Ahmed Mohamed Mostafa Abdel Wahab Khalil has completed his Bachelor Degree of Medicine from Benha University, Egypt. He completed Residency Program in
2010 and obtained Master Degree in Obstetrics and Gynecology in 2011. Then, in 2014, he became Member of Royal College of Obstetricians and Gynecologists.
He finished two years of medical training initiative in UK in 2015. After that he returned back to Egypt to complete his Doctorate degree in Obstetrics and Gynecology
towards the end of 2015. In 2016, he returned back to UK to start working as Speciality Registrar in Medway Hospital, Kent, England.
Objectives: To determine whether endometrial volume or power Doppler indices as measured by three-dimensional (3D) ultrasound
imaging can discriminate between benign and malignant endometrium or between endometrial hyperplasia and endometrial
carcinoma. Also, comparing 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.
Methods: 76 patients with post-menopausal bleeding and endometrial thickness (ET)≥5 mm underwent transvaginal 2D grayscale
and 3D power doppler ultra-sound examination of the corpus uteri. The endometrial volume was calculated, along with the
vascularization index (VI), flow index (FI) and vascularization flow index (VFI) in the endometrium. The ‘gold standard’ was the
histological diagnosis of the endometrium obtained by hysteroscopic-guided biopsy. Receiver–operating characteristics (ROC)
curves were drawn for all measurements to evaluate their ability to distinguish between benign and malignant endometrium and to
differentiate between endometrial hyperplasia and endometrial carcinoma. Multivariate logistic regression analysis was used to create
mathematical models to estimate the risk of endometrial malignancy.
Results : There were 62 benign and 14 malignant endometria. Endometrial thickness and volume were significantly larger in
malignant than in benign endometria, and flow indices in the endometrium was significantly higher. The area under the ROC curve
(AUC) of endometrial thickness was 0.882, that of endometrial volume 0.850, and that of the two best power doppler variables (VI
and VFI in the endometrium) 0.904 and 0.932. The best logistic regression model for predicting malignancy contained the variables
ET and VFI, with AUC 0.900. The mathematically optimal risk cut off value of ET and VFI 12.6 had sensitivity 78.57, specificity 93.55,
+PV 67.7 and –PV 96.2.
Conclusions: 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.