Mandatory medical device diagnostics.
- Transvaginal ultrasonography (ultrasound examination) – for basic diagnostics, in particular endometrial ultrasonography (ultrasound examination of the endometrium) [in postmenopausal women with uterine bleeding (bleeding from the uterus) applies to endometrial thickness (thickness of the endometrium)
- ≤ 3 mm: endometrial cancer must be excluded with a high degree of certainty (threshold of 3 mm, sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e. a positive test result occurs) of 97% (95% CI 94.5-99.6%); specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy in the test) 45.3% (95% CI 43.8-46.8%)))procedure [S3 guideline]:
- For first-time postmenopausal bleeding (bleeding after which the last bleeding has been absent for at least one year) and an endometrial thickness ≤ 3 mm, a sonographic and clinical control examination should first be performed in three months.
- In case of increase in endometrial thickness or persistence of symptoms, histological (fine tissue) clarification is required.
- > 5 mm: suspect (2008 guideline); American College of Obstetricians and Gynaecologists (ACOG) recommends a threshold of 4 mm]
- In asymptomatic patients on tamoxifen therapy, transvaginal ultrasonography should not be performed for early detection of endometrial carcinoma [S3 guideline]….
In histologically confirmed endometrial carcinoma, transvaginal ultrasound is performed to assess myometrial and cervical infiltration.
- ≤ 3 mm: endometrial cancer must be excluded with a high degree of certainty (threshold of 3 mm, sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e. a positive test result occurs) of 97% (95% CI 94.5-99.6%); specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy in the test) 45.3% (95% CI 43.8-46.8%)))procedure [S3 guideline]:
- Hysteroscopy (uteroscopy) with fractionated abrasion – uteroscopy including scraping of the uterine cavity to obtain endometrium for histological (fine tissue) examination/pathology [gold standard].
- Endometrial biopsy using suction technique, so-called pipelle method (outpatient, can be performed without anesthesia).
- X-ray of the thorax (X-ray thorax / chest), in two planes – for staging.
- Abdominal ultrasonography (ultrasound examination of the abdominal organs) – to exclude urinary retention or metastasis in the upper abdomen.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Laparoscopy (abdominal endoscopy) – for suspected ovarian/tubular carcinoma (ovarian/fallopian tube cancer).
- Cystoscopy (urinary bladder endoscopy)* – if urinary bladder infiltration is suspected.
- Rectoscopy (rectoscopy)* – if intestinal wall infiltration is suspected.
- Skeletal scintigraphy (procedure of nuclear medicine, which is a special recording technique of scintigraphy, which can precisely show functional changes in the skeletal system) – in case of reasonable suspicion of distant metastasis (settlement of tumor cells from the place of origin via the blood / lymphatic system to a distant location in the body and there grow new tumor tissue).
- Magnetic resonance imaging of the abdomen (abdominal MRI)/pelvis (pelvic MRI) – for implementation planning of radiation therapy.
* To exclude a stage FIGO IVa.
