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

Abstract

ObjectiveTo 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.MethodsThis 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.ResultsThe 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.ConclusionET, 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.

Assessment of paraclinical characteristics in peri- and postmenopausal bleeding women: is there a correlation between hemoglobin levels and ultrasonic indices?

“…Overall, endometrial hyperplasia should be carefully managed by clinicians to avoid progression to moderate-severe anemia in women with perimenopausal bleeding, and abnormal endometrium thickness is a risk factor for endometrial cancer in women with postmenopausal bleeding. 6 , 7 , 13 , 38 Our study indicated no significant correlation between Hb concentration and endometrial thickness; however, the greater measured uterine size appeared to be associated with lower Hb levels. In fact, a large uterus may be accompanied by bulky fibroids, as well as other intrauterine masses, thus leading to severe hemorrhage and anemia.…”

“… 9 , 10 Ultrasonography has been described as giving gynecologists a second set of eyes, because it can reveal changes in uterine size as well as structural abnormalities in the uterine cavity. 11 , 12 , 13 These non-invasive findings are more acceptable first-line imaging modalities than invasive modalities such as endometrial biopsy or hysteroscopy. 4 , 14 Moreover, some studies have attempted to find correlations between the uterine size or endometrial thickness and the hemoglobin (Hb) concentration; however, the results remains limited in the literature.…”

Three cases of heavy menstrual bleeding with uniform thickening of the junctional zone endometrium

“…Ideally, this should have been performed for the evaluation of HMB possibly associated with malignant disease. 9 The patients' symptoms in these cases were relieved by hormone therapy; therefore, no surgical treatment was performed. Whether hormone therapy will be effective in similar cases in the future requires accumulation of similar cases.…”

“…Ideally, this should have been performed for the evaluation of HMB possibly associated with malignant disease. 9…”

Evaluating Clinical Features in Intracavitary Uterine Pathologies among Vietnamese Women Presenting with Peri-and Postmenopausal Bleeding

“…These modalities may be ultrasound, saline infusion sonography, computerized tomography scanner, magnetic resonance imaging, hysteroscopy, endometrial biopsy, etc. [ 14 15 16 17 18 ] However, some modalities remain expensive for assessment in low- and middle-income countries such as Vietnam. Meanwhile, the physician can firstly approach to initial features, evaluate carefully clinical symptoms, and classify the degree of anemia prior to investigate by additional diagnostic modalities as ultrasound, biopsy, and surgical procedures.…”