Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Malmö, Sweden.
Ultrasound Obstet Gynecol. 2010 Jan;35(1):94-102. doi: 10.1002/uog.7445.
To determine whether endometrial volume or power Doppler indices as measured by three-dimensional (3D) ultrasound imaging can discriminate between benign and malignant endometrium, to compare their diagnostic performance with that of endometrial thickness measurement using two-dimensional (2D) ultrasound examination, and to determine whether power Doppler indices add any diagnostic information to endometrial thickness or volume.
Sixty-two patients with postmenopausal bleeding and endometrial thickness > or = 4.5 mm underwent transvaginal 2D gray-scale and 3D power Doppler ultrasound examination of the corpus uteri. The endometrial volume was calculated, along with the vascularization index (VI), flow index and vascularization flow index (VFI) in the endometrium and in a 2-mm 'shell' surrounding the endometrium. The 'gold standard' was the histological diagnosis of the endometrium obtained by hysteroscopic resection of focal lesions, dilatation and curettage or hysterectomy. Receiver-operating characteristics (ROC) curves were drawn for all measurements to evaluate their ability to distinguish between benign and malignant endometrium. Multivariate logistic regression analysis was used to create mathematical models to estimate the risk of endometrial malignancy.
There were 49 benign and 13 malignant endometria. Endometrial thickness and volume were significantly larger in malignant than in benign endometria, and flow indices in the endometrium and endometrial shell were significantly higher. The area under the ROC curve (AUC) of endometrial thickness was 0.82, that of endometrial volume 0.78, and that of the two best power Doppler variables (VI and VFI in the endometrium) 0.82 and 0.82. The best logistic regression model for predicting malignancy contained the variables endometrial thickness (odds ratio 1.2; 95% CI, 1.04-1.30; P = 0.004) and VI in the endometrial 'shell' (odds ratio 1.1; 95% CI, 1.02-1.23; P = 0.01). Its AUC was 0.86. Using its mathematically optimal risk cut-off value (0.22), the model correctly classified seven more benign cases but two fewer malignant cases than the best endometrial thickness cut-off (11.8 mm). Models containing endometrial volume and flow indices performed less well than did endometrial thickness alone (AUC, 0.79 vs. 0.82).
The diagnostic performance for discrimination between benign and malignant endometrium of 3D ultrasound imaging was not superior to that of endometrial thickness as measured by 2D ultrasound examination, and 3D power Doppler imaging added little to endometrial thickness or volume.
确定三维（3D）超声成像测量的子宫内膜体积或能量多普勒指数是否可以区分良性和恶性子宫内膜，比较其与二维（2D）超声检查测量子宫内膜厚度的诊断性能，并确定能量多普勒指数是否为子宫内膜厚度或体积提供了额外的诊断信息。
62 例绝经后出血且子宫内膜厚度≥4.5mm 的患者接受经阴道 2D 灰阶和 3D 能量多普勒超声检查子宫。计算子宫内膜体积，以及子宫内膜和子宫内膜周围 2mm“壳”内的血管化指数（VI）、血流指数和血管化血流指数（VFI）。“金标准”是通过宫腔镜下切除局灶性病变、扩张和刮宫或子宫切除术获得的子宫内膜组织学诊断。绘制所有测量值的受试者工作特征（ROC）曲线，以评估它们区分良性和恶性子宫内膜的能力。使用多元逻辑回归分析创建数学模型来估计子宫内膜恶性肿瘤的风险。
49 例为良性子宫内膜，13 例为恶性子宫内膜。恶性子宫内膜的子宫内膜厚度和体积明显大于良性子宫内膜，子宫内膜和子宫内膜内的血流指数明显较高。子宫内膜厚度的 ROC 曲线下面积（AUC）为 0.82，子宫内膜体积为 0.78，两个最佳能量多普勒变量（子宫内膜内 VI 和 VFI）的 AUC 为 0.82 和 0.82。预测恶性肿瘤的最佳逻辑回归模型包含变量子宫内膜厚度（优势比 1.2；95%CI，1.04-1.30；P=0.004）和子宫内膜“壳”内的 VI（优势比 1.1；95%CI，1.02-1.23；P=0.01）。其 AUC 为 0.86。使用其数学最佳风险截断值（0.22），该模型正确分类了 7 例良性病例，而不是最佳子宫内膜厚度截断值（11.8mm）分类的 2 例恶性病例。包含子宫内膜体积和血流指数的模型比单独使用子宫内膜厚度的模型表现稍差（AUC，0.79 比 0.82）。
与 2D 超声检查测量的子宫内膜厚度相比，3D 超声成像对良性和恶性子宫内膜的鉴别诊断性能并不优越，而 3D 能量多普勒成像对子宫内膜厚度或体积的增加作用不大。
