Author(s): Sally AR Kotb*, Nahla M Awad and Amal S Zaghlaul
Background: Postmenopausal bleeding (PMB) represents a practical challenge due to the increased risk of endometrial carcinoma which requires efficient evaluation for optimum management. The use of the three vascular patterns that could be depicted by transvaginal Power Doppler sonography (TVPD) is useful to discriminate endometrial carcinoma from other benign conditions. The aim of this study was to evaluate TVPD in discrimination between benign and malignant endometrial lesions in PMB women compared to the histopathologic diagnosis.
Methods: Eligible 180 patients complaining of PMB were involved in the study, they were examined by Gray scale transvaginal sonography to assess the endometrium, TVPD scanning of the endometrial and endometrial myometrial interface vessels (Spiral arteries), followed by pulsed Doppler velocimetry and lastly endometrial biopsy for histopathological diagnosis.
Results: The endometrial characteristics and the different vascular patterns depicted by TVPD showed a good diagnostic ability in depicting endometrial malignancy and differentiate it from benign endometrium:16 cases (8.9%) showed multiple branching vessels pattern (pattern A) strongly correlated with endometrial cancer, 31 cases (17.2%) showed single non branching vessel (pattern B) suggesting polyp, 61 cases (33.9%) showed scattered vessel pattern (pattern C) suggestive of hyperplasia, and no power Doppler signals were detected in 72 cases (40%) diagnosed as atrophy. Atrophy has been found to be the commonest pathological lesions as a cause of PMB. Spiral arteries pulsatility index and resistance index were measured and were significantly lower in malignant endometrium compared to other histopathological benign endometrial pathology p <0.001.
Conclusion: Power Doppler ultrasound is a useful adjunct tool in diagnosis of endometrial pathology in cases with postmenopausal bleeding and shows good reliability in the discrimination between endometrial carcinoma from other benign endometrial conditions.