Endometrial cancer ultrasound
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General imaging guidelinesTransvaginal ultrasound is the initial imaging investigation of choice for patients presenting with the usual symptom of a postmenopausal bleed. A thickened endometrium requires endometrial sampling.
Staging of endometrial carcinoma is a based on the FIGO staging system, which is a surgical and pathological staging following total abdominal hysterectomy, salpingo-oopherectomy, lymphadenectomy and peritoneal washings. Such radical surgery may not be suitable in elderly patients or those with co-morbidities. MRI has role in these patients in determining tumour extent and suitable therapy.
Transvaginal ultrasound
Endometrial carcinoma usually appears as thickening of the endometrium though may appear as a polypoid mass
premenopausal: normal endometrial thickness varies through the menstrual cycle diagnosing abnormally thickened endometrium depends on knowing what the patient's point in the menstrual cycle
postmenopausal: >5 mm is thickened (if not on Tamoxifen)
Sonographic features are non specific and endometrial thickening can also be due to benign proliferation, endometrial hyperplasia or polyps.
Disruption of a subendometrial halo on ultrasound may be suggestive of myometrial involvement.