Transvaginal saline hysterosonography: characteristics distinguishing malignant and various benign conditions

• Published in: American journal of roentgenology (1976) Vol. 172; no. 6; pp. 1513 - 1520
• Main Authors: Laifer-Narin, SL, Ragavendra, N, Lu, DS, Sayre, J, Perrella, RR, Grant, EG
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.06.1999; American Roentgen Ray Society
• Subjects: Adult; Biological and medical sciences; Contrast Media; Diagnosis, Differential; Discriminant Analysis; Endosonography - instrumentation; Endosonography - methods; Endosonography - statistics & numerical data; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Postmenopause; Premenopause; Retrospective Studies; Sodium Chloride; Tumors; Uterine Diseases - diagnostic imaging; Uterine Neoplasms - diagnostic imaging; Uterus - diagnostic imaging; Vagina; Sonography; Human; Malignant tumor; Differential diagnostic; Retrospective; Female genital diseases; Vaginal route; Uterus; Echography; Uterine diseases; Female; Benign neoplasm; Saline solution
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.172.6.10350282

The objective of this study is to establish criteria for distinguishing endometrial polyps, submucosal leiomyomas, endometrial hyperplasia, and endometrial carcinoma on saline hysterosonography. Sixty-three saline hysterosonograms with histologic confirmation were retrospectively analyzed. We found 26 endometrial polyps, 16 submucosal leiomyomas, three endometrial hyperplasias, one abnormal endometrium associated with a sloughed polyp, one pseudopolyp, and three endometrial carcinomas; 15 sonograms revealed no abnormality. In two patients, sonography revealed both polyps and submucosal leiomyomas. The sonographic appearance of these abnormalities was analyzed to define criteria for their diagnosis. Twenty-five of 26 polyps were uniformly echogenic with smooth borders and either had a stalk or formed acute angles with underlying endometrium. Sixteen of 16 submucosal leiomyomas showed heterogeneous echogenicity; however, 13 were sessile and three were pedunculated. Endometrial hyperplasia was manifested by wall thickening in two patients and tiny polypoid excrescences in one patient. In all patients with endometrial carcinoma, the endometrial cavities were poorly distensible despite successful cervical os cannulation. All patients with abnormalities other than endometrial carcinoma had fully distensible uterine cavities. Malignant and various benign endometrial conditions may be accurately distinguished on saline hysterosonography. Uniformity of echogenicity distinguished all polyps from submucosal leiomyomas, but the angulation formed with the endometrial wall by the intracavitary mass did not distinguish all polyps from submucosal leiomyomas. Lack of distensibility of the endometrial canal is a potential sign of endometrial carcinoma.