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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1279-1287 • 0278-4297

Clinical Usefulness of 3-Dimensional Sonography and Power Doppler Angiography for Diagnosis of Endometrial Carcinoma

Luis T. Mercé, MD, PhD, Juan L. Alcázar, MD, PhD, Carmen López, MD, Enrique Iglesias, MD, PhD, Santiago Bau, MD, PhD, Juan Alvarez de los Heros, MD, PhD and José M. Bajo, MD, PhD

International Ruber Hospital, Madrid, Spain (L.T.M., S.B.); University Clinic of Navarra, Pamplona, Spain (J.L.A.); Santa Cristina University Hospital, Madrid, Spain (C.L., J.M.B.); Puerta de Hierro University Hospital, Madrid, Spain (E.I.); and University Hospital of Guadalajara, Guadalajara, Spain (J.A.d.l.H.).

Address correspondence to Luis T. Mercé, MD, PhD, Enrique Leyra 17, 28029 Madrid, Spain. E-mail: ltmerce{at}sego.es

Objective. The purpose of this study was to assess whether endometrial volume (EV) and 3-dimensional (3D) power Doppler indices can discriminate between hyperplasia and endometrial carcinoma and can predict extension of the endometrial carcinoma. Methods. Eighty-four women with uterine bleeding and a histopathologic diagnosis of endometrial hyperplasia (n = 29) or carcinoma (n = 55) were preoperatively examined by transvaginal 3D sonography and power Doppler angiography. Endometrial thickness (ET), EV, the vascularization index (VI), the flow index (FI), the vascularization-flow index (VFI), and the intratumoral resistive index (RI) were measured. A histopathologic diagnosis was made after endometrial biopsy was performed by hysteroscopy or curettage. Results. The EV and 3D power Doppler indices (VI, FI, and VFI) were significantly higher in endometrial carcinoma than endometrial hyperplasia, whereas the intratumoral RI was significantly lower (P < .05). A VFI of 2.07 was the best cutoff for predicting endometrial carcinoma, with sensitivity of 76.5% and specificity of 80.8%. No significant differences were noticed for ET. The endometrial VI was significantly higher when the tumor stage was greater than I. All the 3D power Doppler indices were significantly higher when the carcinoma infiltrated more than 50% of the myometrium. The intratumoral RI was significantly lower in cases with a high histologic grade, myometrial infiltration of more than 50%, and lymph node metastases. Conclusions. The VI, 3D power Doppler indices, and the intratumoral RI are more useful than ET for differentiating between hyperplasia and endometrial carcinoma. Intratumoral blood flow evaluated by pulsed Doppler sonography and 3D power Doppler angiography can predict the spread of endometrial carcinoma.

Key Words: endometrial carcinoma • endometrial hyperplasia • endometrial volume • power Doppler angiography • 3-dimensional power Doppler angiography • 3-dimensional sonography

Abbreviations: ET, endometrial thickness • EV, endometrial volume • FI, flow index • RI, resistive index • ROC, receiver operating characteristic • 3D, 3-dimensional • VFI, vascularization-flow index • VI, vascularization index • VOCAL, Virtual Organ Computer-Aided Analysis

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.