Brief Answer:
detailed explanation given below.
Detailed Answer:
Hello and welcome back,
It is difficult to extrapolate the findings. They have to be viewed in relation to the history and examination and also comparing the probabilities of common versus uncommon causes. You are correct that a homogenous mass is more likely to be benign compared to a heterogenous and vascularity may indicate malignancy. So we cannot draw a line that heterogenous is malignant and homogenous is not.
Also many benign masses show these features, and the probability of benign is always more than malignant as they are more common. So even with these features, benign masses are more common than malignant.
The risk of 6-7% that I quoted was also based upon thick endometrium and not other features as they overlap between benign and malignant.
Conditions like cystic
hyperplasia, glandular hyperplasia etc will show heterogeneity and may also show increased vascularity. There are many overlapping features between hyperplasia and cancer and
ultrasound is not the investigation for choice to confirm the diagnosis. It only suggests that the endometrium is thick. Beyond that other features are non specific. Even Thickness is non specific as it is seen in hyperplasia conversely there are many cases of cancer endometrium that are seen with endometrial thickness less than 5mm. So ultrasound is used as a guide for us, that if there is a thickening then a
biopsy is needed.
I do understand that you are worried and want to know the risk. But it is not always possible for us to give numbers as every case is different and there are no tables to stratify risks for every condition. So I am extremely sorry that I am unable to be more specific in this regard.
As of now, we may say that there is a slight risk [ more than the general population ] considering the age, absent pregnancies and thick endometrium. So please get a biopsy done to clarify matters. No amount of speculations will yield results and a hysteroscopic biospy will settle the matter. Please do not
stress yourself.
I hope I am able to help you this time.
I know the matter is important for you and I share your concern.
Please feel free to ask any further queries and I will be happy to help.
Dr Madhuri