Study of Endometrial Volume and Vascularity by Three Dimensional Power Doppler Ultrasound in Women with Perimenopausal Bleeding

Abstract

The purpose of this study is to evaluate the role of 3D - Power Doppler Angiography in the assessment of cases presented with abnormal uterine bleeding in the perimenopausal period and correlates it with histopathological examination of the performed endometrial biopsy to discriminate between benign and malignant endometrial lesions. This study was conducted between April 2013 and April 2014 in Ain Shams University Maternity Hospital, cases were recruited from the outpatient gynaecological clinic and 100 perimenopausal women were included in this study. All cases presented by abnormal uterine bleeding. Each patient was subjected to complete medical history, complete clinical examination, transvaginal ultrasound examination, 3-Dimensional Power Doppler examination and endometrial sampling for histopathological examination. Based on histopathological examination of endometrial tissue, patients of this study were represented in two main groups (A) Non-malignant group: it contained 94 patients with benign endometrial lesions categorized histopathologically to atrophic endometrium 62 patient, endometrial hyperplasia 16 patient [10 simple/ 6 complex], endometrial polyps 16 patients [14 simple/ 2 complex]. (B) Malignant group: it contained 6 patients with endometrial carcinoma. In the comaparison between non-malignant and malignant group, there was high statistical significant difference (P<0.001) as regards age, BMI, medical history for D.M and breast cancer, medication history for use of Tamoxifen and Oestrogen (HRT), endometrial thickness, endometrial resistive index, endometrial pulsatility index, endometrial volume, endometrial vascularization index, endometrial flow index and endometrial vascularization flow index. No statistical significant difference (P>0.05) was found between the two groups as regarding parity. In the malignant group, malignancy correlate positively with age (P<0.001), BMI (P<0.001), medical history for D.M (P<0.05) and breast cancer (P<0.05), medication history for use of Tamoxifen and Oestrogen (HRT) (P<0.001), endometrial thickness (P<0.001), 2- dimensional power doppler vascular indices; endometrial resistive index (P<0.001), endometrial pulsatility index (P<0.001), endometrial volume (P<0.001), and 3- dimensional power doppler vascular idices; endometrial vascularization index (P<0.001), endometrial flow index (P<0.05) and endometrial vascularization flow index (P<0.001).