Objective: To evaluate the diagnostic accuracy of power Doppler area (PDA) in the detection of endometrial cancer in women with postmenopausal bleeding.
Design: Prospective diagnostic study.
Setting: University hospital.
Population: Seventy-four consecutive women presenting with postmenopausal bleeding and a total endometrial thickness of more than 4 mm.
Methods: The PDA was measured by pelvic ultrasound. Endometrial cancer and hyperplasia with complex atypia were considered abnormal.
Main Outcome Measures: A receiver operating characteristic curve was constructed and area under curve (AUC) calculated as well as positive and negative likelihood ratios (LR+ and LR−).
Results: Eighteen women (24%) had abnormal results of their histological specimen. The AUC of the PDA was 0.88 (95% confidence interval [CI], 0.80-0.98). The LR+ and LR− of the PDA were, respectively, 14.5 (95% CI, 4.69-44.9) and 0.23 (95% CI, 0.09-0.55). In women with total endometrial thickness of 4 to 10 mm, the AUC, LR+, and LR− were, respectively, 0.91 (95% CI, 0.78-1.00), 23.9 (95% CI, 3.29-175.0), and 0.34 (95% CI, 0.13-0.86).
Conclusions: The PDA is an effective measure in the diagnosis and exclusion of endometrial cancer.
- Postmenopausal bleeding
- Endometrial cancer
- Gynecological ultrasound
- Power Doppler
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This study had no funding or grants to acknowledge.
The authors have no conflicts of interest to disclose.
Contribution of authorship: C.D. de Kroon designed the study, collected the data, had a substantial contribution in the analysis and interpretation of the data, and wrote the draft of the article. He approved the final version of the article.
E. Hiemstra had substantial contribution to the analysis and interpretation of the data, wrote the article in cooperation with C.D. de Kroon, and approved the final version.
J.B. Trimbos had substantial contribution in the interpretation of the data, revised the article for intellectual content, and approved the final version of the article.
F.W. Jansen substantially contributed to the design of the study and interpretation of data, revised the article for important intellectual content, and approved the final version of the article.
Ethical approval: Because gynecological ultrasound is part of the routine workup of women presenting with postmenopausal bleeding, special ethical approval by the local ethics committee was not necessary according to the local protocol.
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