The Value Of Three-dimensional Altrasound For Diagnosing Malignant And Benign Endometrial Lesions Of Postmenopausal Women

Backgroud:Endometrial lesions are most common developed in postmenopaussalwomen，and irregular vaginal bleeding usually as the first presenting symptom.Most ofthe women with endometrial lesions are benign， such as endometrialpolyp,endometrial hyperplasia, submucous myoma and so on,and only5-15%areendometrial malignant lesions[1-3],now endometrial thickness (ET) of two-dimensionaltransvaginal sonography has been used as an indicator of endometrial lesions, but itneed for invasive method to reach organizations such as diagnostic curettage,hysteroscopy diagnosis in order to discriminate between benign and malignantlesions.To reduce the intrusion diagnosis method to the pain of patients and avoid theburden caused by excessive treatment to patients and doctors,we need to seek a betterultrasound method of identifying endometrial benign and malignant lesions.Objects:In this study，we use3D-TVS observes endometrial volume andthree-dimensional power Doppler angiography（3D-PDA) observes the blood flowparameters of the following postmenopausal women， those with endometriallesions．Thy are divided into groups of endometrial malignant lesions and endometrialbenign lesions by pathology．To evaluate the value of endometrial thickness、endometrial volume and the blood flow parameters of three-dimensional power Dopplerangiography in the distinguish of the benign endometrial lesions from malignantendometrial lesions in postmenopausal women and to caculate the diagnostic ofintermediate value between the malignant and the benign endometrial lesions.And evaluate the role of endometrial thickness of the two-dimensional ultrasound andendometrial volume and the blood flow parameters of the three-dimensionalultrasonography in distinguishing of the benign endometrial lesions from malignantendometrial lesions of postmenopausal women.Methods：After exclusion of radiotherapy，chemotherapy，hormone therapy andother factors，postmenopausal women with irregular vaginal bleeding was obtained inthe first affiliated hospital of Dalian Medical University during June to October in2013．All the rearch subjects were confirmed by surgery such as hysteroscope ordiagnostic curettage,there were17cases endometrial malignant lesions and19casesendometrial benign lesions by histopathology．All the rearch subjects had measuredendometrial thickness under the2D-TVS,and use the three-dimensional power Dopplerangiography to observe blood flow．The endometrial volume had been measured by thevirtual organ computer aided analysis(Virtual Organ Computer Aided AnalysisVOCAL)software,and use3D-PDAto measure the three blood flow parameters，suchas VI(vascularization index)， FI (flow index),VFI (vascularization flow index)．Weuse the SPSS19software for statistic alanalysis.two-group t-test for independentsamples test was used to compare the differences between benign and malignantgroup.We use the ROC (Receiver Operating Characteristic) curves to evaluate of theendometrial parameters such as endometrial thickness, endometrial volume,VI, FI andVFI in identifying endometrial benign lesions and malignant lesions of the sensitivityand specificity, and establish the diagnosis standard.Result:1.The malignant endometrial group had statistically thicker endometrium(17.28士7.03vs11.00士4.06mm; P <0.01), and larger EV (13.54士9.89cm3vs3.91士2.98cm3；p<0.01) than the benign endometrial group.2.The group with malignant endometrial lesions had significantly higher VI,FIand VFI(P<0.01) than the benign endometrial group.3.In differentiating benign from malignant lesions of endometrium,The area underthe ROC curve of endometrial volume was0.842,it is the highest in all the endometrial parameters in this rearch. The identification of endometrial benign and malignantlesions volume lining best intermediate value is4.10cm3,the sensitivity was88.2%,specificity was73.7%. Using2.8,28.89,0.83as the identification of3D-PDA bloodflow parameters such as VI,Fl and VFI,and the sensitivity and specificity were64.7%and89.3%,82.4%and73.7%,70.6%and89.5%.Conclusion:1. Three-dimensional ultrasound endometrial volume and blood flow parametersof the three-dimensional power Doppler analysis are all good diagnostic tools indifferentiating benign from malignancy in postmenopausal endometrial lesions.2. Two-dimensional ultrasound is still a sensitive method in early diagnosis ofendometrial lesions after menopause; In this study, under the ROC curve comparison,endometrial volume is a better indicator than thickness of two-dimensional ultrasoundin the diagnosis of endometrial benign and malignant lesions.3. The three-dimensional ultrasound volume of endometrial were the bestparameters in identifying benign and malignant lesions of postmenopausal women.