TRANSVAGINAL COLOR AND PULSED DOPPLER SONOGRAPHY OF THE ENDOMETRIUM -A POSSIBLE ROLE IN REDUCING THE NUMBER OF DILATATION AND CURETTAGE PROCEDURES

The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospe ctive study involved 42 postmenopausal patients who were examined, pri or to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vagina l bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cu t-off value of 8 mm), rates of visualization, and the density of uteri ne, myometrial (peritumoral) and endometrial (intratumoral) vessels we re used, along with pulsatility and resistive indices of these vessels , to assess and correlate with endometrium pathology. Endometrial thic kness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in a symptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vesse ls in cases of endometrial carcinoma was 93% and 43% respectively, whi ch was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carc inoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularit y was found in the myometrium (P < 0.01). We concluded that transvagin al color and pulsed Doppler sonography may help in improving different iation of malignant from benign endometrial pathologic conditions, as well as reducing the number of unnecessary dilatation and curettage pr ocedures in postmenopausal women.