Aim of theWork
The aim of this work is to illustrate the role of three –dimentional transvaginal doppler ultrasonograghy as a non invasive method in the diagnosis of endometrial lesions in cases of peri&post menopausal bleeding in comparison to hysteroscopy (hysteroscopic endometrial biobsy) in an attempt to reduce the number of patients in need to diagnostic invasive procedures.
Material and methods:
60cases, recruited from the outpatient gynecological clinic, Benha university Hospitals, were included in the study. All cases presented with peri&PMB. All patients were subjected to 3D transvaginal power Doppler ultrasonographic evaluation of the endometrium, hysteroscopy &hysteroscoic guided biobsy.
The age ranged between 40-60 years with amean of 45.3 years . They had amean parity of 3. They had a mean parity of 3.12. The most common endometrial histopathology normal cases ( 36 cases ,60.0% ) then endometrial polyp(10cases ,16.7) cases, %) then endometrial hyperplasia (8 cases, 13.3%) and endometrial cancer(3cases, 5.0%) then endometrial atrophy (5 cases,5.0 % ).
Three dimensional power doppler ultrasound is comparable to diagnostic hysteroscopy in the diagnosis of intracavitary lesions, the sensitivity, specificity, PPV, NPV and overall accuracy, the result percentages were 67.74% , 54.55% , 89.36% , 23.08% , 65.75% for 3D tv ultrasonography and were 84.48%, 78.57%, 94.23 , 55%, 83.33% for hysteroscopy .The most common endometrial histopathology normal cases ( 36 cases ,60.0% ) then endometrial polyp(10cases ,16.7) cases, %) then endometrial hyperplasia (8 cases, 13.3%) and endometrial cancer(3cases, 5.0%) then endometrial atrophy (5cases,5.0 % ).
Three dimensional power doppler ultrasound has been introduced into the clinical practice during the last 15 years and has been used extensively in cases of abnormal uterine bleeding due to its high ability to register all three imaging planes simultaneously. It also allows more precise evaluation of the uterine cavity, the relation of the myomata and their possible encroachement on the cavity and it also allows measurement of the endometrial volume rather than the endometrial thickness in cases of peri& postmenopauasal bleeding. Endometrial volume measurement was significant investigations to differentiate between atrophic endometrium, benign endometrial pathology and endometrialcarcinoma
However, histopathological diagnosis is always needed to confirm the suspicion