Sonographic Assessment of Vascular Pattern of Endometrial Lesions

Abstract

Objective: Many women referred for gynecologic sonography do not return for recommended sonohysterography when the initial evaluation suggests possible endometrial lesions. We evaluated the accuracy of identifying endometrial polyps by assessment of their vascularity and the reasons these women did not undergo sonohysterography. Material and methods: We used transvaginal sonography (Sequoia^™; Siemens, Malvern, PA) to look for endometrial lesions and color Doppler mapping to evaluate their vascular supply. A recommendation for a sonohysterography was included in the report when such a lesion was suspected. When a patient failed to return for this procedure within six months, we contacted the referring physician for follow-up information. Results: Thirty-four women were included in this study. The most common indication for the initial ultrasonographic examination was abnormal uterine bleeding (85%). The average diameter of the endometrial lesion was 11.7 mm. Only one of the subjects returned for the recommended sonohysterography (2.9%). Complete follow- up information was available for an additional 24 women (70.6%). Of these, fifteen underwent either a hysterography or a hysterectomy. Fourteen (87%) of the fifteen women had the diagnosis of endometrial polyps confirmed and two were found to have submucosal leiomyomata. The remaining nine women chose not to undergo any further evaluation. Conclusions: In our population, the vast majority of women who have an endometrial lesion identified on a gynecologic ultrasound did not return for a sonohysterogram despite our recommendations. Our referring physicians commonly use the ultrasound findings as an indication for invasive diagnostic procedures. This may be an appropriate approach since the combination of a detailed transvaginal sonogram and the use of color Doppler mapping appears to be a highly accurate method for detection of endometrial polyps. We recommend that a resectoscope should always be available at the time of hysteroscopy of these patients. (J GYNECOL SURG 22:19)