title: The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions.
abstract: OBJECTIVE
  The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping.
  
  
  METHODS
  A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings.
  
  
  RESULTS
  Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively.
  
  
  CONCLUSIONS
  Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.
authors.affiliation: Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey. ebrucogendez@gmail.com.
authors.forename: Ebru
authors.initials: E
authors.lastname: Cogendez
authors.affiliation: Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
authors.forename: Meryem Kurek
authors.initials: MK
authors.lastname: Eken
authors.affiliation: Radiology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
authors.forename: Nuray
authors.initials: N
authors.lastname: Bakal
authors.affiliation: Gynecology Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
authors.forename: Ismet
authors.initials: I
authors.lastname: Gun
authors.affiliation: Pathology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ecmel Isik
authors.initials: EI
authors.lastname: Kaygusuz
authors.affiliation: Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ates
authors.initials: A
authors.lastname: Karateke
mesh_terms: D000328:Adult; D000465:Algorithms; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009214:Myoma / Q000000981:diagnostic imaging*; D011127:Polyps / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*; D014621:Vagina
keywords: Endometrial polyp; Power Doppler ultrasound; Submucous myoma