Assessment of the accuracy of endometrial volume and Doppler vascular indices in predicting endometrial carcinoma in women with postmenopausal bleeding

Abstract

Bleeding after menopause is a widespread problem, with 10%-15% of cases later suffering from cancer of the endometrium. It differs from other malignancies, in that early symptomatization is common, allowing early cure. Survival drops with late stages and so studies should strive to increase the precision of various diagnostic practices. Finding a thin endometrium measuring less than 5mm by vaginal scanning in PMB excludes about 99% of endometrial cancers. Sampling of the endometrium is considered necessary in those patients with an endometrium ≥5 mm. However, many “normal” women with PMB and thickened endometria will undergo unnecessary diagnostic procedures. Three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) is a novel sonographic diagnostic modality. This technology permits acquisition of the volume of the endometrium and assessment of its vasculature using 3D power Doppler mapping. During study period, 73 women with postmenopausal bleeding were evaluated at Ain Shams University Maternity hospital. Sixteen patients were excluded due to: endometrial thickness less than5 mm, use of tamoxifen or hormone replacement therapy, and no definitive histological diagnosis. Fifty seven women were included ultimately. Summary 77 For each patient, full history, general, abdominal and pelvic examinations were performed. Routine pre-operative investigations were done. All patients were subjected to transvaginal ultrasound, 3D PDA and endometrial sampling by dilatation and curettage (D&C) under general anesthesia after a written consent and pathological examination of the specimens was obtained. Division according to endometrial pathology into 2 groups was done. Group 1 included 22 patients with malignant endometria. Group 2 included 35 patients with benign endometria. As regards the measurement of endometrial volume, in our study there was a statistical significance in comparison of both groups; in group 1 endometrial volume was 4.99±3.60cc while in group 2 it was 2.26±1.63cc, p-value<0.001. When discussing power Doppler indices : VI, FI and VFI were significantly higher in endometrial cancer, compared with benign diseases. However the ultimate discriminator between noncancerous and cancerous endometrium was the endometrial thickness, with an AUC of 0.94.