Transvaginal power Doppler sonography can discriminate between benign and malignant endometrial conditions in women with postmenopausal bleeding

Objective: To evaluate the role of transvaginal power Doppler sonography in differentiation between benign and malignant endometrial conditions in women with postmenopausal bleeding.
Setting: OB/GYN Dept., Suzan Mubarak University Hospital and Radiology Dept., Minia University Hospital, Minia University, Minia, Egypt.
Study design: Prospective observational study.
Patients: Eighty patients with postmenopausal bleeding.
Intervention(s): Grey scale transvaginal sonography, power Doppler study of the endometrium and endometrial-myometrial interface, and office hysteroscopy and the final diagnosis by histopathological examination of hysteroscopic guided biopsy.
Results: Endometrial power Doppler signals were positive in 69 out of the eighty patients (86.25%): 8 cases showed multiple vessel pattern -A- (10%); 19 cases with single vessel pattern - B- (23.75%); 42 cases with scattered vessel pattern -C- (52.5%) while in the remaining 11 cases (13.75%), no power Doppler signals were detected. The hysteroscopic findings were endometrial polyp in 16 cases (20%), atrophic endometrium in 14 cases (17.5%), hyperplasic endometrium in 32 cases (40%), submucus fibroid in 6 cases (7.5%), cervical polyp in 3 cases (3.75%) and suspicious endometrium for malignancy in 8 cases (10%). Hysteroscopy was more accurate in cases with intracavitary masses (polyps and submucous fibroids) than power Doppler, but power Doppler had a more predictive value for malignant endometrium.
Conclusion: Power Doppler blood flow mapping of the endometrium in women with postmenopausal bleeding is useful to discriminate carcinoma from other endometrial pathologies.

Keywords
Postmenopausal bleeding; Transvaginal sonography; Power Doppler sonography; Office hysteroscopy; Hysteroscopic guided biopsy