Grey scale ultrasound morphology and endometrial vascularity as assessed by color Doppler ultrasound before and during saline infusion for discrimination between benign and malignant endometrium in women with postmenopausal bleeding

Obstetrics and Gynecology. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination. Citation for the published paper: Löfgren, Lars. "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" Access to the published version may require journal subscription. Abstract Objective: To determine if grey scale ultrasound morphology and endometrial vascular morphology as assessed by color Doppler ultrasound can discriminate between benign and malignant endometrium in women with postmenopausal bleeding. Methods: In a prospective study 95 consecutive women with postmenopausal bleeding and endometrial thickness > 4.5 mm as measured by transvaginal ultrasound were included. Grey scale and color Doppler ultrasound examination of the endometrium was performed before and during saline infusion. The ultrasound examiner characterized the morphology of the endometrium and the endometrial vascular tree using a predetermined classification protocol without suggesting a diagnosis. A histopathological diagnosis was obtained by operative hysteroscopy, D&C or hysterectomy. Results: There were no statistically significant differences between benign and malignant endometria in results of ultrasound scan performed without fluid in the uterine cavity. Heterogeneous echogenicity, irregular surface, and both heterogenous echogenicity and irregular surface of a focal lesion (or of the endometrium in the absence of focal lesions) in a uterine cavity filled with fluid (spontaneous or infused) were significantly more common in malignant than in benign endometrium. The sensitivity, false positive rate, positive and negative likelihood ratios of these findings were were found in 67% (8/12) of the malignant endometria vs. in 51% (40/79) of the benign endometria (non-significant difference). Vascular branching tended to be more common in malignant endometria (10/11; 91%) than in benign endometria (39/61; 64%), p = 0.09. Conclusion: Heterogeneous echogenicity and an irregular surface of a focal lesion or of the endometrium in a fluid filled uterine cavity were the most useful ultrasound criteria for predicting endometrial malignancy. Assessment of vascular morphology using color Doppler 3 3 ultrasound was of limited value – if any – for discrimination between benign and malignant endometrium.