title: Sonographic Evaluation for Endometrial Polyps: The Interrupted Mucosa Sign.
abstract: OBJECTIVE
  To evaluate the interrupted mucosa sign for identification of endometrial polyps, using pathologic confirmation as the reference standard, compared to other accepted sonographic findings.
  
  
  METHODS
  We reviewed 195 patients referred for pelvic sonographic evaluations for suspected endometrial polyps in this retrospective Institutional Review Board-approved study. Of these, 82 had tissue sampling of the endometrium and constituted the final study group. Patient data, including age, menopausal status, last menstrual period, and final pathologic diagnosis, were recorded. Sonograms were reviewed by 2 blinded board-certified radiologists for endometrial features, including thickness, echogenicity, vascularity, presence of a mass, and the interrupted mucosa sign. Descriptive statistics and multivariate logistic regression analysis were performed.
  
  
  RESULTS
  The mean age of the patients was 44.99 (SD, 9.88) years, 79.1% of whom were premenopausal. Pathologic diagnosis confirmed polyps in 58 (70.73%). A single feeding vessel was visualized in 36 patients with polyps (62.07%), whereas the interrupted mucosa sign was visualized in 34 (58.62%). The presence of a feeding vessel, the interrupted mucosa sign, or both detected 48 (82.76%) of the polyps. In the multivariate analysis, only the interrupted mucosa sign was a statistically significant predictor of pathologic diagnosis of a polyp (P= .035), with an odds ratio of 3.83 (95% confidence interval, 1.10-13.29). Other sonographic findings were not independent predictors of a polyp: mass (P = .35), single feeding vessel (P = .31), endometrial thickness (P = .88), and endometrial echogenicity (P = .45). The sensitivity, specificity, and positive predictive value of the interrupted mucosa sign were 59%, 75%, and 85%, respectively.
  
  
  CONCLUSIONS
  The interrupted mucosa sign is a promising sonographic sign for identification of endometrial polyps, with greater predictive power than previously described signs. It has the potential to improve the diagnostic performance of sonography, especially when used in combination with other described signs.
authors.affiliation: Department of Radiology, Stanford University Medical Center, Stanford California USA kamaya@stanford.edu.
authors.forename: Aya
authors.initials: A
authors.lastname: Kamaya
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente, Santa Clara, CA.
authors.forename: Pauline Chang
authors.initials: PC
authors.lastname: Yu
authors.affiliation: Virtual Radiologic Professionals, LLC, Eden Prairie, Minnesota USA.
authors.forename: Carla Ramas
authors.initials: CR
authors.lastname: Lloyd
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford California USA.
authors.forename: Bertha H
authors.initials: BH
authors.lastname: Chen
authors.affiliation: Department of Radiology, Stanford University Medical Center, Stanford California USA.
authors.forename: Terry S
authors.initials: TS
authors.lastname: Desser
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Maturen
mesh_terms: D000328:Adult; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D004717:Endometrium / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D011127:Polyps / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: dysfunctional uterine bleeding; endometrial polyp; feeding vessel; gynecologic ultrasound; interrupted mucosa; pedicle artery sign