CHICAGO -- The exact state of the uterus 1 year after global endometrial ablation with Nova-Sure is largely unknown, but certain characteristics are beginning to emerge, Robert Sabbah, M.D., reported at the annual meeting of the AAGL.
Even though global endometrial ablation is becoming increasingly common, radiologists are hard-pressed to describe their findings as there are no data available to allow adequate correlation between ultrasound images, hysteroscopic images, and uterine cavity endometrial sampling.
In addition, there are no clear treatment guidelines for women who have continuous bleeding after global endometrial ablation, he said.
One of the first rules to emerge is that abnormal bleeding after endometrial ablation should always be investigated first with transvaginal rather than transab-dominal ultrasound, said Dr. Sabbah, director of obstetrics and gynecology at Sacred Heart Hospital and professor of obstetrics and gynecology at the University of Montreal.
Transabdominal ultrasound does not properly identify normal endometrial thickening or echogenicity.
Secondly, irregular slight thickening of the endometrial stripe can be simply islets of residual tissue in the cavity.
Dr. Sabbah came to these conclusions based on an ongoing prospective study in which the uteri of 45 women were evaluated with both transvaginal and transabdominal ultrasound 1 year after NovaSure (Cytyc Corp., Palo Alto, Calif.) endometrial ablation. In select cases, the women went on to hysteroscopy or were evaluated with magnetic resonance imaging if the ultrasound appearance of the uterus was abnormal.
On average, the women were aged 44 years and had two children each.
Of the 45 women, 27 (60%) were totally amenorrheic, 15 (33%) had spotting, and 3 (7%) had no improvement with the ablation.
A total of 38 patients had a totally normal echogenic stripe--a more accurate term post ablation than endometrium--and, of these, 8 had myomas.
Three patients had suspicion of islets of residual endometrium due to the focal thickening of the echogenic stripe and echogenic appearance, three had abnormal endometrial images compatible with adenomyosis or postablation alterations, and one patient had a possible synechia.
There were no abnormal pathologies.
In none of the cases did the echogenic stripe exceed 6 mm in thickness by transvaginal ultrasound.
Physicians should read the ultrasound of a premenopausal woman who has undergone endometrial ablation as if she were a postmenopausal patient, and should always expect to find an echogenic stripe of 6 mm or less, he said.
"If you have anything above that, worry and go to hysteroscopy," he said.
Abnormal echogenic stripes or enterogenous myometrium are suggestive of adenomyosis and should be followed by MRI, which is more sensitive and better defines the uterine cavity than ultrasound.
Finally, the preferred method for endometrial stripe should be hysteroscopy and dilation and curettage. Hysteroscopy can confirm the benign nature of ultrasound anomalies, scarring, synechia, and fibrotic tissue in most cases, he said.
BY PATRICE WENDLING
COPYRIGHT 2005 International Medical News Group
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