P14.02: Ultrasonographic evaluation of possible endometrial pathology in symptomatic women via IETA and MUSA rules

To evaluate the accuracy of transvaginal ultrasonography to discriminate endometrial cancerous pathology from benign lesions based on IETA and MUSA rules and definitions. We analysed retrospectively ultrasonic images (2D, 3D/4D) of 240 women that attained the department of gynecological ultrasound complaining for sudden appearance of “vaginal bleeding”. They underwent transvaginal ultrasonography and treated by D&C. Based on histological diagnosis, data have been allocated into 2 groups of benign and malignant cases irrespectively of hormonal status of women (pre- or postmenopausal). All cancerous cases have been correctly diagnosed via application of IETA criteria (100%). In 22 women (15%), endometrial neoplasia has been initially recorded via ultrasonography. Cervical cancer that coexisted in 4 cases obscured the clear delineation between endometrial cavity and cervical canal. Intramural and submucous myomas, described via ultrasonography as well defined lesions, destroyed the endometrial entity producing complex structures that presented differentiated echogenicity (55%). Pathology of adenomyosis has been underlined via hysterectomy in 7 of 18 myomatous uteri. Endometrial polypoid hyperplasia (with or without atypia) has been diagnosed in the rest of patients (n=6/22). Increased vascularisation has been observed in these overdiagnosed as cancerous 22 cases. Application of IETA criteria represents an accurate method to investigate via ultrasonography the possibility of underlying endometrial malignancy in symptomatic women (pre and postmenopausal). False positive results obliged 15% of our sample to undergo a minimal surgical procedure. But none of the cancerous patients has been lost as “benign case”. More prospective studies should be organised in order gynecologists that perform transvaginal ultrasonography to be trained and to become familiar regarding the vascularisation endometrial pattern in benign pathologies such as hyperplasia, adenomyosis and polyps.