Accuracy of 3D Ultrasound in the Diagnosis of Uterine Pathology in Patients with Postmenopausal Bleeding

Objective: To evaluate the diagnostic accuracy of 3-Dimensional transvaginal sonography (3-D TVUS) in detection of myometrial and endometrial lesions compared to uterine histopathological assessment in patients with postmenopausal bleeding(PMB).To estimate the accuracy of transvaginal Power Doppler of the endometrium and subendometrial space in predicting endometrial pathology in PMB patients.

Material and Method: Prospective observational study conducted on 80 postmenopausal patients presenting with PMB.All patients were subjected to 2-dimensional (2-D) and 3-D TVUS of the uterus to detect the presenceof any cavitary or myometrial lesions.Power Doppler sonography was done to detect vascular flow to the endometrium and subendometrial space to measure RI (Resistance Index), PI (Pulsatility Index) and PSV (Peak Systolic Velocity) of remarkable vessels.Histopathological diagnoses were obtained in all cases.

Results: The corresponding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of 3-D TVUS as a diagnostic test for Fibroid were 94.11%, 93.6%, 80% and 98.33% respectively and for Adenomyosis, were 88.88%, 95.77%, 80% and 98.55% respectively.

The accuracy of 3-D TVUS in diagnosing myometrial lesions is of 88.46% sensitivity & 55.56% specificity with accuracy 75% however in diagnosing endometrial lesions is of 77.36% sensitivity & 90% specificity with accuracy 81.93%.

The receiver operating characteristic(ROC) curvesrevealed that the cut-off values of RI=0.76, PI=1.26 & PSV=6.25 (cm/sec) for prediction of abnormal endometrium yielded sensitivity of 98.15%, 73.6% & 75.5% respectively.

Conclusion: 3-D TVUS is an accurate tool in diagnosing the cause of bleeding in postmenopausal patients; it shows high correlation with the histopathological results.

Power Doppler examination of the endometrial and subendometrial space can be used to differentiate normal from abnormal pathology through cut-off values with high sensitivity specially when examining RI values.