Cervical cancer differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]
Overview
Cervical cancer must be differentiated from other diseases that cause abnormal vaginal bleeding, such as cervical polyp, cervical leiomyoma, invasion of the cervix from primary uterine malignancy, vaginal cancer, cervical lymphoma, metastases to cervix, and cervical ectopic pregnancy.
Cervical cancer differential diagnosis
- Cervical cancer must be differentiated from a mass involving the cervix, and causing abnormal vaginal bleeding:[1][2][3]
- Cervical polyp
- Cervical leiomyoma
- Cervical lymphoma
- Cervical sarcoma
- Metastases to the cervix
- Cervical ectopic pregnancy
- Cervicitis
- Cervical erosion ( Ectropion )
- IUD use
- Pelvic inflammatory disease
- Endometriosis
- Adenomyosis
- Nabothian cyst
Abnormal Uterine bleeidng differential diagnosis | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ob-Gyn neoplasm and diseases | Clinical manifestations | Para-clinical findings | Gold standard | ||||||||||||||
Symptoms | Physical exam | Lab Findings | Imaging | Histopathology | |||||||||||||
Abnormal
vaginal bleeding |
Other Genitourinary/ Gastrointestinal symptoms | Abdominal pain | Pelvic
pain |
B symptoms | Gynecological examinations | Abdominal
mass |
HPV
Pap smear STI panel |
Other labs | Ultrasound | Other
imagings | |||||||
Cervical cancer[4][5][6][7][8][9][10][11] |
|
|
+ |
+ | + |
|
+ | ± HPV |
|
|
T2-weighted MRI :
|
Cervical intraepithelial neoplasia:
|
|||||
Cervical polyp[12] |
|
− | − | − |
|
− | − |
|
|
|
|||||||
Cervical leiomyoma[13][14][15][16][17][18][19][20][21] |
|
|
+ | + | − |
|
±
|
− |
|
T2-weighted MRI:
enhancement
|
|
| |||||
Cervical lymphoma[22][23][24] |
|
+ | + | + |
|
+ | Pap smear: | Immunohistochemistry markers: |
|
MRI:
|
|
| |||||
Cervical sarcoma[25][26][27][28] |
|
|
+ | + | ± |
|
+ | − | Leiomyosarcoma markers: |
|
MRI:
|
|
|||||
Cervical erosion(Ectropion)[29][30][31][32][33] |
|
|
+ | + | − |
|
− | − | N/A | N/A | N/A |
|
|
||||
Cervicitis[34][35][36][37][38] |
|
|
+ | + |
|
|
− | STI panel: |
|
MRI:
May be detected as retention cysts in cervix. |
|
||||||
Endometriosis[39][40][41][42][43][44][45] |
|
|
+ | − |
|
+ | − |
(limited value) |
|
|
|
|
|||||
Pelvic inflammatory diseases[46][47][48][49] |
|
|
+ |
|
|
− | STI panel: |
|
Ultrasound:
|
MRI findings:
|
|
| |||||
Adenemyosis[50][51][52][53][54][55] |
|
|
+ | + | − |
|
|
− |
|
|
MRI:
|
|
| ||||
Cervical ectopic pregnancy[56][57] |
|
+ | − | − |
|
± | − |
|
|
T2-weighted MRI:
T1-weighted MRI:
|
|
| |||||
Vaginal cancer[58][59][60][61] |
|
+ | + | ± |
|
|
|
|
Ultrasound:
|
MRI:
|
Biopsy findings:
|
||||||
Paget's disease of vulva to cervix[62][63][64][65][66] |
|
|
− | − | −
|
|
− | − |
|
N/A | MRI:
|
|
| ||||
Nabothian cyst[67][68][69][70] |
|
|
|
− | − |
|
− | − | N/A |
|
T1-weighted
|
|
| ||||
IUD use[71][72][73] |
|
|
+
|
+ | − |
|
− | − |
|
|
N/A | N/A |
References
- ↑ Mwaka, Amos D.; Orach, Christopher G.; Were, Edward M.; Lyratzopoulos, Georgios; Wabinga, Henry; Roland, Martin (2016). "Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda". Health Expectations. 19 (4): 854–867. doi:10.1111/hex.12382. ISSN 1369-6513.
- ↑ Donovan, Kristine A.; Boyington, Alice R.; Judson, Patricia L.; Wyman, Jean F. (2014). "Bladder and bowel symptoms in cervical and endometrial cancer survivors". Psycho-Oncology. 23 (6): 672–678. doi:10.1002/pon.3461. ISSN 1057-9249.
- ↑ Kim, Soo Hyun; Kang, Sokbom; Kim, Yong-Man; Kim, Byoung-Gie; Seong, Seok Ju; Cha, Soon Do; Park, Chan-Yong; Yun, Young Ho (2010). "Prevalence and Predictors of Anxiety and Depression Among Cervical Cancer Survivors in Korea". International Journal of Gynecological Cancer. 20 (6): 1017–1024. doi:10.1111/IGC.0b013e3181e4a704. ISSN 1048-891X.
- ↑ Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.
- ↑ Dunyo, Priscilla; Effah, Kofi; Udofia, Emilia Asuquo (2018). "Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study". BMC Public Health. 18 (1). doi:10.1186/s12889-018-6065-6. ISSN 1471-2458.
- ↑ Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
- ↑ . doi:10.1097/PAS.0000000000000498. Check
|doi=
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(help) - ↑ Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.
- ↑ Alcázar, Juan Luis; Arribas, Sara; Mínguez, José Angel; Jurado, Matías (2014). "The Role of Ultrasound in the Assessment of Uterine Cervical Cancer". The Journal of Obstetrics and Gynecology of India. 64 (5): 311–316. doi:10.1007/s13224-014-0622-4. ISSN 0971-9202.
- ↑ Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
- ↑ Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
- ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
- ↑ Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.
- ↑ Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.
- ↑ Houser, L. Murray; Carrasco, C. H.; Sheehan, C. R. (1979). "Lipomatous tumour of the uterus: radiographic and ultrasonic appearance". The British Journal of Radiology. 52 (624): 992–993. doi:10.1259/0007-1285-52-624-992. ISSN 0007-1285.
- ↑ Keriakos, Remon; Maher, Mark (2013). "Management of Cervical Fibroid during the Reproductive Period". Case Reports in Obstetrics and Gynecology. 2013: 1–3. doi:10.1155/2013/984030. ISSN 2090-6684.
- ↑ Coronado GD, Marshall LM, Schwartz SM (May 2000). "Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study". Obstet Gynecol. 95 (5): 764–9. PMID 10775744.
- ↑ Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.
- ↑ El-agwany, Ahmed Samy (2015). "Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma". The Egyptian Journal of Radiology and Nuclear Medicine. 46 (1): 211–213. doi:10.1016/j.ejrnm.2014.10.001. ISSN 0378-603X.
- ↑ Chaparala RP, Fawole AS, Ambrose NS, Chapman AH (March 2004). "Large bowel obstruction due to a benign uterine leiomyoma". Gut. 53 (3): 386, 430. PMC 1773948. PMID 14960521.
- ↑ Yokoyama Y, Shinohara A, Hirokawa M, Maeda N (2003). "Erythrocytosis due to an erythropoietin-producing large uterine leiomyoma". Gynecol. Obstet. Invest. 56 (4): 179–83. doi:10.1159/000074104. PMID 14564105.
- ↑ Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E (1999). "Malignant lymphoma of the cervix. An unusual presentation and a rare disease". Eur. J. Gynaecol. Oncol. 20 (1): 26–8. PMID 10422676.
- ↑ Kanaan, Daniel; Parente, Daniella Braz; Constantino, Carolina Pesce Lamas; Souza, Rodrigo Canellas de (2012). "Linfoma de colo de útero: achados na ressonância magnética". Radiologia Brasileira. 45 (3): 167–169. doi:10.1590/S0100-39842012000300009. ISSN 0100-3984.
- ↑ Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, Rubin SC, Nasta SD (September 2006). "Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature". Leuk. Lymphoma. 47 (9): 1894–901. doi:10.1080/10428190600687653. PMID 17065003.
- ↑ Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK (November 2005). "Cervical sarcomas: an analysis of incidence and outcome". Gynecol. Oncol. 99 (2): 348–51. doi:10.1016/j.ygyno.2005.06.021. PMID 16051326.
- ↑ Khosla, Divya; Gupta, Ruchi; Srinivasan, Radhika; Patel, Firuza D.; Rajwanshi, Arvind (2012). "Sarcomas of Uterine Cervix". International Journal of Gynecological Cancer. 22 (6): 1026–1030. doi:10.1097/IGC.0b013e31825a97f6. ISSN 1048-891X.
- ↑ Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA (December 2015). "Imaging Features of Uncommon Gynecologic Cancers". AJR Am J Roentgenol. 205 (6): 1346–59. doi:10.2214/AJR.14.12695. PMC 5502476. PMID 26587944.
- ↑ . doi:10.1097/IGC.0b013e31825a97f6. Check
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(help) - ↑ Mitchell L, King M, Brillhart H, Goldstein A (September 2017). "Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis". Sex Med. 5 (3): e212–e214. doi:10.1016/j.esxm.2017.03.001. PMC 5562466. PMID 28460993.
- ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
- ↑ Sharma, Abhishek; Ojha, Ranapratap; Sengupta, Parama; Chattopadhyay, Sarbani; Mondal, Soumit (2013). "Cervical intramural pregnancy: Report of a rare case". Nigerian Medical Journal. 54 (4): 271. doi:10.4103/0300-1652.119670. ISSN 0300-1652.
- ↑ . doi:10.12865/CHSJ.42.02.11. Missing or empty
|title=
(help) - ↑ Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
- ↑ Mattson SK, Polk JP, Nyirjesy P (July 2016). "Chronic Cervicitis: Presenting Features and Response to Therapy". J Low Genit Tract Dis. 20 (3): e30–3. doi:10.1097/LGT.0000000000000225. PMID 27243142.
- ↑ Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.
- ↑ Meyer T (August 2016). "Diagnostic Procedures to Detect Chlamydia trachomatis Infections". Microorganisms. 4 (3). doi:10.3390/microorganisms4030025. PMID 27681919.
- ↑ Woods, Jennifer L.; Bailey, Sarabeth L.; Hensel, Devon J.; Scurlock, Amy M. (2011). "Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?". Journal of Pediatric and Adolescent Gynecology. 24 (6): 359–364. doi:10.1016/j.jpag.2011.06.006. ISSN 1083-3188.
- ↑ Jayakumar, Naveen Kumar Bhagavathula (2015). "Cervicitis: How Often Is It Non-specific!". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2015/11594.5673. ISSN 2249-782X.
- ↑ Hsu AL, Khachikyan I, Stratton P (June 2010). "Invasive and noninvasive methods for the diagnosis of endometriosis". Clin Obstet Gynecol. 53 (2): 413–9. doi:10.1097/GRF.0b013e3181db7ce8. PMC 2880548. PMID 20436318.
- ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
- ↑ Datta S, Kunde K (July 2008). "From vaginal discharge to endometriosis: an unusual case of endometriosis in pregnancy". J Obstet Gynaecol. 28 (5): 552–3. doi:10.1080/01443610802247352. PMID 18850447.
- ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
- ↑ Bedaiwy MA, Falcone T (February 2004). "Laboratory testing for endometriosis". Clin. Chim. Acta. 340 (1–2): 41–56. PMID 14734195.
- ↑ Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D (June 2010). "Endometriomas: their ultrasound characteristics". Ultrasound Obstet Gynecol. 35 (6): 730–40. doi:10.1002/uog.7668. PMID 20503240.
- ↑ . doi:10.1148/rg.314105193. Check
|doi=
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(help) - ↑ Hoenderboom BM, van Benthem B, van Bergen J, Dukers-Muijrers N, Götz HM, Hoebe C, Hogewoning AA, Land JA, van der Sande M, Morré SA, van den Broek I (January 2019). "Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial". Sex Transm Infect. doi:10.1136/sextrans-2018-053778. PMID 30606817. Vancouver style error: initials (help)
- ↑ Jaiyeoba O, Soper DE (2011). "A practical approach to the diagnosis of pelvic inflammatory disease". Infect Dis Obstet Gynecol. 2011: 753037. doi:10.1155/2011/753037. PMC 3148590. PMID 21822367.
- ↑ Czeyda-Pommersheim, Ferenc; Kalb, Bobby; Costello, James; Liau, Joy; Meshksar, Arash; Arif Tiwari, Hina; Martin, Diego (2016). "MRI in pelvic inflammatory disease: a pictorial review". Abdominal Radiology. 42 (3): 935–950. doi:10.1007/s00261-016-1004-4. ISSN 2366-004X.
- ↑ Mitchell, Caroline; Prabhu, Malavika (2013). "Pelvic Inflammatory Disease". Infectious Disease Clinics of North America. 27 (4): 793–809. doi:10.1016/j.idc.2013.08.004. ISSN 0891-5520.
- ↑ Filip G, Balzano A, Cagnacci A (November 2018). "Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance". Minerva Ginecol. doi:10.23736/S0026-4784.18.04291-0. PMID 30486633.
- ↑ Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K (December 1992). "Acute abdomen due to adenomyosis of the uterus: a case report". Asia Oceania J Obstet Gynaecol. 18 (4): 333–7. PMID 1492806.
- ↑ Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K (December 1992). "Acute abdomen due to adenomyosis of the uterus: a case report". Asia Oceania J Obstet Gynaecol. 18 (4): 333–7. PMID 1492806.
- ↑ Zhou Y, Wu B, Li H (October 1996). "[The value of serum CA125 assays in the diagnosis of uterine adenomyosis]". Zhonghua Fu Chan Ke Za Zhi (in Chinese). 31 (10): 590–3. PMID 9275451.
- ↑ Tamai, Ken; Togashi, Kaori; Ito, Tsuyoshi; Morisawa, Nobuko; Fujiwara, Toshitaka; Koyama, Takashi (2005). "MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls". RadioGraphics. 25 (1): 21–40. doi:10.1148/rg.251045060. ISSN 0271-5333.
- ↑ Dartmouth, Katherine (2014). "A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis". Ultrasound. 22 (3): 148–157. doi:10.1177/1742271X14528837. ISSN 1742-271X.
- ↑ Mouhajer M, Obed S, Okpala AM (June 2017). "Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis". Ghana Med J. 51 (2): 94–97. PMC 5611908. PMID 28955106.
- ↑ Rathod, Setu; Samal, SunilKumar (2015). "Cervical ectopic pregnancy". Journal of Natural Science, Biology and Medicine. 6 (1): 257. doi:10.4103/0976-9668.149221. ISSN 0976-9668.
- ↑ Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstet Gynecol Int. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.
- ↑ Miccò, Maura; Sala, Evis; Lakhman, Yulia; Hricak, Hedvig; Vargas, Hebert Alberto (2015). "Imaging Features of Uncommon Gynecologic Cancers". American Journal of Roentgenology. 205 (6): 1346–1359. doi:10.2214/AJR.14.12695. ISSN 0361-803X.
- ↑ Kim, Hwi-Gon; Song, Yong Jung; Na, Yong Jin; Choi, Ook-Hwan (2013). "A Case of Vaginal Cancer with Uterine Prolapse". Journal of Menopausal Medicine. 19 (3): 139. doi:10.6118/jmm.2013.19.3.139. ISSN 2288-6478.
- ↑ Karateke A, Tugrul S, Yakut Y, Gürbüz A, Cam C (2006). "Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report". Eur. J. Gynaecol. Oncol. 27 (5): 528–30. PMID 17139994.
- ↑ van der Linden, M.; Meeuwis, K.A.P.; Bulten, J.; Bosse, T.; van Poelgeest, M.I.E.; de Hullu, J.A. (2016). "Paget disease of the vulva". Critical Reviews in Oncology/Hematology. 101: 60–74. doi:10.1016/j.critrevonc.2016.03.008. ISSN 1040-8428.
- ↑ Lloyd J, Evans DJ, Flanagan AM (July 1999). "Extension of extramammary Paget disease of the vulva to the cervix". J. Clin. Pathol. 52 (7): 538–40. PMC 501500. PMID 10605411.
- ↑ Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ (January 2010). "Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course". Int. J. Gynecol. Pathol. 29 (1): 69–78. doi:10.1097/PGP.0b013e3181b1cc5e. PMID 19952933.
- ↑ Asmouki, Hamid; Oumouloud, Rachid; Aboulfalah, Abderrahim; Soummani, Abderraouf; Marrat, Abdelouahed (2012). "Paget's Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report". Case Reports in Oncological Medicine. 2012: 1–4. doi:10.1155/2012/854827. ISSN 2090-6706.
- ↑ Gonçalves Amorim, Andressa; Batista Fraga Mendes, Brunelle; Neves Ferreira, Rodrigo; Chambô Filho, Antônio (2015). "Paget Disease of the Vulva: Diagnosis by Immunohistochemistry". Case Reports in Dermatological Medicine. 2015: 1–5. doi:10.1155/2015/162483. ISSN 2090-6463.
- ↑ Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
- ↑ Bin Park, Sung; Lee, Jong Hwa; Lee, Young Ho; Song, Mi Jin; Choi, Hye Jeong (2010). "Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation". American Journal of Roentgenology. 195 (2): 517–523. doi:10.2214/AJR.09.3619. ISSN 0361-803X.
- ↑ Torky, Haitham A. (2016). "Huge Nabothian cyst causing Hematometra (case report)". European Journal of Obstetrics & Gynecology and Reproductive Biology. 207: 238–240. doi:10.1016/j.ejogrb.2016.10.042. ISSN 0301-2115.
- ↑ Okamoto, Yoshikazu; Tanaka, Yumiko O.; Nishida, Masato; Tsunoda, Hajime; Yoshikawa, Hiroyuki; Itai, Yuji (2003). "MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation". RadioGraphics. 23 (2): 425–445. doi:10.1148/rg.232025065. ISSN 0271-5333.
- ↑ Trobough GE (March 1978). "Pelvic pain and the IUD". J Reprod Med. 20 (3): 167–74. PMID 347074.
- ↑ Nowitzki, Kristina M.; Hoimes, Matthew L.; Chen, Byron; Zheng, Larry Z.; Kim, Young H. (2015). "Ultrasonography of intrauterine devices". Ultrasonography. 34 (3): 183–194. doi:10.14366/usg.15010. ISSN 2288-5919.
- ↑ . doi:10.5489/cuaj.11100. Check
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