Obstet Gynecol Sci.  2022 Sep;65(5):430-440. 10.5468/ogs.22053.

Endometrial thickness and uterine artery Doppler parameters as soft markers for prediction of endometrial cancer in postmenopausal bleeding women: a cross-sectional study at tertiary referral hospitals from Vietnam

• Nguyen PN
• Nguyen VT

• KMID: 2533816
• DOI: http://doi.org/10.5468/ogs.22053

Abstract

Objective
To determine the value of endometrial thickness (ET) and Doppler indices of uterine artery (UtA) as sonographic markers in predicting endometrial cancer (EC) among postmenopausal bleeding (PMB) women in low-resource settings as Vietnam.
Methods
This cross-sectional study was conducted at the Hue University Hospital and Hue Central Hospital between June 2016 and June 2019. The study enrolled all women who complained of PMB and were followed by transvaginal Doppler ultrasound. Their definitive histopathological examination was the gold standard for comparison.
Results
The UtA Doppler indices, including resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV), were significantly lower in the malignant group than in the benign group. The threshold values of the UtA, RI ≤0.73 and PI ≤1.42, were found with an area under receiver operating characteristic curve (AUC) of 0.85-0.88, and the sensitivity and specificity were 91.3% and 83.3%, respectively. Unlike PSV, the diagnostic value was the lowest, with an AUC of 0.72. ET was a good predictor for the diagnosis of EC, with an AUC of 0.89. In women with PMB, when using the cutoff value of EC more than 12.5 mm, the sensitivity and specificity were 93.8% and 77.8%, respectively. In addition, the higher the stage of EC, the lower the RI and PI and the greater the EC.
Conclusion
ET, and RI, PI, and PSV of the UtA could help in differentiating malignant from benign endometrial changes. Pulsed ultrasonic Doppler velocimetry seems to play a role in predicting the higher stages of EC. Further studies are needed to confirm these findings.

Keyword

Doppler transvaginal ultrasound; Endometrial cancer; Postmenopausal period; Uterine artery; Uterine bleeding

Figure

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  Fig. 1 Measurement of the endometrial thickness following the standard of International Endometrial Tumour Analysis (IETA) [14] (A, B).

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  Fig. 2 Determination of bilateral uterine arteries the Doppler window was opened from 1.5–2.0 mm. The Doppler angle between the ultrasound beam and the vascular direction was <20 degree. RI, PI, and PSV index were automatically calculated from three consecutive waveforms. RI, resistance index; PI, pulsatility index; PSV, peak systolic velocity.

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  Fig. 3 Receiver operating curve (ROC) of endometrial thickness (ET), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). UtA, uterine artery; EC, endometrial cancer; PMB, postmenopausal bleeding.

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  Fig. 4 Correlation between endometrial thickness (ET), resistance index (RI), pulsatility index (PI), and the stages of endometrial cancer.

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  Fig. 5 Correlation between endometrial thickness (ET), resistance index (RI), and pulsatility index (PI).

Reference

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