THE CORRELATION BETWEEN UTERINE ARTERY DOPPLER ULTRASONOGRAPHY RESULTS AND ENDOMETRIAL THICKNESS VERSUS HISTOPATHOLOGICAL RESULTS IN WOMEN WITH PERIMENOPAUSAL BLEEDING

Year 1999, Volume: 12 Issue: 3, 130 - 133, 03.12.2016

Rıfat Erden Nurettin Aka Ülkü Taşkın Eşref Yazıcıeğlu Ayşe Önal

Abstract

Objective: We have aimed at investigating the correlation between uterine artery flow waves and endometrial thickness as well as histopathologic changes in women who presented with either peri or postmenopausal bleeding as transvaginal ultrasonography is obviously less invasive than curettage; the low rate of morbidity or even mortality that exists for curettage is a disadvantage.
Methods: We performed Doppler studies of the uterine artery in 78 women with postmenopausal and perimenopausal bleeding. In all of the patients diagnostic curettage was performed 1 to 7 days after ultrasonography. The curettage material obtained was examined at the Pathology Department of our hospital for histopathologic diagnosis. The specificity and sensitivity of the endometrial thickness and uterine artery resistance index (Rl) were evaluated to diagnose the malignant changes of the endometrium.
Results: Fifty-seven women had non-malignant changes and 21 women had malignant changes on histologic examination of the endometrium. Uterine fibroids were detected in 18 women. When malignant changes were detected in the endometrium, uterine artery resistance index was always below 0.80. The mean uterine artery resistance index was significantly lower in the group of women with pathologic changes of the endometrium (Rl=0.706±0.085) compared to the group with non-pathologic changes (0.821 ±0.072) (p<0.0005). In five of six patients with endometrial carcinoma, blood vessels were detected around the myometrium and endometrium by using color flow imaging. Their Rl was always less than 0.50. All six women with endometrial carcinoma, but only eleven of 15 women with endometrial hyperplasia, had endometrial thickness greater than 5 mm.
Conclusion: Doppler velocimetry of the uterine artery is useful (100%) for detecting pathologic changes of the endometrium in patients presenting with perimenopausal bleeding. The presence of high resistance in the uterine artery, may allow a more conservative approach in this group of patients.
Key Words: Perimenopausal bleeding,
Endometrial histopathology, Doppler velocimetry.

References

• Weiner Z, Deck D, Rottam S, Brandes JM, Thaler I. Uterine artery How velocity waveforms and color flow imaging in women with perimenopausal and postmenopausal bleeding, Acta Obstet Gynecol Scand 1993:72; 162-166.
• Granberg S, Wikland M, Karlsson B, Horstrom A, Friberg LG. Endometrial thickness as measured by
• endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol 1991;164:47-52.
• Grimes DA. Diagnostic dilatation and curettage: a reapraisal. Am J Obstet Gynecol 1982,142:1-6.
• Stowall TG, Solomon SK, Link FW. Endometrial sampling prior to hysterectomy. Am J Obstet Gynecol 1989;73:405-409.
• Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol 1975;45:537-541.
• Word B, Gravice LC, Wideman GL. The fallacy of simple uterine curettage. Obstet Gynecol 1958;12:642-647.
• Mendelson EB, Bohm-Velez M, Joseph ft, rteiman
• fIL. Endometrial abnormalities: Evaluation with transvaginal sonography. Am J Radiol
• ; 150:139-142.
• Timor-tritsch IE, Bar-Yam Y, Elgali S, Rottem S. The technique of transvaginal sonography with the use of 6.5 mflz probe. Am J Obstet Gynecol 1988,158:1019-1024.
• Fleischer AC, Gordon Art, Entman SS, Kepple DM. Transvaginal scanning of the endometrium. JCU 1990;18:337-349.
• Kurjak A, Zalud I, lurkovic D, Alfirevic Z, Milijan M. Transvaginal color flow Doppler for the assessment of pelvic circulation. Acta Obstet Gynecol Scand 1989;68:131-135.
• Thaler I, Manor D, Rottem S, et al. Hemodynamic evaluation of female pelvic vessels using high frequency transvaginal image-directed Doppler system. JCU 1990;8:364-367.
• Merce LT, Garcia GL, de la Fuente F. Doppler ultrasound assessment of endometrial pathology. Acta Obstet Gynecol Scand 1991;70:525-530.
• Kurjac A, Zalud I, Jurkovic D. The assessment of abnormal pelvic blood flow by transvaginal color Doppler. Ultrasound Med Biol 1990;16:437-442.
• Kurjac A, Shalon fl, Sosie A, et al. Endometrial carcinoma in postmenopausal women: Evaluation by color Doppler ultrasonography. Am J Obstet Gynecol 1993; 169:1597-1603.