title: Diagnostic utility of three-dimensional power Doppler ultrasound for postmenopausal bleeding.
abstract: OBJECTIVE
  We evaluated the role of three-dimensional power Doppler ultrasound (3D PD-US) to detect endometrial lesions in women with postmenopausal endometrial bleeding.
  
  
  METHODS
  In this prospective observational study, from January 2009 to November 2012, we recruited 225 postmenopausal women with postmenopausal uterine bleeding who met the study criteria. Women who had hematologic disease, chronic medical diseases, or nonuterine pelvic diseases were excluded. Prior to endometrial biopsy, the patients underwent a baseline transvaginal ultrasound screening. The vascular indices and endometrial volumes were calculated with 3D PD-US and compared with the endometrial histopathology.
  
  
  RESULTS
  Among the endometrial histopathologic findings of 174 women, atrophic endometrium was the most common finding (30.5%). Endometrial malignancy was confirmed in 28 cases (16.1%), and endometrial hyperplasia was diagnosed in 17 cases (9.8%). The prevalence of endometrial cancer was high in patients who had endometrial thickness >9.5 mm (p < 0.001) and volume greater than 4.05 mL (p < 0.001). For the endometrial carcinoma only, the cutoff values of vascular index, flow index, and vascular flow index for predicting malignancy were 13.070, 12.610, and 3.764, respectively. For endometrial hyperplasia, endometrial thickness and vascular flow index were significant findings.
  
  
  CONCLUSIONS
  Endometrial vasculature and volume can be obtained using 3D PD-US. The diagnostic usefulness of 3D PD-US for endometrial diseases is promising in women with postmenopausal endometrial bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Wonkwang Medical Science, College of Medicine, Wonkwang University, Iksan, Republic of Korea.
authors.forename: Ari
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan, Republic of Korea.
authors.forename: Sungwook
authors.initials: S
authors.lastname: Chun
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Kosin University, Busan, Republic of Korea. Electronic address: hykyale@yahoo.com.
authors.forename: Heung Yeol
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000368:Aged; D001284:Atrophy / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D002277:Carcinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D004714:Endometrial Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D016889:Endometrial Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D004717:Endometrium / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D009929:Organ Size; D017698:Postmenopause; D011446:Prospective Studies; D012372:ROC Curve; D018608:Ultrasonography, Doppler; D014592:Uterine Hemorrhage / Q000209:etiology*
keywords: endometrial biopsy; postmenopausal bleeding; power Doppler; three-dimensional ultrasound