The diagnostic value of endometrial thickness and volume measurements by three‐dimensional ultrasound in patients with postmenopausal bleeding

Abstract

We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps. The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3% and positive predictive value of 54.5%. With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women.

The Clinical Value of 3‐Dimensional Saline Infusion Sonography in Addition to 2‐Dimensional Saline Infusion Sonography in Women With Abnormal Uterine Bleeding

“…In these studies, 3D sonography allowed improved classification of ovarian tumors 14 as well as improved evaluation of the postmenopausal endometrium. 15,16 Finally, 3D sonography was highly accurate in the diagnosis of müllerian anomalies. 17 Increasing experience with 3D sonography in combination with many favorable reports on SIS resulted in the introduction of 3D-SIS.…”

Value of Three Dimensional Power Doppler Ultrasound in Prediction of Endometrial Carcinoma in Patients with Postmenopausal Bleeding

“…Both thickness and volume were greater in cases with late and less-differentiated malignancies. The measurements of endometrial volume were better than endometrial thickness as a diagnostic test for detecting endometrial malignancy in symptomatizing postmenopausal women (6). Yamen et al (8) authenticated that both endometrial volume and thickness measurements by 3D and 2D scanning, respectively, were adequately reproducible but that the reproducibility of 3D was superior.…”

3D Ultrasound in Gynecology and Reproductive Medicine

“…3D ultrasound imaging provides us with an assessment of endometrial volume in contrast with endometrial thickness measurements produced by 2D ultrasound. Gruboeck et al compared endometrial thickness measurements against endometrial volume measurements in 103 women who presented with postmenopausal bleeding [28]. Using a cutoff volume of 13 ml, endometrial cancer was diagnosed with a sensitivity of 100% and a specificity of 98% using 3D ultrasound, compared with a sensitivity of 83% and a specificity of 88% for endometrial thickness measurements with optimum cutoff levels of 15 mm.…”