title: Thin endometrial echo complex on ultrasound does not reliably exclude type 2 endometrial cancers.
abstract: OBJECTIVE
  The objective of this study was to determine the ultrasonographic characteristics of the uterus and endometrial echo-complex (EEC) of postmenopausal patients diagnosed with type 2 endometrial cancer, including uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC), and other endometrial high-grade carcinomas (HGC).
  
  
  METHODS
  Postmenopausal patients with type 2 endometrial cancer who underwent preoperative pelvic ultrasound were identified. Histologic diagnoses were made by biopsy or hysterectomy. Ultrasound reports were abstracted for the following parameters: EEC thickness, presence of intracavitary fluid or lesion, myometrial mass, uterine size, and adnexal mass. Ultrasound films were re-reviewed by a single gynecologic ultrasonographer.
  
  
  RESULTS
  Fifty-two patients with detailed ultrasound reports comprised the study population. Twenty-six films were available for re-review and inter-examiner agreement was 92%. Forty-four women (85%) presented with abnormal vaginal bleeding. Thirty-four patients (65%) had a thickened EEC measuring >5 mm. In 9 cases (17%), the EEC measured <4 mm. In an additional 9 patients (17%) the EEC was indistinct. One or more other ultrasound abnormalities were found in each of the 18 cases with a non-thickened EEC: intracavitary fluid or lesion (8; 44%), myometrial mass (12; 67%), enlarged uterus (13; 72%), or adnexal mass (5; 28%).
  
  
  CONCLUSIONS
  A thin or indistinct endometrial stripe, especially when associated with other ultrasound abnormalities does not reliably exclude type 2 endometrial cancer. Postmenopausal vaginal bleeding requires endometrial sampling despite a thin EEC in the presence of other ultrasonographic abnormalities or persistent bleeding.
authors.affiliation: UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1740, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Cecilia
authors.initials: C
authors.lastname: Wieslander
authors.forename: Gail
authors.initials: G
authors.lastname: Hansen
authors.forename: Ilana
authors.initials: I
authors.lastname: Cass
authors.forename: Steven
authors.initials: S
authors.lastname: Vasilev
authors.forename: Christine H
authors.initials: CH
authors.lastname: Holschneider
mesh_terms: D000290:Adnexa Uteri / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging