Uterine blood flow assessment by colour Doppler for prediction of malignant endometrial pathologies in women with abnormal uterine bleeding

Abstract

Introduction: Colour Doppler has emerged as useful adjunct to transvaginal sonography in evaluation of women with AUB. This study was carried out to evaluate the role of measurement of the Resistance index (RI) and Pulsatility index (PI) of the uterine arteries by Colour Doppler sonography to discriminate between benign and malignant endometrial condition in women with abnormal bleeding.Material and Methods: This prospective analytical study was performed to evaluate 70 women (30-60 years) with AUB. Spiral arterioles flow patterns, Resistance index (with 0.81 as cut off) and Pulsatility index (with 1.83 as cut off) of uterine arteries were analysed by colour Doppler after detailed TVS. They were compared with Histopathological report of Endometrial Aspiration biopsy. Results: 10 patients (14.3%) had RI in malignancy range (> 0.81) and 9 patients (12.9%) had PI in malignancy range (< 1.83). Out of these 8 had both RI and PI in malignancy range. Thus 11 cases (15.7%) having either RI/PI or RI and PI both, in malignancy range were considered to be suspected of malignancy. Out of these 11 cases, 5 patients were diagnosed to have Hyperplasia/Malignancy on histopathology. There were no False Negative cases, making the sensitivity 100% and specificity 90.7% of TVS with colour Doppler. For the vascular patterns, both cases of hyperplasia had scattered vessel pattern and all 3 cases of carcinoma had multiple vessel pattern, making the association of vascular pattern with AUB diagnosis significant (p<0.001).Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions. Therefore, it is recommended that CDTU with TVS should be used as screening modality in all AUB patient.