title: An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding.
abstract: OBJECTIVE
  To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium > or = 5 mm.
  
  
  METHODS
  Eighty-three women with postmenopausal bleeding and endometrium > or = 5 mm underwent gray-scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray-scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off-line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy.
  
  
  RESULTS
  Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the 'objective probability of endometrial malignancy'. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the 'subjective probability of malignancy'. Endometrial thickness > or = 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the 'objective probability of malignancy' (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001-0.02). The 'objective probability of malignancy' detected more malignancies at endometrium 5-15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89).
  
  
  CONCLUSIONS
  Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5-15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development.
authors.affiliation: Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Sweden. elisabeth.epstein@obst.mas.lu.se
authors.forename: E
authors.initials: E
authors.lastname: Epstein
authors.forename: L
authors.initials: L
authors.lastname: Skoog
authors.forename: P-E
authors.initials: PE
authors.lastname: Isberg
authors.forename: F
authors.initials: F
authors.lastname: De Smet
authors.forename: B
authors.initials: B
authors.lastname: De Moor
authors.forename: P-A
authors.initials: PA
authors.lastname: Olofsson
authors.forename: S
authors.initials: S
authors.lastname: Gudmundsson
authors.forename: L
authors.initials: L
authors.lastname: Valentin
mesh_terms: D000368:Aged; D000465:Algorithms; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D004717:Endometrium / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D017698:Postmenopause; D011237:Predictive Value of Tests; D012372:ROC Curve; D018608:Ultrasonography, Doppler / Q000379:methods*; D014592:Uterine Hemorrhage / Q000150:complications / Q000209:etiology*; D014621:Vagina / Q000000981:diagnostic imaging