Diagnostic performance of sonohysterography and MRI diffusion in benign endometrial lesion characterization

Abstract Objectives To assess pretreatment endometrial abnormalities in newly diagnosed, nontreated histologically documented breast cancer patients using sonohysterography and MRI diffusion. Methods In a prospective study, 45 women with histologically documented newly diagnosed non treated breast cancer and abnormal endometrium was detected by transvaginal and/or abdominal US, sonohysterography and MRI diffusion was used for further characterization of the type of endometrial lesion (non-pathologic endometrium, endometrial hyperplasia, polyp, sub mucous myoma, or malignancy). Results compared with final histopathological diagnosis reached by hysteroscopy, endometrial biopsy or surgical findings as gold standard. Results Transvaginal and/or abdominal US showed an abnormally thick endometrium in the studied non treated breast cancer patients, sonohysterography and MRI diffusion were done for all patients. The diagnostic performance of sonohysterography for 3 main endometrial abnormalities (i.e. endometrial hyperplasia, polyps and submucous myoma) was 95%, sensitivity, 90% specificity, 89% Positive predictive values, 94% negative predictive values, and accuracy 95%, while MRI diffusion with ADC cut off value1.15 × 10 −3  mm 2 /s, showed 96% sensitivity, 94% specificity 98% negative predictive values and 99% positive predictive value and accuracy 91%. Best results were seen in cases of submucous myoma where sensitivity and specificity of both techniques reached to 100%. There was 91%, 93% agreement between HSG, MRI diffusion and histopathological results respectively (p = 0.002). Conclusion High incidence of occult endometrial lesions in breast cancer patients in dependent of tamoxifen therapy, suggests pretreatment endometrial assessment. HSG is accurate in discrimination between focal and diffuse endometrial lesions, and help making a decision for either hysteroscopy or directed biopsy, but cannot reliably differentiate benign and malignant lesions. MRI DWI is accurate noninvasive method in distinguishing benign from malignant endometrial lesions which need further evaluation by biopsy. We recommend that HSG can be used as an initial investing technique in cases of endometrial abnormalities, however in cases of failed HSG or biopsy, MRI diffusion can provide an efficient alternative tool to exclude malignancy.