OPTIMIZATION OF EARLY ULTRASOUND DIAGNOSIS OF ENDOMETRIAL CANCER: A COMPREHENSIVE ASSESSMENT OF SONOGRAPHIC FEATURES IN COMBINATION WITH UTERINE BLEEDING TYPE AND GYNECOLOGICAL STATUS
Gazhonova V.E.1, Akopyan E.G.2, Antonova I.B.3, Tsallagova Z.S.3
1 - Central State Medical Academy, Administrative Department of the President of the Russian Federation.
2 - Clinical and Diagnostic Center Medsi on Belorusskaya, Medsi Group of Companies.
3 - Russian Scientific Center of Roentgenology and Radiology. Moscow, Russia.
Purpose. To optimize the early ultrasound diagnosis of endometrial cancer (EC) at the primary outpatient stage by introducing additional ultrasound and clinical predictors. The research focused on a comprehensive assessment of the endometrial structure in correlation with menopausal status (premenopause/postmenopause), the type of abnormal uterine bleeding (AUB) in premenopause, and the presence or absence of postmenopausal bleeding (PMB).
Materials and methods. A retrospective single-center study was conducted involving 47 patients with verified EC (18 in premenopause, 29 in postmenopause) and 119 patients with benign endometrial pathology. Two main study groups (patients with AUB in premenopause and with PMB in postmenopause) and two control groups (50 patients in premenopause and 50 in postmenopause without endometrial pathology) were formed. All patients underwent comprehensive transvaginal ultrasound (TVUS) assessing endometrial thickness and structure, its contours, and vascularization. The ultrasound data were analyzed in conjunction with gynecological status, the type of uterine bleeding, and anamnestic factors. Statistical data processing was performed using the MedCalc software package.
Results. Premenopausally, a key ultrasound predictor of EC was found to be irregular and indistinct endometrial contours, which were not observed in benign processes. The most prognostically significant type of AUB for EC in this group was irregular uterine bleeding (88.88% of cases), while intermenstrual bleeding was more often associated with polyps. The combination of sonographic features with an irregular AUB type demonstrated high diagnostic efficacy (sensitivity 97.5%, specificity 98.3%). In postmenopause, for patients with PMB, the median endometrial thickness in EC was 13.06 mm, and the most significant sonographic signs were heterogeneous structure with cystic inclusions (61.1%) and irregular contours (50,0%). In asymptomatic postmenopausal patients, the threshold value of endometrial thickness for EC risk was lower than the commonly accepted standard (9.94 mm), and a more reliable predictor than the absolute value was its uneven thickness (72.7% of cases). Vascularization correlated with endometrial thickness and was not an independent early predictor.
Conclusion. This study demonstrates that to improve the effectiveness of early endometrial cancer diagnosis, it is necessary to go beyond the assessment of endometrial thickness alone. A comprehensive ultrasound approach, stratified by gynecological status and the type of uterine bleeding, is of key importance. Combining specific sonographic features (irregular contours, heterogeneous structure) with clinical data (irregular AUB pattern in premenopause, presence/absence of PMB) can significantly increase diagnostic accuracy at the primary care level and contribute to earlier detection of the disease.
Keywords: endometrial cancer, ultrasound examination, transvaginal sonography, abnormal uterine bleeding, postmenopausal bleeding, endometrial thickness.
Corresponding author: Gazhonova V.E., e-mail: e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Gazhonova V.E., Akopyan E.G., Antonova I.B, Tsallagova Z.S. Optimization of early ultrasound diagnosis of endometrial cancer: a comprehensive assessment of sonographic features in combination with uterine bleeding type and gynecological status. REJR 2026; 16(1):80-92. DOI: 10.21569/2222-7415-2026-16-1-80-92.
Received: 01.12.25 Accepted: 14.01.26