Endometrial Polyp / Intracavitary Lesion Imaging

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] TVUS focal sign → SIS/hysteroscopy
   TVUS focal sign → SIS / hysteroscopy? (An endometrial polyp = focal overgrowth of glands + stroma, often causing AUB; risk factors tamoxifen/obesity/HRT. TVUS: focal hyperechoic endometrial thickening or an oval intracavitary mass, may be isoechoic to endometrium (occult); a single feeding vessel on color Doppler (feeding-vessel sign) is specific (~95%). Best imaged in the early proliferative phase (days 3–7, thin endometrium).)
   • TVUS focal lesion + feeding-vessel sign (suspected polyp) → Suspected polyp · confirm by SIS/hysteroscopy
   • Diffuse thickening / hard to define focality / differentiate submucosal fibroid → Diffuse/unclear · SIS to distinguish
2. [End] Suspected polyp · confirm by SIS/hysteroscopy
   TVUS focal lesion + single feeding vessel (suspected polyp): SIS (saline infusion sonography) is the imaging gold standard — a polyp is a smooth hyperechoic intracavitary mass, pedunculated or broad-based, outlined by fluid; hysteroscopy is the diagnostic gold standard (direct view + concurrent resection/pathology).
3. [End] Diffuse/unclear · SIS to distinguish
   Diffuse thickening/unclear focality/differentiate submucosal fibroid: SIS distinguishes focal vs diffuse — a polyp (intact endometrium-myometrium interface, single feeding vessel, acute angle with endometrium, homogeneous echo) vs submucosal fibroid (interface disruption, branching vascularity, obtuse angle, heterogeneous echo); focal lesion → targeted hysteroscopy, diffuse → blind sampling acceptable.

Source guidelines & references

• Endometrial polyp imaging and SIS (Radiology Key; PMC 2019)
• SIS vs TVUS vs hysteroscopy for diagnosing endometrial polyps meta-analysis (PMC 2020) · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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