Role of Transvaginal Three-dimensional Power Doppler Ultrasound and Hysteroscopy in Postmenopausal Bleeding

Vollständiger Abstract

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A BSTRACT Background: Postmenopausal bleeding (PMB) is a warning symptom and is associated with endometrial malignancy in 10%–15% of cases. Endometrial thickness (ET) measurement using transvaginal ultrasound (TVS) guides the course of action, with ET >4 mm being ominous. Three-dimensional power Doppler (3DPD) ultrasound raises diagnostic utility with endometrial volume (EV) and vascularity indices-vascularization index (VI), flow Index (FI) and vascularization FI (VFI), while hysteroscopy provides a direct view of uterine lesions. Previous studies have worked on role of 3DPD or hysteroscopy in PMB patients, but none have compared these two. Hence, this study was conducted. Methods: This prospective observational study was conducted at a tertiary center, including 75 women with PMB. They underwent 3DPD ultrasound followed by hysteroscopy and endometrial biopsy. The diagnostic accuracy of Doppler parameters was analyzed using receiver operating characteristic curves. Hysteroscopic results were compared with histopathology, followed by comparison of 3DPD and hysteroscopy. Results: Out of 75 patients, 65 (86.6%) had benign pathologies and 10 (13.4%) had malignancies. 3DPD parameters VI, VFI, and EV were significantly higher in the malignant group. EV had the highest diagnostic performance, with an area under curve (AUC) of 0.88 (cutoff ≥7.34 cm 3 ), yielding 80% sensitivity and 80% specificity. VI, FI, and VFI achieved sensitivity/specificity of 80%/78.5%, 70%/70.8%, and 80%/73.8%, with AUCs of 0.83, 0.69, and 0.82, respectively. Hysteroscopy demonstrated 100% sensitivity and specificity for detecting endometrial malignancy and endometrial polyps. Cohen’s kappa analysis of hysteroscopy and 3DPD showed agreement of 78.67%, 70.67%, 78.67%, and 80% between hysteroscopy and VI, FI, VFI and EV, respectively. Conclusion: 3DPD, particularly EV, is a valuable noninvasive tool in PMB. Hysteroscopy remains a highly sensitive and specific modality for detecting malignancy, showing good correlation with 3DPD.