الفهرس 
Uterine endometriumOnly 14 pages are availabe for public view
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Abstract
This prospective study aimed to evaluate the role of transvaginal ultrasound (TVU) and transvaginal Color Doppler ultrasonography (TV-CDU) in diagnosis of peri-menopausal women with abnormal uterine bleeding (AUB) and endometrial hyperplasia (EH) without atypia as documented by histopathological examination of Dilatation and Curettage (D&C) biopsy. Also, the study aimed to evaluate the therapeutic yield of oral progesterone therapy as judged by post-treatment transvaginal imaging versus D&C biopsy.
The study included 20 women within age range of 35-45 years and presented to Gynecology outpatient clinic with AUB secondary to EH as approved by D&C endometrial biopsy.
All women received progesterone therapy in the form of norethisterone 5 mg tablet twice daily starting from the 14th day of start of bleeding for 12 days for 3 consecutive months. At the end of the three month therapeutic course, patients were evaluated clinically and underwent TVS and TV-CDU and D&C biopsy to determine the therapeutic effect compared and post-treatment measures were compared versus pre-treatment measures.
Mean pre-treatment endometrial thickness (ET) was 11.4±2; range: 8.7-17 mm. All patients showed post-treatment regression of ET with mean decrease of 32.9%±12.3%; range: 14.3%-50%. Mean post-treatment ET was 7.7±2.4; range: 5-13 mm and was significantly lower compared to pre-treatment ET. However, 7 patients (35%) still had ET>8 mm and were considered to still have EH.
Mean pre-treatment endometrial resistance index (RI) was 0.86±0.043; range: 0.75-0.95. All patients showed diminution of their endometrial RI with mean decrease of 31.8%±9.8%; range: 12.9%-44.1%. Mean post-treatment endometrial RI was 0.586±0.088; range: 0.51-0.75 and was significantly lower compared to pre-treatment endometrial RI.
Mean pre-treatment endometrial pulsatility index (PI) was 2.25±0.28; range: 1.92-2.75. All patients showed diminution of their endometrial PI with the mean decrease of 21.8%±12.3%; range: 4.1%-43.2%. Mean post-treatment endometrial PI was 1.73±0.14; range: 1.5-1.93 and was significantly lower compared to pre-treatment PI.
Pathological examination of pre-treatment D&C biopsy defined 17 patients had simple EH and 3 patients had complex EH. Post-treatment D&C endometrial biopsy defined 13 patients had normal endometrium. Six patients had SEH; 5 had persistent SEH and one was CEH on pre-treatment biopsy, while one patient had persistent CEH. The frequency of women had post-treatment EH was significantly lower compared to pre-treatment frequency. The frequency of women with CEH among those had EH was non-significantly lower in post-treatment compared to pre-treatment biopsies. Total therapeutic success rate as documented by post-treatment D&C biopsy and defined as the frequency of women got normal endometrium was 65%.
TVU showed a sensitivity rate for defining EH of 85.7%; specificity rate of 92.3% and accuracy rate for diagnosis of EH of 90%. TV-CDU showed a sensitivity rate for defining EH of 71.4%; specificity rate of 84.6% and accuracy rate for diagnosis of EH of 80%. Both TVU and TV-CDU showed non-significant difference as regards diagnostic yield for EH.
Diagnostic yield of combined TVU and TV-CDU showed sensitivity rate for diagnosis of EH of 83.3% and specificity rate of 91.7% and accuracy rate of diagnosis of 88.9%.