The Value Of Transvaginal Three-dimensional Ultrasonography For Diagnosing Normal Endometrium And Endometrial Lesions Of Postmenopausal Women

Women are prone to develop various endometrial lesions during their last third of life time-postmenopause. Postmenopausal bleeding (PMB) is the most common presenting complaint. And ultrasonography is important for diagnosis. Two-dimensional transvaginal ultrasound is widely used in clinical with its fast, economic and repeatable characteristics. It not only can roughly discriminate between benign and malignant lesions combined with blood flow parameters, but also can diagnose the histology of the endometrial lesions combined with the dilatation and curettage (D & C) or hysteroscopy. However, the atrophied uterus in postmenopausal women often confounds the border between endometrium and myometrium. Furthermore, the morphology of endometrium may vary considerably caused by systemic disease and hormone replacement therapy. Because of these factors, endometrial thickness only has a low predictive value and may lead to over diagnosis and treatment of PMB, causing unnecessary suffering. Recently three-dimensional power Doppler imaging (3D-PDI) has gained a lot of attention in clinical research. Besides the advantages of 2D ultrasonography,3D-PDI possesses higher resolving power and higher precision of volume measurement of the region of interest, which are used to evaluate the vascularity of the endometrium, and assess the physiological/pathological changes of the endometrium, then provide important information for clinical management and follow up therapy. At present, There is no unified description of 3D ultrasonic features of endometrial lesions in postmenopausal women globally. The aims of our study were to determine the ultrasonography characteristics of endometrium in healthy postmenopausal women of different ages by using 3D ultrasound examination and establish the normal standard parameters of ultrasonography. Another purpose was to compare the value of parameters of 3D ultrasonography with 2D ultrasonography to diagnose the endometrial lesions of post menopausal women. Section 1 Study of the three-dimensional ultrasonic features of endometrium in normal postmenopausal womenObjective:To study the 3D ultrasonic parameters of uterine endometrium in different ages of normal postmenopausal women and establish 3D ultrasonic parameters reference of normal postmenopausal endometrium.Methods:88 patients who attend Obstetrics and Gynecology Hospital of Fudan University were recruited from February 2009 to the end of August 2009. Two-dimensional and three-dimensional ultrasonography were performed. The endometrial thickness, endometrial volume, PI(pulsatility index), RI (resistance index), VI (vascularization index), FI (flow index), and VFI (vascularization flow index) were recorded. The SPSS 15 software was statistically used to find if the ultrasound parameters varying with the different time span after menopause of normal postmenopausal women.95% reference value was used to calculate the range of normal endometrial volume, endometrial thickness, PI, RI, VI, FI and VFI for postmenopausal women.Result:1. The mean value of endometrial volume, endometrial thickness and VI, FI, VFI of the normal group were 0.76±0.57cm3,3.15±1.30mm, 0.05±0.30,4.10±9.36 and 0.02±0.10. No color doppler signal was found in the normal endometrium and PI, RI couldn't be measured.2. Endometrial thickness and endometrial volume are not related with time span after menopause.3. The vascularization and blood flow of endometrium had no relationship with time span after menopause.4. The 95% reference value of endometrial volume, endometrial thickness and VI, FI, VFI of the postmenopausal women were 0 to 1.69cm3,0 to 5.28mm,0 to 0.54,0 to 19.45, and 0 to 0.18.Conclusion:1. Endometrial thickness and endometrial volume did not vary with the time span after menopause.2. The vascularization and blood flow of endometrium did not vary with the time span after menopause. Section 2 transvaginal three-dimensional ultrasound in diagnosing malignant and benign endometrial lesions of postmenopausal womenObjective:To evaluate the value of endometrial volume and three-dimensional power Doppler analysis (3D-PDA) in the diagnosis of benign and malignant endometrial lesions in postmenopausal women and to establish the cut-off value between the malignant and the benign endometrial lesions. Then evaluate the role of three-dimensional ultrasound in predicting malignant and benign endometrial lesions of postmenopausal women.Methods:93 women diagnosed as endometrial pathologic status by histopathologic examination from February 2009 to the end of February 2010 were divided into benign and malignant groups. The normal postmenopausal women in Section One were used as control group. The 2D and 3D ultrasound examinations were performed within 24 hours prior to the operation. The images were stored and analyzed later. Then we used VOCAL program to measure the endometrium volume, VI, FI and VFI.The SPSS 15 software was used for statistical analysis. ANOVA and LSD test was used to compare the differences among the control group, benign and malignant group. Pared t-test and calculating coefficient of variation were used to evaluate the repeatability of 3D ultrasound measurement. Chi-square test was used to compare the differences of diagnose accordance rate between 3D ultrasound and 2D ultrasound. The ROC Curves was used to calculate the sensitivity and specificity of endometrial thickness, endometrial volume, VI, FI and VFI in differentiating and establish the cut-off diagnostic value between malignant and benign endometrial lesions.Result:1. Endometrial volume of the malignant endometrial lesions group was statistically higher than that of the benign group (18.11±19.35cm3 vs. 13.55±9.77cm3;p<0.01).2. Compared with the benign endometrial group, the malignant group had significantly higher VI, FI and VFI (p<0.01).3. Using ultrasonagraphy for differentiating normal endometrium from abnormal one. The ROCAUC of endometrial thickness was 0.976, higher than others. Using a cutoff of 5.5mm to identify normal and abnormal, the sensitivity was 90.3% and the specificity was 94.3%.4. Using ultrasonagraphy for differentiating benign from malignant lesions of endometrium. The ROCAUC of endometrial volume was 0.858, higher than others. Using a cutoff of 7.73cm3 to identify benign and malignant lesions, the sensitivity was 76.9% and the specificity was 85.0%. Using 0.331,25.749,0.1015 as the cut-off value for VI, FI and VFI, the sensitivity and specificity were 84.6% and 75.0%,84.6% and 73.8%,84.6% and 77.5%.5. The diagnose accordance rate of the 3D ultrasound for diagnosing malignant and benign endometrial lesions was statistically higher than that of the 2D ultrasound (93.5% vs.82.8%; p<0.01).Conclusion:1. Three-dimensional endometrial volume and three-dimensional power Doppler analysis are good diagnostic tools to predict malignant and benign endometrial lesions in postmenopausal women.2. 2D ultrasound measuring endometrial thickness is proved to be a satisfactory indicator for the early endometrial lesions detection. Endometrial volume and the blood flow parameters measured by 3D ultrasound were benefit to diagnosis between malignant and benign endometrial lesions.3. Endometrial volume and VI is the best indicator for differentiating benign and malignant endometrial disease.