title: Sonographic endometrial three-layer pattern in symptomatic first-trimester pregnancy: not diagnostic of ectopic pregnancy.
abstract: OBJECTIVE
  We evaluated a recent report that suggested that a "3-layer" appearance of the endometrium on sonography is diagnostic of ectopic pregnancy in symptomatic pregnant patients.
  
  
  METHODS
  We reviewed the log of pelvic sonograms performed to rule out ectopic pregnancy in women presenting with first-trimester bleeding and/or pain during a 29-month period. Medical records and sonograms of patients without sonographic evidence of intrauterine pregnancy were reviewed to determine final diagnoses and whether the 3-layer pattern was present.
  
  
  RESULTS
  One hundred twenty patients with available follow-up had no sonographic evidence of intrauterine pregnancy. Fifty-nine (49%) had ectopic pregnancy. An endometrial 3-layer pattern was noted sonographically in 15 patients (13%), of whom 6 (40%) had ectopic pregnancy. As a diagnostic sign of ectopic pregnancy, the endometrial 3-layer pattern had a sensitivity of 10.2%, specificity of 85.2%, positive predictive value of 40%, negative predictive value of 50.5%, and accuracy of 49.2%.
  
  
  CONCLUSIONS
  The endometrial 3-layer pattern is neither sensitive nor specific for the diagnosis of ectopic pregnancy.
authors.affiliation: Department of Radiology, University Hospital and New Jersey Medical School, Newark 07103, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Wachsberg
authors.forename: S
authors.initials: S
authors.lastname: Karimi
mesh_terms: D000328:Adult; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal