• The objective of this work was to study the role of transvaginal ultrasonography and Doppler in the assessment of the endometrium in patients with postmenopausal bleeding.
• This study included 70 postmenopausal patients (for more than 1 year) from Benha Gynecological Outpatient Clinic between January 2014 to November 2015.
• The group was subjected to detailed history taking, thorough general and pelvic examination, transvaginal ultrasonography and transvaginal pulsed Doppler on both uterine and spiral arteries for the evaluation of sonomorphological pattern and Doppler indices.
• Fractional curettage was done for all patients with postmenopausal bleeding and the results of ultrasonography and Doppler were compared to the histopathological findings.
The present study revealed the following:
1. In the study group, it was found that10 patients of a total number of 70 patients had endometrial carcinoma with endometrial thickness of all malignant cases more than 10 mm.
2. It was also found that 60 patients had benign endometrial pathology, 17 of them had endometrial polyp (the endometrial thickness ranged from 18-21.4mm), 28 cases had endometrial hyperplasia (the endometrial thickness ranged from 7.98-9.78 mm), and 15 cases had non specific pathology (the endometrial ranged from 9.56 -12.06 mm). ET carries a sensitivity 90% and specificity 66.7% to diagnose malignant cases in PMB when using a cut-off thickness 11.75mm
3. In the study group for the echogenicity it was found that in endometrial carcinoma, the majority of cases were hyperechogenic (8 a cases out of 10 cases) , but the cases revealed endometrial polyp by histopathology showed echogenic endometrium in all cases diagnosed as such.
4. In the study group for the subendometrial halo it was found that in all cases of endometrial carcinoma (10 patients) it cannot be identified but in non malignant it was intact( 60 patients) .
5. In the study group the intracavitary fluid was present in 6 cases out of 10 cases diagnosed as endometrial carcinoma and was absent in all benign cases .
6. There were highly positive significant association between histopathology and all of endometrial thickness, absent sub endometrial halo and intracavitary fluid
7. As regard uterine artery Doppler indices
• The mean PI of malignant endometrium was 0.65± 0.09 while the mean PI of benign endometrial lesion was 1.05 ± 0.29.
• The mean RI of malignant endometrium was 0.74 ± 0.13 while the mean RI of non-malignant lesion was 0.51 ± 0.04.
8. As regard spiral artery Doppler indices
• The mean PI of malignant endometrium was 0.57± 0.09 while the mean PI of benign endometrial lesion was 1.14 ± 0.32.
• The mean RI of malignant endometrium was 0.46 ± 0.03 while the mean RI of non-malignant lesion was 0.64 ± 0.12.
10. As regard spiral artery Doppler indices, There was a significant association between histopathology and pulsatile index in malignant cases. The best cutoff value for PI of spiral artery is 0.59, where the sensitivity for malignant cases was 90% and the specificity was 88.3%. Also there was a significant association between histopathology and resistive index. In malignant cases the best cutoff value for RI of spiral artery is 0.52, where the sensitivity for malignant cases was 90% and the specificity was 81.7%.
10. As regard uterine artery Doppler indices, There were a significant association between histopathology and resistant index in malignant cases The best cutoff value for PI of uterine artery is 0.77, where the sensitivity for malignant cases was 90% and the specificity was 86.7% and also significant negative association between histopathology and pulsatile index, in malignant cases only The best cutoff value for RI of uterine artery is 0.55, where the sensitivity for malignant cases was 90% and the specificity was 88.3%.
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