In Part I we looked at evaluating endometrial thickness in premenopausal woman. In Part II, we will look at evaluating endometrial thickness with ultrasound in further detail.
Evaluating Endometrial Thickness in Postmenopausal Women
For post-menopausal endometrium there are some differing opinions, but generally I think that most authors would agree, or most examiners would agree, that up to 8 mm in a post menopausal woman who is not bleeding is normal. This is not a bleeding patient. And in fact, some radiologists would say up to 11 mm is normal.
If the woman is bleeding, then I would say that 5 mm is the upper limit of normal. Some radiologists will say 4 mm is the upper limit of normal.
Now this is not normal endometrium for post menopausal women. That endometrium is atrophic. It is abnormal endometrium, and that is why the patient is bleeding, because her endometrium is atrophic. The importance being that if you sample this endometrium with a Pipelle, you get back insufficient tissue for diagnosis. So the gynecologist doesn’t know where they stand.
So it is very valuable, when you do a sonogram, you identify atrophic endometrium, endometrium under 5 mm or under 4 mm, and even though that’s a pathologic diagnosis, it means that the patient almost certainly does not have endometrial carcinoma.
With endometrial carcinoma, you’re still using that 5 mm cut-off, but quite often, it’s a really horrendous looking thing. You will see this gigantic mass inside of the patient’s uterus which constitutes the endometrial carcinoma.
You will also want to pay close attention to focal thickenings of the endometrium. So here we have very thin endometrium but all of a sudden it becomes focally thickened. These are either usually and most commonly endometrial polyps, but occasionally they are submucous myomas.
Submucous myomas shadow, endometrial polyps do not.
Submucous myomas have multiple vessels that feed them, while endometrial polyps have single vessels.
What you do want to ask for this in this instance is a sonohysterogram, so that you can identify the lesion as a focal abnormality, identify its location in the uterus and the size of its base. When you see that lesion hysteroscopically it will give you a much better image of the lesion.
Author: Roy A. Filly, MD
Diagnostic Imaging Review: For Residents, Fellows and Radiologists
Female Pelvis Section
Tags: abnormal endometrium, ALL, CT, diagnosing endometriosis, diagnostic, Diagnostic Imaging, endometrial cancer, endometrial carcinoma, Endometrial Thickness, endometriosis, female pelvis, imaging, MI, NEC, PE, polyps, rad, radiologist, scanning, sonogram, TTE, ultrasound