The Role of Ultrasound in Endometrial Cancer

Endometrial cancer is the most common gynecologic malignancy in developed countries. The vast majority of cases occur after menopause, with postmenopausal bleeding being the presenting symptom in 95% of the cases. The use of transvaginal ultrasonography (TVS) is the sin e qua non in the assessment of these women. The finding of endometrial thickness of 5 mm or more is associated with increased likelihood for endometrial cancer, and should prompt further investigations. In cases with confirmed endometrial cancer, MRI and ultrasound are used to assess the depth of invasion to the myometrium and the cervical stroma. Recent studies have shown that – in experienced hands - a combination of gray-scale ultrasound with color and/or power Doppler examination has comparable results to that of MRI in the estimation of cancer invasion ≥ 50% in the myometrium or in the cervical stroma. Lack of uniformity in objective measurements is the main problem that hampers our ability to correctly predict myometrial or cervical stroma invasion with ultrasound. However, ultrasound is cheap, easy to perform and more readily available than any other imaging modality. The present article examines the use of gray-scale and Doppler ultrasound imaging in estimating the risk of endometrial cancer