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Additional value of Doppler ultrasound to B-mode ultrasound in assessing for uterine intracavitary pathologies among perimenopausal and postmenopausal bleeding women: a multicentre prospective observational study in Vietnam

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Abstract

Purpose

To determine the role of Doppler ultrasonography when combined with B-mode ultrasonography in diagnosing uterine intracavitary pathologies (UIPs) in perimenopausal and postmenopausal bleeding women.

Methods

This multicentre prospective observational study included 150 women aged > 40 years with abnormal uterine bleeding (AUB), who were hospitalised at Hospital X and Hospital Y between June 2016 and June 2019. All participants underwent transvaginal B-mode ultrasound and transvaginal Doppler ultrasound, and the results of sonography were compared to histopathological endpoint.

Results

The morphological features, structure, margin, border line of the endometrial-mass lesion, intracavitary uterine fluid, and Doppler signal clearly differed between benign and malignant intracavitary pathologies (p < 0.0001). However, echogenicity had a limited value in differentiating among UIPs (p = 0.1). The sensitivity and specificity of the pedicle sign in diagnosing endometrial polyps were 50.0% and 97.6%; for the circular pattern in endometrial fibroids were 46.2% and 100.0%; for the multiple vessel pattern in endometrial cancer were 64.0% and 96.0%; and for the scattered vessel pattern in endometrial hyperplasia were 43.96% and 56.43%, respectively. The additional value of Doppler ultrasound was greater than that of separate B-mode ultrasound in assessing UIPs in our study.

Conclusions

B-mode ultrasound used in combination with Doppler as a noninvasive tool was significantly valuable in the diagnostic procedures for UIPs in perimenopausal and postmenopausal bleeding women. Doppler ultrasound and B-mode transvaginal ultrasound should be used together routinely for discrimination between malignant diseases and benign endometrial changes. Further studies are needed to better understand the benefits of combining Doppler ultrasound and B-mode ultrasound in routine sonographic practice.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUB:

Abnormal uterine bleeding

EC:

Endometrial cancer

EH:

Endometrial hyperplasia

EP:

Endometrial polyps

EF:

Endometrial fibroid

TV-CDU:

Transvaginal color Doppler ultrasound

UIPs:

Uterine intracavitary pathologies

References

  1. Vitale SG, Watrowski R, Barra F et al (2022) Abnormal uterine bleeding in perimenopausal women: the role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics (Basel) 12(5):1176. https://doi.org/10.3390/diagnostics12051176

    Article  PubMed  Google Scholar 

  2. Feliciano EE, Santos AM, Agunod CD, Boshra AY, Suliman S, Malabanan MC (2020) Perimenopausal women distressing from abnormal uterine bleeding: a Philippine quality of life assessment-based correlational study. Ann Med Health Sci Res 10:838–845

    Google Scholar 

  3. Committee on Practice Bulletins—Gynecology (2021) Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol 120(1):197–206. https://doi.org/10.1097/AOG.0b013e318262e320

  4. Practice bulletin no. 136 (2013) Management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol 122(1)

  5. Boeckstaens S, Dewalheyns S, Heremans R et al (2020) Signs and symptoms associated with uterine cancer in pre- and postmenopausal women. Heliyon 6(11):e05372. https://doi.org/10.1016/j.heliyon.2020.e05372

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yao Y, Lv W, Xie X, Cheng X (2019) The value of hysteroscopy and transvaginal ultrasonography in the diagnosis of endometrial hyperplasia: a systematic review and meta-analysis. Transl Cancer Res 8(4):1179–1187. https://doi.org/10.21037/tcr.2019.06.33

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jones ER, O’Flynn H, Njoku K, Crosbie EJ (2021) Detecting endometrial cancer. Obstet Gynaecol 23(2):103–112

    Article  Google Scholar 

  8. Abdalla S, Abou-Taleb H, Badary DM, Ali WA (2021) Multiparametric transvaginal ultrasound in the diagnosis of endometrial cancer in post-menopausal bleeding: diagnostic performance of a transvaginal algorithm and reproducibility amongst less experienced observers. Br J Radiol. 94(1119):20201195

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goyal M, Agarwal VK (2016) Diagnostic Accuracy of B-mode USG and doppler scan for ovarian lesions. J Clin Diagn Res 10(9):TC01–TC04. https://doi.org/10.7860/JCDR/2016/20619.8446

    Article  PubMed  PubMed Central  Google Scholar 

  10. Epstein E, Valentin L (2006) Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 28(1):89–95

    Article  CAS  PubMed  Google Scholar 

  11. El-Sharkawy M, El-Mazny A, Ramadan W, Hatem D, Abdel-Hafiz A, Hammam M et al (2016) Three-dimensional ultrasonography and power Doppler for discrimination between benign and malignant endometrium in premenopausal women with abnormal uterine bleeding. BMC Womens Health 16:18

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cogendez E, Eken MK, Bakal N et al (2015) The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions. J Med Ultrasonics 42:533–540. https://doi.org/10.1007/s10396-015-0628-2

    Article  Google Scholar 

  13. Alcazar JL, Castillo G, Minguez JA, Galan MJ (2003) Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium. Ultrasound Obstet Gynecol 21:583–588

    Article  CAS  PubMed  Google Scholar 

  14. Van Den Bosch T, Verbakel JY, Valentin L et al (2021) Typical ultrasound features of various endometrial pathologies described using international endometrial tumor analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol 57(1):164–172. https://doi.org/10.1002/uog.22109

    Article  PubMed  Google Scholar 

  15. Sladkevicius P, Installé A, Van Den Bosch T et al (2018) International endometrial tumor analysis (IETA) terminology in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm: agreement and reliability study. Ultrasound Obstet Gynecol. 51(2):259–268. https://doi.org/10.1002/uog.18813

    Article  CAS  PubMed  Google Scholar 

  16. Furau AM, Toma MM, Ionescu C et al (2021) The correlation of the IETA ultrasound score with the histopathology results for women with abnormal bleeding in western Romania. Diagnostics (Basel) 11(8):1342. https://doi.org/10.3390/diagnostics11081342

    Article  CAS  PubMed  Google Scholar 

  17. Leone FP, Timmerman D, Bourne T, Valentin L, Epstein E, Goldstein SR, Marret H, Parsons AK, Gull B, Istre O, Sepulveda W, Ferrazzi E, Van den Bosch T (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35(1):103–112. https://doi.org/10.1002/uog.7487

    Article  CAS  PubMed  Google Scholar 

  18. Ashour ASA, Fawzy T, Faisal M (2017) The relationship between transvaginal ultrasound endometrial thickness and body mass index and endometrial pathology in women with postmenopausal bleeding. Med J Cairo Univ 85(5):2017–2023

    Google Scholar 

  19. Madkour NM (2017) An ultrasound risk-scoring model for prediction of endometrial cancer in post-menopausal women (using IETA terminology). Middle East Fertil Soc J 1–5

  20. Razik MA, Walid A, Maksoud MA (2012) Transvaginal and color doppler ultrasound assessment of endometrial pathology in patients with postmenopausal bleeding. Egypt Soc Gynaecol Obstet 38(2):709–714

    Google Scholar 

  21. Talaat S, Mostafa N, Alrauof MA (2009) Diagnostic value of ultrasound and colour Doppler in endometrial and cervical polyps. Med J Cairo Univ 77(1):397–403

    Google Scholar 

  22. Cil AP, Tulunay G, Kose MF, Haberal A (2010) Power Doppler properties of endometrial polyps and submucosal fibroids: a preliminary observational study in women with known intracavitary lesions. Ultrasound Obstet Gynecol 35(2):233–237. https://doi.org/10.1002/uog.7470

    Article  CAS  PubMed  Google Scholar 

  23. Badawy AM, Abu-Elata M (2003) Can colour Doppler ultrasonography predict the prognosis of endometrial hyperplasia? J Obstet Gynaecol 23(3):282–284. https://doi.org/10.1080/01443610310000100105

    Article  CAS  PubMed  Google Scholar 

  24. Azmy OM (2014) Haitham B (2014) Ultrasound imaging of endometrial cancer, gynecologic neoplasia. In: Rizk BRMB, Puscheck EE (eds) Ultrasonography in gynecology. Cambridge University Press, Cambridge, pp 224–232

    Chapter  Google Scholar 

  25. AbdelMaboud NM, Elsaid HH (2015) Role of transvaginal ultrasonography and colour Doppler in the evaluation of postmenopausal bleeding. Egypt J Radiol Nucl Med 46(1):235–243

    Article  Google Scholar 

  26. Li Z, Li L (2019) Risk of malignancies among asymptomatic postmenopausal women with thickened endometrium: a cohort study. Medicine 98(6):e14464

    Article  PubMed  PubMed Central  Google Scholar 

  27. El Kady SR, Abd El Fatah AT, Mohamed IH, Salem SM (2020) Correlation between endometrial histopathology in postmenopausal uterine bleeding and transvaginal colour doppler. AIMJ. 1(12):249–52

    Google Scholar 

  28. Amreena S, Singha M, Choh NA, Saldanhab C, Gojwaria TA (2018) Doppler evaluation of endometrial polyps. Egypt J Radiol Nucl Med 49:850–853. https://doi.org/10.1016/j.ejrnm.2018.03.005

    Article  Google Scholar 

  29. Perez-Medina T, Bajo J, Huertas MA, Rubio A (2002) Predicting atypia inside endometrial polyps. J Ultrasound Med 21(2):125–128. https://doi.org/10.7863/jum.2002.21.2.125

    Article  PubMed  Google Scholar 

  30. Liu MJ, Liu ZF, Yin WH, Chen XR, Gao LY, Sun HJ (2019) Application of transvaginal three-dimensional power Doppler ultrasound in benign and malignant endometrial diseases. Medicine (Baltimore) 98(46):e17965. https://doi.org/10.1097/MD.0000000000017965

    Article  PubMed  Google Scholar 

  31. Nguyen PN, Nguyen VT (2022) Value of endometrial thickness and Doppler parameters of uterine artery in predicting endometrial cancer in postmenopausal women with abnormal uterine bleeding: a cross-sectional study in Vietnam [published online ahead of print, 2022 Apr 29]. Obstet Gynecol Sci https://doi.org/10.5468/ogs.22053

  32. Grigore M, Popovici R, Himiniuc LM et al (2021) The added value of three-dimensional ultrasonography in uterine pathology. Exp Ther Med 22(5):1261. https://doi.org/10.3892/etm.2021.10696

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hanafi S, Abou-Gabal A, Akl S, El Baset HA (2014) Value of three dimensional power Doppler ultrasound in prediction of endometrial carcinoma in patients with postmenopausal bleeding. J Turk Ger Gynecol Assoc 15(2):78–81. https://doi.org/10.5152/jtgga.2014.07355

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wynants L, Verbakel JYJ, Valentin L, De Cock B, Pascual MA, Leone FPG et al (2022) The risk of endometrial malignancy and other endometrial pathology in women with abnormal uterine bleeding: an ultrasound-based model development study by the IETA group. Gynecol Obstet Invest 87(1):54–61. https://doi.org/10.1159/000522524

    Article  CAS  PubMed  Google Scholar 

  35. Madkour NM (2017) An ultrasound risk-scoring model for prediction of endometrial cancer in post-menopausal women (using IETA terminology). Middle East Fertil Soc J 22(3):201–205. https://doi.org/10.1016/j.mefs.2017.01.009

    Article  Google Scholar 

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Acknowledgments

We thank the patients, who agreed to allow us to participate in our research and to publish their clinical data. The authors are also grateful to all teachers and colleagues working at the Department of Gynecology, the Department of Image Diagnostic, and the Department of Histopathology at Hue Central Hospital and at Hue University Hospital. We are thankful directly to PhD. M.D Van Duc Vo, Ph.D. M.D Thao Nguyen Nguyen Tran, M.D. Ngoc Ty Nguyen Thi., M.D. Diem Thu Nguyen Thi, M.D. Phuong Minh Nguyen Thi, M.D. Thanh Thuy Tran Thi. All of them attributed to provide us the pictures, take care for patient and shared their precious experiences related to manage this clinical course with us.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao ward, District 1, Ho Chi Minh City, 730000, Vietnam

    Phuc Nhon Nguyen

  2. Clinical Research Unit, Tu Du Hospital, Ho Chi Minh City, Vietnam

    Phuc Nhon Nguyen

  3. Hue Medical College, Hue University, Thua Thien Hue, Vietnam

    Van Tuan Nguyen

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  1. Phuc Nhon Nguyen
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Correspondence to Phuc Nhon Nguyen.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

This study was approved by Ethical Committee of the Hue University of Medicine and Pharmacy with IRB approval number 1435/QD-DHYD.

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Written informed consent was obtained from the patients for recruitment in study.

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Nguyen, P.N., Nguyen, V.T. Additional value of Doppler ultrasound to B-mode ultrasound in assessing for uterine intracavitary pathologies among perimenopausal and postmenopausal bleeding women: a multicentre prospective observational study in Vietnam. J Ultrasound 26, 459–469 (2023). https://doi.org/10.1007/s40477-022-00732-w

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