Role of transvaginal ultrasonography in the management of young patients affected by atypical endometrial hyperplasia

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Author Info

Ailyn Mariela Vidal Urbinati Anna Daniela Iacobone Davide Radice Dorella Franchi Eleonora Petra Preti Raffaela Di Pace Sara Boveri Vanna Zanagnolo

Corresponding Author

Dorella Franchi
Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology IRCCS, Milan, Italy

A B S T R A C T

Purpose: To evaluate the efficacy of transvaginal ultrasonography (TVUS) as a tool for selection and prospective surveillance of patients younger than 40 years undergoing hormonal uterus-sparing therapy for atypical endometrial hyperplasia (AEH) and endometrial cancer (EC). Methods: From February 2006 to July 2014, patients younger than 40 with AEH and EC, referred to the European Institute of Oncology for conservative management, were enrolled in a prospective observational study, consisting of insertion of a levonorgestrel-releasing intrauterine device (LNG-IUD) for 1 year with GnRH analogue administration for 6 months. TVUS was performed every 3 months, to assess endometrial thickness, any signs of myometrial infiltration and ovarian morphology. Endometrial biopsy was performed at 6 and 12 months. Results: 16 patients with AEH and 32 with well-differentiated EC were enrolled. Myometrial infiltration was correctly identified in 6 cases of EC at instrumental pre-treatment evaluation (66.7% at TVUS and 66.7% at MRI). Overall the reduction of endometrial thickness was of 6.0±5.6 (52.6%) and 6.8±6.2 (59.6%) millimeters at 6 and 12 months, respectively, compared to baseline (P<0.001). Synchronous or metachronous early-stage ovarian cancer was observed in 10 patients (20.8%). Conclusions: TVUS might be a helpful tool in the pre-treatment assessment of myometrial infiltration and synchronous ovarian disease, and in the prospective surveillance of patients undergoing hormonal fertilitysparing therapy, however endometrial biopsy still remains the gold standard for the evaluation of response to conservative treatment.

Article Info

Article Type

Research Article

Publication history

Received: Mon 18, Feb 2019
Accepted: Mon 11, Mar 2019
Published: Thu 28, Mar 2019

Copyright

© 2023 Dorella Franchi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JSO.2019.01.005