Deborah Levine

The Sonographic Appearance of Endometrial Intraepithelial Neoplasia

ObjectivesTo describe the sonographic findings of endometrial intraepithelial neoplasia (EIN), a precursor of endometrial cancer.MethodsCases were found by word search of pathology database 1/2013 to 6/2019. One hundred and seventy‐eight patients with ultrasound <1 year prior to biopsy were included. Medical records were searched for patient data. Two radiologists blindly classified images. Differences of opinion were decided by clinical report. Univariate and multivariate analyses were performed.ResultsMedian time between ultrasound and first sampling procedure was 49 days. Median age was 55 (range 28–85) years. Endometrial thickness ranged from 2 to 90 mm. Mean endometrial thickness was 13 ± 6 mm in the noncancer group and 16 ± 11 mm in the cancer group (P = .02). The endometrium was almost always heterogeneous 175/178 (98%). Cysts were almost always multiple (89/109, 82%) and >1 mm (72/109, 66%). Masses were most often >5 mm (56/105, 55%) and ill‐defined (41/105, 39%). Vascularity was present in 93/178 examinations (52%) and always associated with cysts and/or mass. There were 92 cancers, 25 with invasion (including 4 with tumor extension into adenomyosis). In 47 cases, the endometrial‐myometrial interface was graded as ill‐defined, 39 of whom had hysterectomy. There was macroscopic cancer in 11, microscopic cancer in 4, and invasive carcinoma in 12 patients (P for invasive cancer versus other outcomes = .02). Depth of invasion was 5‐ >95%, with 6 cancers >50%. Multivariate analysis showed thickness, polyps, and type of bleeding as the best set of independent variables for cancer (area under the receiver operating characteristic (ROC) curve [AUC] = .75). Replacing type of bleeding with age or menopausal status had AUC of .73 and .74, respectively.ConclusionsEIN has a variety of sonographic appearances with thickened endometrium with cysts and masses being common. Ill‐definition of the endometrial‐myometrial interface is a poor prognostic finding when seen in the absence of adenomyosis.

Ovarian Cystadenomas: Growth Rate and Reliability of Imaging Measurements

ObjectivesTo evaluate the growth rate of benign ovarian cystadenomas and the degree of variability in ultrasound measurements.MethodsTwo independent retrospective cohorts of women found to have benign cystadenomas at surgery were identified. To assess growth rate, ultrasounds on women in a community‐based health system were reviewed and the growth rate was determined based on the maximum reported size dimension using a mixed effect model. To assess measurement variability, two radiologists independently measured presurgical adnexal imaging findings for women in a tertiary care referral setting. Interobserver, intra‐observer, and intermodality (cine clip versus still images) variability in measurements was determined using correlation coefficients (CC) and Bland–Altman analysis, with the proportion of measurements varying by more than 1 cm calculated.ResultsFor growth rate assessment, 405 women with 1412 ultrasound examinations were identified. The median growth rate was 0.65 cm/year with mucinous cystadenomas growing faster at 0.83 cm/year compared to 0.51 cm/year for serous cystadenomas (median test P < .0001). To evaluate measurement variability, 75 women were identified with 176 ultrasound studies. The within‐subject standard deviations for ultrasound measurements were 0.74 cm for cine clip images and 0.41 cm for static images, with 11% of measurements overall differing by more than 1 cm.ConclusionsCystadenomas grow on average 0.65 cm/year, which is similar in magnitude to the inherent error observed in measurement on ultrasound, suggesting that repeat ultrasound at intervals of longer than a year will often be needed to accurately assess growth if a cyst represents a benign cystadenoma.