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The Use of Transvaginal Ultrasound in Type II Endometrial Cancer
  1. Caroline C. Billingsley, MD*,
  2. Kimberly A. Kenne, MD*,
  3. Catherine D. Cansino, MD,
  4. Floor J. Backes, MD*,
  5. David E. Cohn, MD*,
  6. David M. O’Malley, MD*,
  7. Larry J. Copeland, MD*,
  8. Jeffrey M. Fowler, MD* and
  9. Ritu Salani, MD, MBA*
  1. *Department of Obstetrics and Gynecology, Division of Gynecology Oncology, College of Medicine, The Ohio State University, Columbus, OH; and
  2. Department of Obstetrics and Gynecology, Division of Gynecologic Specialties, University of California, Davis, Sacramento, CA.
  1. Address correspondence and reprint requests to Ritu Salani, MD, MBA, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, The Ohio State University, 320 W 10th Ave, M210 Starling Loving, Columbus, OH 43210. E-mail:


Objective To determine the use of the transvaginal ultrasound (TVUS) in postmenopausal women with type II endometrial cancer.

Methods/Materials A retrospective review was conducted for 173 women with pathology proven type II endometrial cancer at a single institution. Those who underwent preoperative TVUS were included, and the following data were obtained: endometrial stripe (EMS) measurement, uterine and/or adnexal findings, and uterine size/volume. Clinicopathologic factors were abstracted. Descriptive and regression analyses were performed.

Results Fifty-eight women comprised the cohort, and the median age was 66.5 years (50–85 years). The most commonly reported symptom was postmenopausal bleeding in 53 patients (91.4%). The EMS was reported as thin (⩽5mm) or indistinct in 16 patients (27.5%). Approximately 60% of patients had 1 or more ultrasound abnormalities: intracavitary mass (31%), intracavitary fluid (12.1%), myometrial lesion (31.03%), and adnexal mass (12.1%). Poorly differentiated endometrioid cancer (53.45%) represented the predominant histology. Of the 16 (27.5%) women with a thin/indistinct EMS, 5 women (8.6%) did not have any abnormal ultrasound findings whatsoever.

Conclusions Women with type II endometrial cancer had a thin/indistinct EMS on TVUS in approximately 25% of cases. Lack of any ultrasound abnormality, including a thickened EMS, was noted in approximately 10% of patients. The use of TVUS, which has been of value in type I cancer, is limited in type II endometrial cancer. Therefore, endometrial sampling should be included in the evaluation of all women with postmenopausal bleeding, regardless of EMS thickness.

  • Endometrial cancer
  • Endometrial stripe
  • Type II, Pelvic ultrasound

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  • The authors report no conflicts of interest.

  • An abstract of this study was presented as a poster presentation at the Society of Gynecologic Oncology 19th Annual Winter Meeting on February 20-22, 2014, in Breckenridge, Colorado.