Ailyn Mariela Vidal  Urbinati,Anna Daniela  Iacobone,Davide Radice,Dorella  Franchi,Eleonora Petra  Preti,Raffaela Di  Pace,Sara Boveri,Vanna  Zanagnolo,
Role of transvaginal ultrasonography in the management of young patients affected by atypical endometrial hyperplasia
Journal of Surgical Oncology
2019
2674-3000
http://dx.doi.org/10.31487/j.JSO.2019.01.005
https://www.sciencerepository.org/role-of-transvaginal-ultrasonography-in-the-management-of-young-patients-affected-by-atypical-endometrial-hyperplasia_JSO-2019-1-105 
Abstract: 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.Keywords: Endometrial cancer, atypical endometrial hyperplasia, conservative treatment, transvaginal ultrasonography