الفهرس 
Postmenopausal BleedingOnly 14 pages are availabe for public view
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Abstract
Bleeding after menopause is a widespread problem, with 10%-15% of cases later suffering from cancer of the endometrium. It differs from other malignancies, in that early symptomatiza¬tion is common, allowing early cure. Survival drops with late stages and so studies should strive to increase the precision of various diagnostic practices (1). The ideal diagnostic strategy is still debatable. A thin endometrium measuring less than 5mm by vaginal scanning in PMB excludes about 99% of endo¬metrial cancers. Sampling of the endometrium is considered necessary in those patients with an endometrium ≥5 mm. However, many “normal” women with PMB and thickened endometria will undergo unnecessary diagnostic procedures. (2). Three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) is a novel sonographic diagnostic modality. This technology permits acquisition of the volume of the endometrium and assessment of its vasculature using 3D power Doppler mapping. During study period, 130 women with postmenopausal bleeding were evaluated at ghamra military hospital. Thirty five patients were excluded due to: endometrial thickness less than5 mm, Use of tamoxifen or hormone replacement therapy, Power Doppler artifacts due to electronic disturbances, Very poor image quality, and no definitive histological diagnosis. Ninety-five women were included ultimately.
For each patient, full history, general, abdominal and pelvic examinations were performed. Routine pre-operative investigations were done.
All patients were subjected to transvaginal ultrasound, 3D PDA and endometrial sampling by dilatation and curettage (D&C) under general anesthesia after a written consent and pathological examination of the specimens obtained. Division according to endometrial pathology into 2 groups was done. Group 1 included 35 patients with malignant endometrium. Group 2 was 60 patients with benign endometrium. As regards the measurement of endometrial volume, in our study there was a high statistical significance in comparison of both groups; in group 1 endometrial volume was 17.98±5.61 cc while in group 2 it was 10.77±5.51cc, p-value<0.001. However it was not statistically significant when used to compare different histopathologies. Endometrial volume was higher in patient with endometrial polyps. Endometrial volume; VI, FI and VFI were significantly higher in endometrial cancer, compared with benign diseases, when discussing power Doppler indices in differentiating different histopathologies it was statistically significant for VI and FI while VFI nearly equal in patient with carcinoma and endometrial polyps. The ultimate discriminator between non-cancerous and cancerous endometrium was VI, with an AUC of 0.966.