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Accuracy of endometrial 2D ultrasound and power doppler in predicting endometrial pathology among patients with endometrial disease at Dr. Jose Fabella Memorial Hospital

Madelynne P. Olalia, MD and Leilani C. Coloma, MD, FPOGS
Department of Obstetrics and Gynecology, Dr. Jose Fabella Memorial Hospital

Background: Transvaginal sonography with Doppler study has helped improve the clinician’s ability to diagnose and manage intrauterine abnormalities. Use of International Endometrial Tumor Analysis (IETA) may help predict the risk of endometrial pathologies based on ultrasound appearance.

Objective: To determine the accuracy of 2D ultrasound and power Doppler in the examination of the endometrium using the international endometrial tumor analysis classification in predicting intrauterine disease among patients with endometrial pathology in Dr. Jose Fabella Memorial Hospital.

Study Design: A cross-sectional study was done on patients who were diagnosed with abnormal uterine bleeding and underwent 2D ultrasound and power Doppler studies. Sonographic features were classified using International Endometrial Tumor Analysis group classification and correlated with the histopathologic diagnosis.

Results: Seventy-three patients were included in the study. The age of the subjects was significantly associated with the the histopathologic findings of benignity or malignancy. At 40-49 years old, there was significantly higher proportion of subjects with benign lesions, and 60 years and above had predominance of malignancy. The top three histopathologic diagnoses: endometrial polyp 41 cases (46.2%), proliferative endometrium 9 cases (12.3%), and simple hyperplasia without atypia 8 cases (11.0%). Patients diagnosed with malignancy had significantly thickened endometrium at 2.9 cm. The color content of the endometrium (color score) were statistically significant among different pathologies. Positive predictive value is the same for both, while Doppler showed a higher negative predictive value. Total accuracy was higher for Doppler.

Conclusion: Both greyscale ultrasound and Doppler are 100% accurate in predicting benign lesions but Doppler has a higher accuracy in predicting malignant lesions. The IETA group consensus on descriptive and morphologic nomenclature in describing endometrial findings for power Doppler and on greyscale ultrasound is clinically valuable.