Three-dimensional endometrial volume and power Doppler angiography for prediction of endometrial carcinoma in woman 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 symptomatiza¬tion is common, allowing early cure. Survival drops with late stages and so studies should strive to increase the precision of various diagnostic practices The ideal diagnostic strategy is still debatable. A thin endometrium measuring less than 5 mm by vaginal scanning in PMB excludes about 99% of endo¬metrial cancers. Sampling of the endometrium is considered necessary in those patients with an endometrium ≥5 mm. However, many “normal” women with postmenopausal bleeding and thickened endometrium 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, 80 women with postmenopausal bleeding have inclusion criteria were evaluated Ain Shams University Hospital. 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 obtained. Division according to endometrial pathology into 3 groups was done. Group 1 included 26 patients with malignant endometrium. Group 2 was 18 patients with atrophic endometrium. Group 3 was 36 patients with endometrial hyperplasia and polyp. As regards the measurement of endometrial volume, in the study there was a high statistical significance in comparison of both groups; in group 1 endometrial volume was 18.63± 4.71cc while in group 2 it was 11.31±4.34cc, group 3 it was14.04±5.32cc p-value<0.001. However it was not statistically significant when used to compare different histopathology. Endometrial volume was higher in patient with endometrial polyps. Endometrial volume; VI, FI and VFI were significantly higher in endometrial cancer, compared with benign diseases. When discussing power Doppler indices in differentiating different histopathology it was statistically significant for VI and FI while VFI nearly equal in patient with carcinoma and endometrial polyps. The ultimate discriminator between non-cancerous and cancerous endometrium was VI, with an AUC of 0.655.