Imaging of endometrial lesion

Introduction & Background: The main role of imaging of endometrium is to differentiate between normal and abnormal endometrium and triage patients to those patients requiring guided biopsy vs. those patients that can be managed by blind biopsy. Endometrial thickness of 5mm has been proven to be a reliable threshold to ex-clude endometrial cancer. Transvaginal sonography (TVS) can detect focal pathology in most cases. Endo-metrial polyp and submucosal fibroid (SMF) have distinguishing features on TVS. Endometrial polyp is recog-nized by the presence of a complete endometrial stripe sign. SMF presenting as endometrial mass shows stretched overlying endometrium and continuity with myometrium as specific features. Sonohysterography (SHG) is indicated when TVS is suboptimal or inconclusive as well as for staging of SMF prior to surgery. Hys-teroscopic removal of SMF requires that more than 50% of the mass is intracavitary. Some technical points re-lated to SHG and the mechanism and sonographic changes of endometrium due to tamoxifen are also dis-cussed. An algorithm is presented for sonographic-based assessment of endometrial thickening.