Top

BMC Women's Health

Published in:

Open Access 01-12-2016 | Research article

Three-dimensional ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding

Authors: Mohamed El-Sharkawy, Akmal El-Mazny, Wafaa Ramadan, Dina Hatem, Aly Abdel-Hafiz, Mohamed Hammam, Adel Nada

Published in: BMC Women's Health | Issue 1/2016

Abstract

Background

Ultrasonography has been extensively used in women suspected of having a gynecological malignancy. The aim of this study is to evaluate the efficacy of 3D ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding.

Methods

This cross-sectional study included 78 premenopausal women with abnormal uterine bleeding scheduled for hysteroscopy and endometrial curettage. The endometrial thickness (ET), uterine artery pulsatility index (PI) and resistance index (RI), and endometrial volume (EV) and 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured and compared with hysteroscopic and histopathologic findings.

Results

The ET (P <0.001), EV (P <0.001), and endometrial VI (P <0.001) and VFI (P = 0.043) were significantly increased in patients with atypical endometrial hyperplasia and endometrial carcinoma (n = 10) than those with benign endometrium (n = 68); whereas, the uterine artery PI and RI and endometrial FI were not significantly different between the two groups. The best marker for discrimination between benign and malignant endometrium was the VI with an area under the ROC curve of 0.88 at a cutoff value of 0.81 %.

Conclusion

3D ultrasonography and power Doppler, especially endometrial VI, may be useful for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.CrossRefPubMed

Sorosky JI. Endometrial cancer. Obstet Gynecol. 2008;111(2 Pt 1):436–47.CrossRefPubMed

Mettler L. The cystic adnexal mass: patient selection, surgical techniques and long-term follow-up. Curr Opin Obstet Gynecol. 2001;13(4):389–97.CrossRefPubMed

Clark TJ, Barton PM, Coomarasamy A, Gupta JK, Khan KS. Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies. BJOG. 2006;113(5):502–10.CrossRefPubMed

Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding. Maturitas. 2003;45(4):275–82.CrossRefPubMed

Bega G, Lev-Toaff AS, O’Kane P, Becker Jr E, Kurtz AB. Three-dimensional ultrasonography in gynecology: technical aspects and clinical applications. J Ultrasound Med. 2003;22(11):1249–69.CrossRefPubMed

Alcázar JL, Jurado M. Three-dimensional ultrasound for assessing women with gynecological cancer: a systematic review. Gynecol Oncol. 2011;120(3):340–6.CrossRefPubMed

Campbell S. Placental vasculature as visualized by 3D power Doppler angiography and 3D color Doppler imaging. Ultrasound Obstet Gynecol. 2007;30(6):917–20.CrossRefPubMed

Mercé LT, Alcázar JL, Engels V, Troyano J, Bau S, Bajo JM. Endometrial volume and vascularity measurements by transvaginal three-dimensional ultrasonography and power Doppler angiography in stimulated and tumoral endometria: intraobserver reproducibility. Gynecol Oncol. 2006;100(3):544–50.CrossRefPubMed

10.

Alcazar JL, Galvan R. Three-dimensional power Doppler ultrasound scanning for the prediction of endometrial cancer in women with postmenopausal bleeding and thickened endometrium. Am J Obstet Gynecol. 2009;200(1):44. e1-6.CrossRefPubMed

11.

Odeh M, Vainerovsky I, Grinin V, Kais M, Ophir E, Bornstein J. Three-dimensional endometrial volume and 3-dimensional power Doppler analysis in predicting endometrial carcinoma and hyperplasia. Gynecol Oncol. 2007;106(2):348–53.CrossRefPubMed

12.

Epstein E, Skoog L, Isberg PE, De Smet F, De Moor B, Olofsson PA, Gudmundsson S, Valentin L. An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding. Ultrasound Obstet Gynecol. 2002;20(4):370–6.

13.

Makled AK, Elmekkawi SF, El-Refaie TA, El-Sherbiny MA. Three-dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding. J Obstet Gynaecol Res. 2013;39(5):1045–51.CrossRefPubMed

14.

Kurjak A, Kupesic S, Sparac V, Bekavac I. Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography. J Ultrasound Med. 2001;20(8):829–40.CrossRefPubMed

15.

Kupesic S, Kurjak A, Hajder E. Ultrasonic assessment of the postmenopausal uterus. Maturitas. 2002;41(4):255–67.CrossRefPubMed

16.

Galván R, Mercé L, Jurado M, Mínguez JA, López-García G, Alcázar JL. Three-dimensional power Doppler angiography in endometrial cancer: correlation with tumor characteristics. Ultrasound Obstet Gynecol. 2010;35(6):723–9.PubMed

17.

Saarelainen SK, Vuento MH, Kirkinen P, Mäenpää JU. Preoperative assessment of endometrial carcinoma by three-dimensional power Doppler angiography. Ultrasound Obstet Gynecol. 2012;39(4):466–72.CrossRefPubMed

18.

Lieng M, Qvigstad E, Dahl GF, Istre O. Flow differences between endometrial polyps and cancer: a prospective study using intravenous contrast-enhanced transvaginal color flow Doppler and three-dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol. 2008;32(7):935–40.CrossRefPubMed

19.

Opolskiene G, Sladkevicius P, Jokubkiene L, Valentin L. Three-dimensional ultrasound imaging for discrimination between benign and malignant endometrium in women with postmenopausal bleeding and sonographic endometrial thickness of at least 4.5 mm. Ultrasound Obstet Gynecol. 2010;35(1):94–102.CrossRefPubMed

20.

De Smet F, De Brabanter J, Van den Bosch T, Pochet N, Amant F, Van Holsbeke C, Moerman P, De Moor B, Vergote I, Timmerman D. New models to predict depth of infiltration in endometrial carcinoma based on transvaginal sonography. Ultrasound Obstet Gynecol. 2006;27(6):664–71.

Title: Three-dimensional ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding
Authors: Mohamed El-Sharkawy
Akmal El-Mazny
Wafaa Ramadan
Dina Hatem
Aly Abdel-Hafiz
Mohamed Hammam
Adel Nada
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Women's Health / Issue 1/2016
Electronic ISSN: 1472-6874
DOI: https://doi.org/10.1186/s12905-016-0297-3

At a glance: The STEP trials

Springer Medicine

Three-dimensional ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial

Biological factors that place women at risk for HIV: evidence from a large-scale clinical trial in Durban

Menstrual pattern among adolescent girls of Pokhara Valley: a cross sectional study

Prevalence and determinants of unintended pregnancy among pregnant woman attending ANC at Gelemso General Hospital, Oromiya Region, East Ethiopia: a facility based cross-sectional study

Correlation of body mass index levels with menarche in adolescent girls in Shaanxi, China: a cross sectional study

Self-administered multi-level pregnancy tests in simplified follow-up of medical abortion in Tunisia