Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding

Research output: Contribution to journalArticle


Objective: To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology. Methods: This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology. Results: The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19–92 years), median parity was 2 (range, 0–10) and median body mass index was 24.9 kg/m2 (range, 16.0–72.1 kg/m2). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0–5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4–3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2–1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6–3.4%)) cases with a single vessel without branching on unenhanced ultrasound. Conclusions: The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely.


  • T. Van Den Bosch
  • J. Y. Verbakel
  • L. Wynants
  • B. De Cock
  • M. A. Pascual
  • F. P.G. Leone
  • J. L. Alcazar
  • A. Votino
  • R. Fruscio
  • C. Lanzani
  • C. Van Holsbeke
  • A. Rossi
  • L. Jokubkiene
  • M. Kudla
  • A. Jakab
  • E. Domali
  • E. Epstein
  • C. Van Pachterbeke
  • T. Bourne
  • B. Van Calster
  • D. Timmerman
External organisations
  • University Hospitals Leuven
  • Catholic University of Leuven
  • Skåne University Hospital
  • Maastricht University
  • University Hospital Brugmann
  • University of Milano-Bicocca
  • Hospital Oost-Limburg
  • University of Udine
  • Medical University of Silesia
  • National and Kapodistrian University of Athens
  • Karolinska Institutet
  • Queen Charlotte's and Chelsea Hospital
  • USP Dexeus University Institute
  • University of Milan
  • University Clinic of Navarra
  • San Gerardo Hospital
  • University of Debrecen
  • Alexandra Hospital, Athens
  • Södersjukhuset
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine
  • Radiology, Nuclear Medicine and Medical Imaging


  • cancer, diagnosis, endometrium, hyperplasia, IETA, leiomyoma, polyp, sonohysterography, ultrasonography
Original languageEnglish
Pages (from-to)164-172
Number of pages9
JournalUltrasound in Obstetrics and Gynecology
Issue number1
Publication statusPublished - 2021
Publication categoryResearch