Skip to main content
SpringerLink
Log in

Transvaginal ultrasonography and uterine artery Doppler in diagnosing endometrial pathologies and carcinoma in postmenopausal bleeding

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract.

Routine dilatation and curettage (D&C) in all patients with postmenopausal bleeding (PMB) is debatable, as 70%–80% will eventually receive benign diagnoses. Endometrial thickness (ET) measurements by transvaginal ultrasonography (TVUS) are used with high sensitivity to detect patients who would benefit from D&C, yet they suffer from low specificity that fails to reduce undue invasive procedures. The aim of this study was to define optimal cutoffs for ET in diagnosing endometrial pathologies in PMB and to assess a possible complementary role for Doppler ultrasonography. The study population consisted of 97 women with PMB; 39, 22 and 36 of whom had endometrial cancer (EC), benign endometrial pathologies and normal endometrial findings, respectively, defined by D&C performed after TVUS, which was used to measure uterine dimensions and ET, together with pulsatility and resistance indices (PI and RI, respectively) of the uterine arteries. Receiver operating characteristics curves revealed ET to be the most valuable parameter to prognosticate both EC and any endometrial pathology (sensitivities of 90% and 89%, and specificities of 79% and 94% with optimal cutoffs of 9.6 and 7.7 mm, respectively). Binary logistic regression revealed uterine artery RI to be the only independent variable that could be used together with ET, which increased the sensitivity of ET to 97% and 93% for EC and any endometrial pathology, but caused its specificity to regress to 58% and 53%, respectively. Same levels of sensitivity, yet better levels of specificity of 60% and 89%, respectively, were attained by using a cutoff of 6.3 mm for ET alone. Assessing uterine artery Doppler indices has no complementary role for measuring ET in evaluating PMB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Bourne TH, Campbell S, Whitehead MI, Royston P, Steer CV, Collins WP (1990) Detection of endometrial cancer in postmenopausal women by transvaginal ultrasonography and colour flow imaging. BMJ 301:369

    Google Scholar 

  2. Conoscenti G, Meir YJ, Fischer-Tamaro L, Maieron A, Natale R, D'Ottavio G, Rustico M, Mandruzzato G (1995) Endometrial assessment by transvaginal sonography and histological findings after D&C in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 6:108–115

    Google Scholar 

  3. Creasman WT, Weed JC (1981) Carcinoma of the endometrium (FIGO stages I&II): clinical features and management. In: Copeland M (ed) Gynecologic Oncology. Churchill Livingstone, Edinburgh, pp 562–577

  4. Develioðlu OH, Bilgin T, Yalcin OT, Ozalp S, Ozan H (1999) Adjunctive use of the uterine artery resistance index in the preoperative prediction of myometrial invasion in endometrial carcinoma. Gynecol Oncol 72:26–31

    Google Scholar 

  5. Flam F, Almström H, Hellström A-C, Moberger B (1995) Value of uterine artery Doppler in endometrial cancer. Acta Oncol 34:779–782

    Google Scholar 

  6. Granberg S, Wikland M, Karlsson B, Norström A, Lars-Gösta F (1991) Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol 164:47–52

    Google Scholar 

  7. Grimes DA (1982) Diagnostic dilatation and curettage: a reappraisal. Am J Obstet Gynecol 142:1–6

    Google Scholar 

  8. Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, Valentin L (1995) Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding – a Nordic multicenter study. Am J Obstet Gynecol 172:1488–1494

    Google Scholar 

  9. Kazadi-Buanga J, Jurado-Chacon M (1994) Etiologic study of 275 cases of endo-uterine hemorrhage by uterine curettage. Rev Fr Gynecol Obstet 89:129–133

    Google Scholar 

  10. Kupesic-Urek S, Shalan H, Kurjak A (1993) Early detection of endometrial cancer by transvaginal color Doppler. Eur J Obstet Gynecol Reprod Biol 49:46–49

    Google Scholar 

  11. Kurjak A, Shalan H, Sosic A, Benic S, Zudenigo D, Kupesic S, Predanic M (1993) Endometrial carcinoma in postmenopausal women: Evaluation by transvaginal color Doppler ultrasonography. Am J Obstet Gynecol 169:1597–1603

    Google Scholar 

  12. MacKenzie IZ, Bibby JG (1978) Critical assessment of dilatation and curettage in 1,029 women. Lancet 2:566–568

    Google Scholar 

  13. Mestwerdt W, Krenzfelder D (1983) Neue diagnostische Möglichkeiten beim Endometriumkarzinom und seinen Vorstufen. Gynäkologe 16:87–92

    Google Scholar 

  14. Morrow CP, Townsend DE (1987) Tumors of the endometrium. In: Morrow CP, Townsend DE (eds) Synopsis of gynecologic oncology. John Wiley, New York, pp 159–205

  15. Shipley CF, Smith ST, Launer RL, Nelson GH (1993) Estimation of uterine volume with ultrasound in women with endometrial carcinoma. J Reprod Med 38:608–610

    Google Scholar 

  16. Sladkevicius P, Valentin L, Marsál K (1994) Endometrial thickness and Doppler velocimetry of the uterine arteries as discriminators of endometrial status in women with postmenopausal bleeding: a comparative study. Am J Obstet Gynecol 171:722–728

    Google Scholar 

  17. Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, Brand R, Grady D (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280:1510–1517

    Google Scholar 

  18. Stock RJ, Kanbour A (1975) Prehysterectomy curettage. Obstet Gynecol 45:537–541

    Google Scholar 

  19. Stovall TG, Solomon SK, Ling FW (1989) Endometrial sampling prior to hysterectomy. Obstet Gynecol 73:405–409

    Google Scholar 

  20. Taipale P, Tarjanne H, Heinonen UM (1994) The diagnostic value of transvaginal sonography in the diagnosis of endometrial malignancy in women with peri- and postmenopausal bleeding. Acta Obstet Gynecol Scand 73:819–823

    Google Scholar 

  21. Weber G, Merz E, Bahlmann F, Rosch B (1998) Evaluation of different transvaginal sonographic diagnostic parameters in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 12:265–270

    Google Scholar 

  22. Weiner Z, Beck D, Rottem S, Brandes JM, Thaler I (1993) Uterine artery flow velocity waveforms and color flow imaging in women with perimenopausal and postmenopausal bleeding. Correlation to endometrial histopathology. Acta Obstet Gynecol Scand 72:162–166

    Google Scholar 

  23. Word B, Gravlee LC, Widemon GL (1958) The fallacy of simple uterine curettage. Obstet Gynecol 12:642–645

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Uludag University, Bursa, Eskisehir, Turkey

    Osman H. Develioglu & Tufan Bilgin

  2. Uludag Universitesi, Tip Fakultesi, Kadin Hastaliklari ve Dogum A.B.D, Gorukle 16059 Bursa, Turkey

    Osman H. Develioglu

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey

    Omer T. Yalcin & Sinan Özalp

Authors
  1. Osman H. Develioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tufan Bilgin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Omer T. Yalcin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sinan Özalp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osman H. Develioglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Develioglu, O.H., Bilgin, T., Yalcin, O.T. et al. Transvaginal ultrasonography and uterine artery Doppler in diagnosing endometrial pathologies and carcinoma in postmenopausal bleeding. Arch Gynecol Obstet 268, 175–180 (2003). https://doi.org/10.1007/s00404-002-0364-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-002-0364-x

Keywords.

Search

Navigation