Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding

T. Van den Bosch*, J.Y. Verbakel, L. Valentin, L. Wynants, B. De Cock, M.A. Pascual, F.P.G. Leone, P. Sladkevicius, J.L. Alcazar, A. Votino, R. Fruscio, C. Lanzani, C. Van Holsbeke, A. Rossi, L. Jokubkiene, M. Kudla, A. Jakab, E. Domali, E. Epstein, C. Van PachterbekeT. Bourne, B. Van Calster, D. Timmerman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology.Methods: This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology.Results: The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m(2) (range, 16.0-72.1 kg/m(2) ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound.Conclusions: The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely. Copyright (C) 2020 ISUOG. Published by John Wiley & Sons Ltd.
Original languageEnglish
Pages (from-to)164-172
Number of pages9
JournalUltrasound in Obstetrics & Gynecology
Issue number1
Publication statusPublished - 1 Jan 2021


  • cancer
  • color doppler
  • diagnosis
  • endometrium
  • gray-scale
  • hyperplasia
  • ieta
  • leiomyoma
  • office
  • polyp
  • polyps
  • saline infusion sonography
  • sonohysterography
  • thickness
  • transvaginal ultrasonography
  • ultrasonography
  • IETA

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