Value of 3D Ultrasonography with Malignancy Risk Model for Screening for Endometrial Cancer with Postmenopausal Bleeding

Abstract

Background With the increasing incidence and mortality of endometrial cancer (EC) , early and effective screening for EC has become a hot research topic. Objective To investigate the value of three-dimensional (3D) ultrasonography with a malignancy risk model for screening for EC with postmenopausal bleeding (PMB) . Methods A total of 168 patients who visited the Second Affiliated Hospital of Zhengzhou University for PMB between January 2019 and December 2020 were selected, and 136 of them were found with benign endometrial lesion, other 32 with EC by histopathological examination. All of them underwent 3D transperineal ultrasonography, and parameters such as endometrial volume, vascularization index (VI) , flow index (FI) , and vascularization-flow index (VFI) were calculated using VOCAL software. Clinical data were retrospectively collected, in which endometrial thickness, recurrent vaginal bleeding, age, body mass index (BMI) , and history of diabetes mellitus were included in a malignancy risk model and scored for predicting EC with PMB. The ROC curve was plotted and the area under which (AUC) was calculated to measure the performance of 3D transperineal ultrasonography, malignancy risk model, and the combination of them in predicting EC with PMB. Results Compared with those with benign endometrial lesion, EC patients had greater average BMI, and higher rate of vaginal bleeding (P<0.05) . Moreover, they also had thicker average endometrial thickness, greater average endometrial volume as well as higher average VI, FI, and VFI (P<0.05) . In predicting EC with PMB, 3D transperineal ultrasonography (the combination of EV, VI, FI and VFI parameters) combined with the malignancy risk model had a greater AUC than did 3D transperineal ultrasonography { 0.949 〔95%CI (0.908, 0.989) 〕vs 0.883〔95%CI (0.817, 0.949) 〕} (Z=4.762, P=0.032) , and the malignancy risk model { 0.949〔95%CI (0.908, 0.989) 〕 vs 0.723〔95%CI (0.629, 0.817) 〕} ( Z=2.613, P=0.018) . The sensitivity, specificity, and Youden index of the combined use of 3D transperineal ultrasonography and malignancy risk model for predicting EC with PMB were 84.4%, 96.3%, and 0.807, respectively. Conclusion The combined use of 3D transperineal ultrasonography and malignancy risk model for predicting EC with PMB has high accuracy, which could be used to initially triage patients.

Keywords

• endometrial neoplasms|gynecologic neoplasms|uterine hemorrhage|postmenopause|ultrasonography, doppler|malignant risk model|diagnosis, differential