regular junctional zone (63%), moderate colour score (74%). Vascular pattern included both single vessel with or without branching (32%), multiple vessels with branching (32%) and scattered vessels (26%). Half of women had uniform and half non-uniform endometrium. Majority of women with atypical endometrial hyperplasia had focal lesions with regular surface. Endometrium thickness and echogenicity varies widely in women with atypical hyperplasia. Large prospective studies are needed to assess if these ultrasound features can predict atypical endometrial hyperplasia.