Objective. The objective of this study was to determine the ultrasonographic characteristics of the uterus and endometrial echo- complex (EEC) of postmenopausal patients diagnosed with type 2 endometrial cancer, including uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC), and other endometrial high- grade carcinomas (HGC). Methods. Postmenopausal patients with type 2 endometrial cancer who underwent preoperative pelvic ultrasound were identified. Histologic diagnoses were made by biopsy or hysterectomy. Ultrasound reports were abstracted for the following parameters: EEC thickness, presence of intracavitary fluid or lesion, myometrial mass, uterine size, and adnexal mass. Ultrasound films were re-reviewed by a single gynecologic ultrasonographer. Results. Fifty- two patients with detailed ultrasound reports comprised the study population. Twenty- six films were available for rereview and inter- examiner agreement was 92% . Forty- four women (85% ) presented with abnormal vaginal bleeding. Thirty- four patients (65% ) had a thickened EEC measuring > 5 mm. In 9 cases (17% ), the EEC measured < 4 mm. In an additional 9 patients (17% ) the EEC was indistinct. One or more other ultrasound abnormalities were found in each of the 18 cases with a non- thickened EEC: intracavitary fluid or lesion (8; 44% ), myometrial mass (12; 67% ), enlarged uterus (13; 72% ), or adnexal mass (5; 28% ). Conclusion. A thin or indistinct endometrial stripe, especially when associated with other ultrasound abnormalities does not reliably exclude type 2 endometrial cancer. Postmenopausal vaginal bleeding requires endometrial sampling despite a thin EEC in the presence of other ultrasonographic abnormalities or persistent bleeding. Objective. The objective of this study was to determine the ultrasonographic characteristics of the uterus and endometrial echo-complex (EEC) of postmenopausal patients diagnosed with type 2 endometrial cancer, including uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC) and other endometrial high grade carcinomas (HGC). Methods. Postmenopausal patients with type 2 endometrial cancer who underwent preoperative pelvic ultrasound were identified. Histologic diagnoses were made by biopsy or hysterectomy. Ultrasound reports were abstracted for the following parameters: EEC thickness, presence of intracavitary fluid or lesion, myometrial mass, uterine size, and adnexal mass. Ultrasound films were re-reviewed by a single gynecologic ultrasonographer. Results. Fifty-two patients with detailed ultrasound reports comprised the study population. Twenty- six films were available for rereview and inter-examiner agreement was 92%. Forty- four women (85%) presented with abn Thirteen patients (17%), the EEC measured <4 mm. In an additional 9 patients (17%) the EEC was indistinct. One or more other ultrasound abnormalities were found in each of the 18 cases with a non-thickened EEC: intracavitary fluid or lesion (8; 44%), myometrial mass (12; 67%), enlarged uterus or adnexal mass. (5; 28%). Conclusion. A thin or indistinct endometrial stripe, especially when associated with other ultrasound abnormalities does not sure exclude type 2 endometrial cancer. Postmenopausal vaginal bleeding requires endometrial sampling with a thin EEC in the presence of other ultrasonographic abnormalities or persistent bleeding.