US Pelvis Transabdominal A combined transabdominal and transvaginal approach is most appropriate for pelvic US imaging. Transabdominal US is most helpful in the case of an enlarged uterus or uterine tumor, in which the limited field-of-view of TVUS cannot image all portions of the uterus or uterine tumor. US Pelvis Transvaginal If the initial imaging and clinical evaluation (eg, endometrial sampling) of women with AUB are negative, endometrial cancer in these women is extremely unlikely [10]. Nonetheless, repeat TVUS can be performed to reassess the endometrium, because endometrial cancers may be missed on initial imaging or endometrial sampling [59]. If on repeat imaging, the endometrium remains <4 mm in a postmenopausal woman, the negative predictive value for cancer is nearly 100% [10]. US Sonohysterography US sonohysterography, also referred to as hysterosonography, can be used in the setting of AUB, particularly if the initial TVUS demonstrates a focal endometrial abnormality [48]. The technique involves transcervical injection of sterile fluid, such as saline, in combination with routine TVUS [10,49]. Although some authors describe transcervical injection of gel [37], sterile saline is currently the accepted standard endometrial contrast agent [49]. The literature supports the use of US sonohysterography as an examination to further characterize endometrial observations on TVUS [48-51]. US sonohysterography can help distinguish between leiomyomas and endometrial polyps with pooled accuracies of 97% [51]. With the sonohysterographic features of an intact myometrial- endometrial interface, a single vessel, an acute angle with the endometrium, and a homogenous echogenicity, the likelihood ratio of an endometrial polyp is optimized, whereas the combined features of absent endometrial- myometrial interface, arborized vascular pattern, obtuse angle with the endometrium, and a heterogeneous echogenicity maximizes the likelihood ratio of an intracavitary or submucosal leiomyoma [50].
Abnormal Uterine Bleeding. US Pelvis Transabdominal A combined transabdominal and transvaginal approach is most appropriate for pelvic US imaging. Transabdominal US is most helpful in the case of an enlarged uterus or uterine tumor, in which the limited field-of-view of TVUS cannot image all portions of the uterus or uterine tumor. US Pelvis Transvaginal If the initial imaging and clinical evaluation (eg, endometrial sampling) of women with AUB are negative, endometrial cancer in these women is extremely unlikely [10]. Nonetheless, repeat TVUS can be performed to reassess the endometrium, because endometrial cancers may be missed on initial imaging or endometrial sampling [59]. If on repeat imaging, the endometrium remains <4 mm in a postmenopausal woman, the negative predictive value for cancer is nearly 100% [10]. US Sonohysterography US sonohysterography, also referred to as hysterosonography, can be used in the setting of AUB, particularly if the initial TVUS demonstrates a focal endometrial abnormality [48]. The technique involves transcervical injection of sterile fluid, such as saline, in combination with routine TVUS [10,49]. Although some authors describe transcervical injection of gel [37], sterile saline is currently the accepted standard endometrial contrast agent [49]. The literature supports the use of US sonohysterography as an examination to further characterize endometrial observations on TVUS [48-51]. US sonohysterography can help distinguish between leiomyomas and endometrial polyps with pooled accuracies of 97% [51]. With the sonohysterographic features of an intact myometrial- endometrial interface, a single vessel, an acute angle with the endometrium, and a homogenous echogenicity, the likelihood ratio of an endometrial polyp is optimized, whereas the combined features of absent endometrial- myometrial interface, arborized vascular pattern, obtuse angle with the endometrium, and a heterogeneous echogenicity maximizes the likelihood ratio of an intracavitary or submucosal leiomyoma [50].