Postmenopausal bleeding Power Doppler Thickened endometrium
Alcazar JL, Castillo G, Minguez JA, Galan MJ. Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium. Ultrasound Obstet Gynecol 2003 Jun;21(6):583-58.
Objective To evaluate the role of transvaginal power
Doppler sonography to discriminate between benign
and malignant endometrial conditions in women presenting
with postmenopausal bleeding and thickened
endometrium at baseline sonography.
Methods Ninety-one postmenopausal women (median
age, 58 years; range, 47–83 years) presenting with uterine
bleeding and a thickened endometrium (≥5-mm doublelayer
endometrial thickness) on transvaginal sonography
were included in this prospective study. Endometrial
blood flow distribution was assessed in all patients by
power Doppler immediately after B-mode transvaginal
sonography. Three different vascular patterns were
defined: Pattern A: multiple-vessel pattern, Pattern B:
single-vessel pattern and Pattern C: scattered-vessel
pattern. Histological diagnoses were obtained in all cases.
No patient taking tamoxifen citrate or receiving hormone
replacement therapy was included.
Results Histological diagnoses were as follows: endometrial
cancer: 33 (36%), endometrial polyp: 37 (41%),
endometrial hyperplasia: 14 (15%), endometrial cystic
atrophy: 7 (8%). Blood flow was found in 97%, 92%,
79% and 85% of cases of carcinoma, polyp, hyperplasia
and endometrial cystic atrophy, respectively. A total of
81.3% of vascularized endometrial cancers showed Pattern
A, 97.1% of vascularized polyps exhibited Pattern B
and 72.7% of vascularized hyperplasias showed Pattern
C. Sensitivity and specificity for endometrial cancer were
78.8% and 100%. For endometrial polyp these respective
values were 89.2% and 87% and for hyperplasia they
were 57.1% and 88.3%.
Conclusions Transvaginal power Doppler blood flow
mapping is useful to differentiate benign from malignant
endometrial pathology in women presenting with postmenopausal
bleeding and thickened endometrium at baseline