Three‐dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding

Abstract

The aim of this study was to evaluate the efficacy of 3D power Doppler angiography (3D-PDA) for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding (PMB). One-hundred and fifty women with PMB and an endometrial thickness (ET) of ≥4 mm on 2D sonography were assessed by 3D-PDA before endometrial sampling to obtain definitive histological diagnosis of endometrial pathology. Endometrial volume (EV), vascularity index (VI), flow index (FI) and vascularity-flow index (VFI) were calculated by computer-aided analysis. Of the 150 women, 114 (76%) had benign endometrial lesions and 36 (24%) had endometrial carcinoma. Patients with endometrial carcinoma had significantly thicker endometrium (15.8 ± 7.7 vs 9.9 ± 5.9 mm; P < 0.001), larger EV (9.1 ± 4.7 vs 2.6 ± 3.5 mL, P < 0.001) and higher 3D-PDA indices (P < 0.001) than patients with benign endometrial lesions. The best variable for distinguishing between benign and malignant endometrium was VI, with an area under the receiver operating characteristic curve (AUC) of 0.86. In contrast, the ET had an AUC of only 0.62. The best-fit logistic regression model for the diagnosis malignancy contained only VI as an independent factor (P = 0.002). 3D-PDA measurements may be useful for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding.