ENDOMETRIAL THICKNESS AND DOPPLER VELOCIMETRY OF THE UTERINE ARTERIES AS DISCRIMINATORS OF ENDOMETRIAL STATUS IN WOMEN WITH POSTMENOPAUSAL BLEEDING - A COMPARATIVE-STUDY

OBJECTIVE: Our purpose was to compare the ability of transvaginal Doppler ultrasonographic examination with that of gray-scale ultrasonographic examination to discriminate between benign and malignant and between normal and pathologic endometrium in women with postmenopausal bleeding. STUDY DESIGN: One hundred thirty-eight consecutive women scheduled for curettage because of postmenopausal bleeding underwent transvaginal ultrasonography, including color and spectral Doppler techniques, within 8 days preceding the operation. The thickness of the endometrium was measured. Doppler signals of the maximum blood flow velocity obtained from the two main uterine arteries and subendometrial and intraendometrial arteries were evaluated for pulsatility index and time-averaged maximum velocity. The results of the examinations were compared with the histologic diagnosis of the curettage specimen. RESULTS: Receiver-operator characteristic curves showed endometrial thickness to be a better discriminator between normal and pathologic and between benign and malignant endometrium than any Doppler variable, 14 mm being the optimal threshold value for differentiating between benign and malignant endometrium (sensitivity 88%, specificity 81%). CONCLUSION: Measurement of endometrial thickness with transvaginal ultrasonography is a better method for discriminating between benign and malignant or normal and pathologic endometrium than is Doppler velocimetry of the uterine arteries.