Comparative study between the Diagnostic Accuracy of 3D – power Doppler Ultrasound and Office Hysteroscopy in predicting Endometrial Carcinoma in Patients with postmenopausal Bleeding

Abstract

Backgroud: Using two – dimensional (2D)/three dimensional (3D) transvaginal ultrasound, the sonographic appearance of endometrial cancer is significantly associated with tumor stage, grade and size. More advanced tumors often have a mixed/hypoechoic echogenicity, a higher color score and multiple globally entering vessels, whereas less advance tumors are more often hyperechoic and have no or a low color score. Objectives: The aim of this work was to compare the predictive value of 3D power Doppler ultrasound in endometrial carcinoma (by measuring endometrial thickness, and vascular indices namely velocity index, flow index and velocity flow index) with hysteroscopy with endometrial biopsy in patients with postmenopausal bleeding. Study design: One hundred forty patients with postmenopausal bleeding and endometrial thickness ≥ 4.5 mm were included after full explanation of the procedure and verbal consent from them. 3D power Doppler ultrasound in the ultrasound unit using Volusen E6 General Electric where the endometrial thickness was measured. In those patients who show endometrial thickness ≥ 4.5 mm, endometrial volume was measured along with the vascularization indices Vascularization index (VI), flow index (FI), and vascularization flow index (VFI) Office hysteroscopy was performed one week later in the early cancer detection unit. Results: Forty seven patients (33.6%) were diagnosed to have endometrial carcinoma and ninety three (66.4%) have benign endometrium . Both endometrial thickness and volume were significant predictors. The median values of 3D power Doppler indices of endometrial blood flow (VI, FI and VFI) were all significantly higher in women who had malignant lesions when compared to those who had benign lesions. ROC curves were constructed for estimating the validity of 3D Power Doppler indices of endometrial blood flow in prediction of high-grade malignant endometrial lesion. Hysteroscopic findings of intrauterine mass, hypervascularization, hypervascular thick endometrium or hypervascular intrauterine mass were significantly associated with histopathological diagnosis of malignant lesions. Conclusion: Based on our results we can conclude that 3D-PD ultrasound has a high predictive value in discrimination between benign and malignant endometrial lesions in patients with postmenopausal bleeding. Despite the predictive value of 3D-PD ultrasound still hysteroscopy, histopathology examination of endometrial biopsy, is the golden role for prediction of endometrial malignant lesions and it is highly advisable in patient with postmenopausal bleeding and endometrial thickness > 4.5 mm. Key words: 3D-power Doppler ultrasound, Postmenopausal bleeding, Endometrial Thickness, Endometrial vascular indices, hysteroscopy, Endometrial carcinoma.