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Why Is Ultrasound Test Repeated?

Posted on Thu, 27 Feb 2014

Question: I have had a couple d and c . Recent ultrasound at dr office he said showed 9.5 thickness mm, i had another ultrasound done and read by a radiologist this time, the trasvaginal pelvic ultrasound revealsca normal sized uterus measuring 6.2x3.2x3.4 well defined central uterine echo measuring 8mm demonstrating mild thickening , thevendometrial cavity appears empty. No evidence if free fluid . Assessment of the adnexa shows both ovaries to be ofva normal size. The impression wasmild prominence of the endometrial lining measuring 8mm in this post menopausal patient. One may like conservative followup with repeat transvaginal pelvic ultrasound in three months time. My question is the ob/gyn wants to do another d and c . I have stenosis. My ca 125 is 18. I am hesitant t go under general anesthesia if I do not have too. Your input will be appreciated. The d and c was 2 yrs ago, and no cancer. Thank you XXXX

Answered by Dr. Timothy Raichle (19 minutes later)

Brief Answer: Hello, I would be happy to help... Detailed Answer: Can you answer the following questions: 1. Why were the previous ultrasounds done? 2. Why was the most recent ultrasound done? 3. Did the D&C's show anything of concern, like "hyperplasia"? 4. Because of the stenosis, did they have problems doing the prior D&C's? 5. Were all of the D&C's done with you post-menopausal (i.e. when were they done)? Thank you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Timothy Raichle (1 hour later)

Ultrasounds done for postmenapausal Follow ups had endometrial thickness at one time 10mm Had an aunt on mom side had ovarian cancer Most recent ultrasound done to check endometrial lining D And c done 7/29/11 with hysteroscopy Results on d and c microscopic diagnosis on 7/29/11 was A. Endocervix curettage Blood admired with fragments of cervical tissue with mild chronic inflammation and a few fragments suggesting lower uterine segment negative for malignancy. B. endometrium curettage Polyploid fragments of endometrium demonstrating complex endometrial Hyperplasia without cytologuc atypica. A follow up endometrial biopsy was done I his office in 12/22/2011whuch showed no e dome trial hyperplasia. I was put on progesterone f 3 mos. post surgery. In was not due to see gyn until may but my primary doctor at annual physical showed a ca125 of 33 so he sent me to my gyn but a repeat ca 125 was not received at the time of appt til several days later and that repeat ca125 was 18. The gyn ultrasound is just a probe in vagina and only a few seconds , he said my endometrium was9.5 from last may of 9.1. I had an ultrasound. Few days ago done with GE LOGIQe and it was a though ultrasound read by a board certified radiologist Dr XXXXXXX Hoffman M D in Fla. I wrote you prior report. My question am I save at waiting 3 months for a repeat and putting off the surgery . I did think I once saw a s It of mucous blood but I had a uti at same time. I am an RN and I just do not want to have any unnecessary surgery. I had cone biopsy years ago which caused the stenosis. Thank you Anymore info you need ask me. He used ultrasound for the stenosis guidance and baby cervical rods All d an c postmenapause

Answered by Dr. Timothy Raichle (4 hours later)

Brief Answer: Thank you and sorry for the delay... Detailed Answer: First of all, CA125 is completely useless when evaluating the uterus. It is a marker of ovarian cancer which is unrelated to the current problem. So, I would not get too distracted by this lab. With regard to the uterus, I would boil the story down to this: At age 60, you were evaluated presumably for postmenopausal bleeding and underwent a hysteroscopy with D&C and this revealed a significant finding of "complex hyperplasia without atypia". You underwent 3 months of progesterone therapy and a followup endometrial biopsy revealed no hyperplasia. Actually, up to this point I think this was managed perfectly. Then you underwent a followup scan as described above that showed thickening of the endometrial lining and your GYN wants to do another D&C. Also, sampling in the office is likely made more difficult by your cervical stenosis. I actually agree with their plan and recommendation. The problem is that the cervical stenosis prevents your uterus from "telling you" there is a problem by bleeding. So you could have a recurrence of the same problem as before (complex hyperplasia) without any bleeding. This is a concerning situation. Given that the followup ultrasound showed abnormal thickening (yes 8-9mm in a postmenopausal woman with your history is abnormal), the BEST way to evaluate for uterine cancer or pre-cancerous hyperplasia is to take you to the OR where your cervix can be properly dilated and an excellent sample obtained. So in response to your original question, I agree with the recommendation to do a repeat D&C. Let me know if this helps. Again, I am sorry about the delay.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar