# Non-invasive endometrial assessment: shear wave elastography in diagnosing endometrial hyperplasia

## TL;DR

This study shows that shear wave elastography can help diagnose endometrial hyperplasia non-invasively in premenopausal women with abnormal bleeding.

## Contribution

The study introduces shear wave elastography as a non-invasive diagnostic tool for endometrial hyperplasia with measurable predictive value.

## Key findings

- Highest-SWE had 85.9% sensitivity and 48.0% specificity for diagnosing endometrial hyperplasia.
- Mean-SWE and highest-SWE were significantly higher in hyperplasia groups than in normal endometrium.
- Body mass index, uterine free fluid, mean-SWE, and highest-SWE were independent predictors of hyperplasia.

## Abstract

Endometrial hyperplasia is a precursor lesion that may progress to endometrial carcinoma, particularly in cases with atypia. Early and accurate diagnosis is essential for timely intervention. The aim of the study was to evaluate the diagnostic performance of shear wave elastography in differentiating normal endometrium, non-atypical hyperplasia, and atypical hyperplasia in premenopausal women with abnormal uterine bleeding.

This prospective study included 235 premenopausal women over 45 years of age with abnormal uterine bleeding. All patients underwent transvaginal ultrasonography and shear wave elastography using a Toshiba Aplio 500 system. Five regions of interest were placed within heterogeneous endometrial areas, and mean shear wave elastography (mean-SWE) and highest shear wave elastography (highest-SWE) values were recorded. Histopathological evaluation was performed via probe curettage, and patients were categorized into three groups: normal endometrium, non-atypical hyperplasia, and atypical hyperplasia. Receiver operating characteristic curve analysis and logistic regression were conducted.

Mean-SWE and highest-SWE values were significantly higher in the hyperplasia groups compared to the normal endometrium group (p=0.021, p=0.001). Highest-SWE had the highest diagnostic accuracy (cut-off: 37.71 kPa, sensitivity: 85.9%, specificity: 48.0%). Logistic regression identified body mass index, uterine free fluid, mean-SWE, and highest-SWE as independent predictors of endometrial hyperplasia (p<0.05).

Shear wave elastography demonstrated significant potential as a non-invasive tool for diagnosing endometrial hyperplasia. Mean-SWE and highest-SWE were independent predictors, supporting shear wave elastography as a complementary method to transvaginal ultrasonography. Future research should optimize shear wave elastography protocols for gynecological assessments.