{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T22:52:31Z","timestamp":1788648751087,"version":"build-2803163510"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Ultrasonography is essential for diagnosing endometrial pathologies, such as hyperplasia, polyps, and endometrial cancer. The International Endometrial Tumor Analysis (IETA) group provides guidelines for using ultrasound to assess endometrial thickness, texture, and irregularities, aiding in the diagnosis of these conditions. The aim of this study was to evaluate the utility of various endometrial morphological features, as assessed by gray-scale ultrasound, and endometrial vascular features, as assessed by power Doppler ultrasound, in differentiating benign and malignant endometrial pathologies. A secondary objective was to compare the effectiveness of these ultrasound techniques in assessing myometrial invasion. Methods: A total of 162 women, both pre- and postmenopausal, with or without abnormal vaginal bleeding were enrolled in a prospective study. All participants underwent transvaginal gray-scale and color Doppler ultrasound examinations, conducted by examiners with over 15 years of experience in gynecological ultrasonography. Endometrial morphology and vascularity characteristics were evaluated based on the IETA group criteria, which include parameters such as endometrial uniformity, echogenicity, the three-layer pattern, regularity of the endometrial\u2013myometrial border, Doppler color score, and vascular pattern (single dominant vessel with or without branching, multiple vessels with focal or multifocal origin, scattered vessels, color splashes, and circular flow). Sonographic findings were compared with histopathological results for comprehensive assessment. Results: The mean age of the study population was 56.46 \u00b1 10.84 years, with a range from 36 to 88 years. Approximately 53.08% of the subjects were postmenopausal. The mean endometrial thickness, as measured by transvaginal ultrasonography, was 18.02 \u00b1 10.94 mm with a range of 5 to 64 mm (p = 0.028), and it was found to be a significant predictor of endometrial malignancy. The AUC for the ROC analysis was 0.682 (95% CI: 0.452\u20130.912), with a cut-off threshold of 26 mm, yielding a sensitivity of 62.5% and a specificity of 89%. Vascularization was absent in 68.4% of patients with polyps. Among the cases with submucosal myomas, 80% exhibited a circular flow pattern. Malignant lesions were identified in 22.84% of the cases. Subjective ultrasound assessment of myometrial invasion, categorized as &lt;50% or \u226550%, corresponded in all cases with the histopathological evaluation, demonstrating the effectiveness of ultrasound in evaluating myometrial invasion in endometrial cancer. Conclusions: In this study, cystic atrophic endometrium was identified as the most prevalent cause of postmenopausal bleeding. The most significant ultrasound parameters for predicting malignancy included heterogeneous endometrial echogenicity, increased endometrial thickness, and the presence of multiple vessels with multifocal origins or scattered vascular patterns. Additionally, color Doppler blood flow mapping was demonstrated to be an effective diagnostic tool for the differential diagnosis of benign intrauterine focal lesions.<\/jats:p>","DOI":"10.3390\/diagnostics15070891","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T16:26:31Z","timestamp":1743611191000},"page":"891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Role of Ultrasound in Diagnosing Endometrial Pathologies: Adherence to IETA Group Consensus and Preoperative Assessment of Myometrial Invasion in Endometrial Cancer"],"prefix":"10.3390","volume":"15","author":[{"given":"Mihaela Camelia","family":"T\u00eernovanu","sequence":"first","affiliation":[{"name":"Department of Mother and Child Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"\u201cCuza Vod\u0103\u201d Women\u2019s Clinical Hospital, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7859-840X","authenticated-orcid":false,"given":"Elena","family":"Cojocaru","sequence":"additional","affiliation":[{"name":"Department of Morphofunctional Sciences I\u2014Pathology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad Gabriel","family":"T\u00eernovanu","sequence":"additional","affiliation":[{"name":"Saint Josef Hospital, 65189 Wiesbaden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Morphofunctional Sciences I\u2014Histology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2624-8890","authenticated-orcid":false,"given":"\u0218tefan Drago\u0219","family":"T\u00eernovanu","sequence":"additional","affiliation":[{"name":"\u201cSaint Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"},{"name":"Department of Surgery II\u2014Orthopedics and Traumatology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3994-6579","authenticated-orcid":false,"given":"Ludmila","family":"Lozneanu","sequence":"additional","affiliation":[{"name":"Department of Morphofunctional Sciences I\u2014Histology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8969-8016","authenticated-orcid":false,"given":"Razvan","family":"Socolov","sequence":"additional","affiliation":[{"name":"Department of Mother and Child Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"\u201cElena Doamna\u201d Women\u2019s Clinical Hospital, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorana","family":"Anton","sequence":"additional","affiliation":[{"name":"Department of Mother and Child Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"\u201cCuza Vod\u0103\u201d Women\u2019s Clinical Hospital, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-0859","authenticated-orcid":false,"given":"Roxana","family":"Covali","sequence":"additional","affiliation":[{"name":"\u201cElena Doamna\u201d Women\u2019s Clinical Hospital, 700038 Iasi, Romania"},{"name":"Department of Medical Bioscience, Faculty of Bioengineering, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"Toma","sequence":"additional","affiliation":[{"name":"\u201cElena Doamna\u201d Women\u2019s Clinical Hospital, 700038 Iasi, Romania"},{"name":"Department of Medical Bioscience, Faculty of Bioengineering, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/tog.12150","article-title":"Endometrial pathology in postmenopausal women\u2014An evidence based approach to management","volume":"17","author":"Otify","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S0002-9378(11)90683-8","article-title":"Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding","volume":"163","author":"Goldstein","year":"1990","journal-title":"Am. J. Obs. 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