Dopler ultasound scoring system for identification of endometrial cancer in postmenopausal patients

Abstract

Introduction: Endometrial cancer (EC) is the most common malignancy of the female genital tract in the developed world. Nowadays, preoperative evaluations using advanced imaging techniques have become more common, but little has been done on the best imaging technique for routine use and preoperative evaluations of endometrial carcinoma. The aim of this study was to evaluate the predictive value of Doppler ultrasound scoring system in detection of endometrial malignancy in postmenopausal patients with vaginal bleeding. Material and Methods: This cross-sectional study, was conducted at the University Clinic of Obstetrics and Gynecology, Skopje and included 164 postmenopausal patients admitted to the Gynecology Department of the clinic. They were divided into two main groups based on their clinical presentation and further subdivided according to histopathological results. All patients underwent a standard transvaginal ultrasound examination followed by power Doppler endometrial vascularity assessment, as well as histopathological analyses of endometrial sampling for each of them was performed. Univariate and multivariate logistic regression were utilized to determine the predictive values of Doppler parameters and the scoring system. Results: Significant associations were found between endometrial malignancy and various factors, including number of blood vessels, presence of densely packed bundles, the values of pulsatility index, resistance index, time averaged maximum velocity and peak systolic velocity. Among these, pulsatility index had the greatest influence (Wald=11.32/ p<0.01 (p=0.001)) and time averaged maximum velocity had the weakest influence (Wald=0.10/ p>0.05 (p=0.73)). Clinical scoring system exhibited a sensitivity of 79.60%, the specificity is 97.30%, and overall model accuracy is 91.50%. Conclusion: The results of our study have proved that all Doppler parameters are significant predictive factors in determining endometrial cancer in postmenopausal patients with vaginal bleeding. Their combination could obtain a non-invasive scoring system that could reduce invasive procedure in diagnosis of the endometrial malignancy in patients with ultrasound characteristic of thickened endometrium more than 5mm. For this scoring system, there is a need of modern ultrasound device and clinician with greater experience.