Follow-Up Labs for Endometrial Mass
For patients with an endometrial mass, the recommended follow-up laboratory tests should include complete blood count, liver and renal function tests, and collection of peritoneal fluid/washings during surgical staging, as these provide essential baseline information for diagnosis and treatment planning. 1, 2
Initial Diagnostic Evaluation
When an endometrial mass is identified, the following diagnostic approach is recommended:
Laboratory Tests
- Complete blood count (CBC) 1, 2
- May show anemia if abnormal bleeding is present
- Elevated mean corpuscular volume (MCV) has been associated with endometrial carcinoma 3
- Liver function tests 1
- Renal function tests 1
- Pregnancy test (in women of childbearing age) 4
- Coagulation studies (prothrombin time and partial thromboplastin time) if bleeding is heavy 4
Imaging Studies
- Transvaginal ultrasound (TVUS) as the initial imaging modality 2
- Measurement of endometrial thickness (cut-off point of 3-4 mm) 1
- Contrast-enhanced dynamic MRI if cervical involvement is suspected 1, 2
- Superior to both ultrasound and CT for local disease assessment
- 85-88% accuracy for assessing cervical involvement
Tissue Sampling
- Endometrial biopsy using Pipelle or Vabra devices (sensitivity 99.6% and 97.1%, respectively) 1
- Hysteroscopy with biopsy if needed for definitive diagnosis 1
Surgical Staging and Additional Labs
If endometrial cancer is confirmed, surgical staging is recommended, which includes:
- Collection of peritoneal fluid or washings for cytology 1, 2
- Total hysterectomy with bilateral salpingo-oophorectomy 1, 2
- Thorough exploration of abdominal cavity 1, 2
- Assessment of pelvic and para-aortic lymph nodes 1, 2
- Omentectomy in high-risk cases (especially for serous carcinomas) 1, 2
Post-Treatment Follow-Up
After treatment, follow-up should be structured as follows:
- Clinical and gynecological examinations every 3-4 months for the first 3 years 2
- Every 6 months during the fourth and fifth years 2
- Annually thereafter 2
Important Considerations
- Most recurrences occur within the first 3 years after treatment 2, 5
- The majority of recurrences are symptomatic 5
- Routine technical examinations such as PAP smears or systematic radiography have unproven benefit 2
Special Considerations
- For patients with suspected Lynch syndrome (hereditary non-polyposis colorectal carcinoma), which accounts for up to 5% of endometrial cancers, universal testing for mismatch repair genes is recommended 1, 2
- Patients with hormone receptor-positive tumors may benefit from hormone level monitoring if treated with medroxyprogesterone acetate 2
Common Pitfalls to Avoid
- Failing to consider patient factors (obesity, uterine position) that may limit TVUS accuracy 2
- Not correlating imaging findings with histological grade and other risk factors 2
- Overlooking the possibility of Lynch syndrome in younger patients with endometrial cancer 2
- Relying solely on endometrial thickness measurement without subsequent endometrial sampling 1
By following this structured approach to follow-up labs and diagnostic testing, clinicians can ensure appropriate evaluation and management of patients with endometrial masses, potentially improving early detection of malignancy and optimizing treatment outcomes.