ACCURACY OF COLOR DOPPLER IN DETECTING ENDOMETRIAL ABNORMALITIES IN WOMEN WITH PERI AND POSTMENOPAUSAL BLEEDING.

Background: In most women with peri and post menopausal bleeding have non malignant endometrial changes. However’ uterine currettage is mandatory to exclude malignant changes. Diagnostic curretage has been the method of choice for many years to diagnose cancer of endometrium in patients with post menopaual bleeding. Although it is a simple technique, however it is an invasive and uncomfortable procedure and not without danger. For this reason many different methods have been developed to minimize the need of currettage. Trans-vaginal sonography and color doppler of uterine artery have shown good accuracy in detecting normal endometrium from abnormal. Objectives: Aim of this work is to evaluate the role of color doppler study of endometrium and Doppler velocimetric measurement of uterine artery as non invasive screening procedures to detect endometrial pathology in peri and post menopausal bleeding and to correlate the sonographic results with hispathological finding in order to discriminate normal from pathological endometrium. Methodology: This study was carried out in Department of Obstetrics and Gynaecology with collaboration of Department of Pathology and Department of Radiology. 100 patients were selected and they were presented with chief complaints of peri and post menopausal bleeding and subjected to Trans-vaginal sonography, color Doppler n diagnostic curettage. The data obtained from the ultrasound and Doppler examinations is compared to the results of the Histopatholigical Diagnosis After currettage. Results: This study included 100 patients with abnormal uterine bleeding, 70 perimenopausal and 30 post menopausal. These patients were initially screened with vaginal ultrasound for endometrial thickness and Doppler indices were obtained from the uterine artery (especially the resistance index RI and the pulsatility index). These results were compared to the histopathological findings. As regards the results of Doppler velocimetric study of the uterine artery in the present study: (i) The resistance index (RI) of the uterine artery, was significantly higher in patients with atrophic endometrium and also in patients with benign endometrial lesions (0.85±0.036) compared to those with abnormal pathological endometrium (mean RI 0.73±0.078) denoting a decrease in the vascular impedance leading to increase blood flow in pathological endometrium conditions especially malignancy. The present study recommend the use of 0.83 as a cut off values for uterine artery RI as maximum sensitivity and specificity was seen at this value in discriminating normal endometrium from abnormal pathological endometrium. (ii) The pulsatality index (PI) of the uterine artery, was significantly higher in patients with atrophic endometrium and also in patients with benign endometrium lesions compared to those with endometrial abnormalities (mean PI 3.88 ± 0.432 and 1.65 ± 1.17 respectively). When choosing the cut off limit for the PI, a value of 3.80 seemed to be the most appropriate as it was associated with a sensitivity of 92.6% and a specificity 73.9%. Conclusion: Doppler velocimetric study of the uterine artery offers simple non invasive valuable method in screening cases of peri and postmenopausal bleeding and the present study recommend the use of 0.83 and 3.80 as a cut off values for uterine artery RI and PI respectively to discriminating normal endometrium from abnormal pathological endometrium. This value had resulted in a sensitivity of 92.3% and a specificity of 66.67 % for RI, a sensitivity of 92.6% and a specificity of 73.9% for PI, giving this technique a great reliability in differentiating normal from pathological endometrial patterns in cases of peri and postmenopausal bleeding. Doppler velocimetric study of the uterine artery posses high sensitivity and specificity that makes it clinically useful as a single screening tool in discriminating normal from abnormal pathological endometrium in cases with peri and postmenopausal bleeding. But we emphasize the importance of the combined examination of transvaginal ultrasound and color doppler to increase the screening accuracy and to decrease as much as possible the false results that may occur in either of them alone, as the ultrasonography evaluates the endometrial morphology while Doppler study in concerned with hemodynamic changes and thus both techniques are complementary.