Assessment of endometrial volume and vascularization using transvaginal 3D power Doppler angiography in women with postmenopausal bleeding

Objective: To compare the usefulness of 3D power Doppler angiography (3D-PDA) and endometrial thickness measurement by 2D Doppler ultrasound in the distinction of benign from malignant disease in postmenopausal women with abnormal uterine bleeding (AUB) and an endometrial thickness greater than 4.5 mm. Methods: Forty-eight women with AUB and an endometrial thickness greater than 4.5 mm on 2D ultrasound underwent 3D-PDA. The endometrium and a 5-mm subendometrial "shell" were evaluated at rotation angles of 9 degrees and 30 degrees. Endometrial volume, vascularity index, flow index, and vascularization flow index were obtained. Results: The histologic findings were normal or benign for 38 women (79%) and malignant for 10 (21%). All vascular indices were significantly higher in the group with malignancies except for the vascularization flow index. There were no differences in the values obtained using the 9 degrees or the 30 degrees angle. Receiver-operating characteristics curves were traced for all indices. The vascularity index had the best area under the curve (0.78), 77.8% sensitivity, and 82.6% specificity. The areas under the curve were smaller for the shell than for the endometrium. Conclusion: 3D-PDA was not found better than 2D ultrasound at distinguishing benign from malignant disease in women with AUB and an endometrial thickness greater than 4.5 mm. (c) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.