Abstract:
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Purpose: To determine the accuracy of the trilaminar endometrial pattern as a predictor for the diagnosis of ectopic pregnancy.
Methods and Materials: A 3 year prospective study of 441 patients with a potential diagnosis of ectopic pregancy, based upon a positive pregnancy test and clinical presentation with vaginal bleeding and/or pelvic pain. We excluded all patients with an intrauterine gestational sac documented on the initial ultrasound exam. We recorded the endometrial thickness and pattern, any additional sonographic findings and the patient's final outcome. The Chi square test was used to compare frequencies, and student's t-test and Analysis of Variance were used to compare means. The ROC curve was used to assess the ability of the endometrial thickness to diagnose or exclude ectopic pregnancy.
Results: 441 patients were initially enrolled. The final diagnosis was indeterminate in 38 patients (8.6%) who were excluded, leaving 403 patients in the final study group. The beta-hCG level was comparable in all diagnostic groups. In the 403 patients, the trilaminar endometrial pattern had a specificity of 94 % and a sensitivity of 38 % for the diagnosis of ectopic pregnancy. The positive predictive value was 92%. The endometrial thickness was thinner in patients with ectopic pregnancy compared to patients with other diagnosis (mean = 9.5mm +/- 5.67 vs. 12.9mm +/- 8.37, p= 0.000) but the ROC curve for the endometrial thickness failed to identify a cutoff value useful for the diagnosis of ectopic pregnancy. (Area under the curve = 0.365 {0.308-0.422}, p=0.000).
Conclusion: The trilaminar endometrial pattern is highly predictive but insensitive for the diagnosis of ectopic pregnancy. The endometrial thickness was not helpful in the diagnosis of ectopic pregnancy.
Questions about this event email: sjohnso@med.wayne.edu
Johnson MD, S,
Role of Sonographic Endometrial Pattern in the Diagnosis of Ectopic Pregnancy. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3102137.html
