When is endometrial carcinoma included in the differential diagnoses of abnormal uterine bleeding (AUB) and how is it ruled out?

Updated: Dec 07, 2018
  • Author: Millie A Behera, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Rule out endometrial carcinoma in all patients at high risk for the condition, including patients with the following characteristics:

  • Morbid obesity

  • Diabetes or chronic hypertension

  • Age >35 years

  • Longstanding, chronic eugonadal anovulation

Traditionally, carcinoma was ruled out by endometrial sampling via dilation and curettage (D&C). More recently, endometrial sampling in the office via aspiration, curetting, or hysteroscopy has become popular and is also relatively accurate.

Real-time ultrasonographic measurement and evaluation of the endometrial stripe can be helpful in distinguishing individuals bleeding with thick endometrium from those with thin, denuded endometrium, endometrial polyps, uterine fibroids, or other uterine pathology.

Saline-infusion sonohysterography is also very useful in evaluating for intracavitary (submucosal) fibroids and endometrial polyps.

Most endometrial biopsy specimens will show proliferative or dyssynchronous endometrium.


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