Study title:
Transvaginal and Colour Doppler Ultrasonography Compared to Endometrial Histopathology in Postmenopausal Uterine Bleeding.
Study type:
Prospective clinical.
Study setting:
Department of Obstetrics & Gynecology, Faculty of Medicine, Benha University, Benha, Egypt.
Study duration:
JULY 2015 to JUNE 2016.
Introduction:
Postmenopausal bleeding (PMB) is a common gynecological problem. It can be a sign of endometrial carcinoma. However, the cause of PMB is often benign but cancer is the most danger etiology of it. The cause of postmenopausal bleeding should be considered to be endometrial cancer until proved otherwise.
Endometrial thickness measurement by transvaginal sonography has been shown to be an effective non-invasive method to detect, or to rule out, endometrial disease in women with postmenopausal bleeding. However, this technique is non-specific for discriminating between different endometrial diseases. Transvaginal colour and power Doppler sonography were introduced to ascertain or refute the diagnosis of endometrial disease when ultrasound is used.
Aim of the study:
Evaluation of transvaginal ultrasound and transvaginal Colour Doppler of the endometrium compared with hysteroscopically-guided endometrial sample histopathology in Postmenopausal uterine bleeding.
Patients:
Ninety Egyptian patients with postmenopausal bleeding.
Methods:
All patients were submitted to
* Thorough history taking
* Complete general examination including calculation of BMI.
* Complete Gynecological examination.
* Cervical cytology (PAP smear)
* Laboratory investigations
Procedures:
Transvaginally:
* PAP smear for cytology
* 2D conventional ultrasonography
* 3D Colour Doppler to measure RI, PI, PSV
* Power Doppler endometrial vascular mapping of its vasculature
* Hysteroscopy (diagnostic and for directed biopsies) from the endometrium or endometrial lesions under general anesthesia.
* Fractional endometrial curettage was done followed by complete endometrial curettage.
All collected endometrial samples and biopsies from lesions were sent for histopathology as the final diagnosis.
Statically:
Patients were divided according to the results of the endometrial histopathology into 3 groups:
Group I: Included 10 patients who had malignant endometrium (carcinoma)
Group II: Included 26 patients who had hyperplastic endometrium(18 without and 8 with atypia).
Group III: Included 54 patients who had benign endometrium other than endometrial hyperplasia(atrophy, break down with proliferative changes and polyps).
Group II and III were added together as non-neoplastic (benign) endometrial group (n=80) for statically comparison with malignant endometrial group (n=10).
Results:
Clinically:
Patients with endometrial carcinoma were found to be significantly older age (P =0.009), with higher body mass index (BMI) (P 0.05)
Transvaginal ultrasound (TVUS):
Five mm endometrial thickness (ET) was used as the cutoff point for differentiating malignant from benign endometrium. Malignant endometrial had a significantly thicker ET compared to benign endometrium being ≥ 5mm (P |
