DIAGNOSTIC UTILITY OF SONOGRAPHICALLY THICKENED ENDOMETRIUM AND COLOR DOPPLER IN POSTMENOPAUSAL BLEEDING

Abstract

Background: Abnormal uterine blood loss at any females' age is upsetting. Nevertheless, post-menopausal bleeding (PMB) is of superior distress because it is a clinical indication of the occurrence of endometrial malignancy. Trans-vaginal sonography (TVS) and Doppler velocimetry signify non- invasive techniques for screening of the endometrium. Objective: To explore the relationship between endometrial thickness and color doppler by TVS and its implication to predict endometrial pathology in symptomatic and asymptomatic postmenopausal women. Subjects and methods: A total of 50 symptomatic and asymptomatic postmenopausal ladies were recruited to this study during the period from February 2020 to September 2020 at Kafr El-Sheikh General Hospital, and Al-Sayed Galal Hospital of Al-Azhar University. TVS and Color Doppler were done to all of them, then fractional D & C to suspicious cases. Results: Out of the 25 women with PMB, endometrial hyperplasia was seen in 10 women (40%), endometrial hyperplasia and polyps were detected in 4(16%) of patients, and multiple myoma in 3 (12%) of patients. In control group, multiple myoma was detected in only one case. Also, nabothian follicle was shown in another case, and there was one case diagnosed with solitary myoma. There was a statistically significant difference between the two studied groups regarding TVS findings. Endometrial thickness (6 mm or more) was found in all PMB cases, and 10(40%) of control cases, while endometrial thickness of 5-6 mm was detected in the other 15 (60%) of control cases. Approximately, half of the women with PMB (40%) had no abnormal vascularity. Sixteen percent had single-vessel, 32 percent had scattered-vessel, and 8 percent had multiple-vessel pattern. Also, iso or hypo-echogenic intracavitary nodule displayed a vascular ring was detected in only one PMB case. The cut of value of ET 7.75 mm had 93.8% sensitivity and with specificity, positive predictive value, negative predicted value and diagnostic accuracy (87.5%, 93.8%, 87.5% and, 91.7% respectively). Also, Roc curve analysis showed that all Doppler indices were not significant in the detection of the abnormal findings in biopsy. Conclusion: Both tran-svaginal sonography and color doppler ultrasound were complementary in the post-menopausal bleeding investigation and endometrial biopsy yet residues as the gold standard for final diagnosis.