Role of Uterine Artery Doppler Indices in Predicting Endometrial Pathology in Perimenopausal and Postmenopausal Women Presenting with Abnormal Uterine Bleeding
Aashi Sarvesh, Shraddha Shetty Kandavar, Santosh RaiAbstract
Context:
Abnormal uterine bleeding (AUB) in perimenopausal and postmenopausal women requires evaluation to exclude premalignant and malignant endometrial pathology. Uterine artery Doppler may improve diagnostic accuracy when combined with transvaginal ultrasonography (TVS).
Aim:
The aim of this study is to evaluate the diagnostic utility of uterine artery Doppler indices in predicting endometrial pathology among perimenopausal and postmenopausal women presenting with AUB.
Settings and Design:
This was a prospective, observational study conducted at a tertiary care hospital.
Subjects and Methods:
A total of 175 perimenopausal and postmenopausal women with AUB underwent TVS with assessment of endometrial thickness (ET), uterine artery pulsatility index (PI), and resistance index (RI). Endometrial tissue samples obtained by Pipelle biopsy or dilatation and curettage underwent histopathological examination. Histopathological diagnoses were established using standard diagnostic criteria and correlated with the PALM–COEIN classification.
Statistical Analysis Used:
Receiver operating characteristic curve analysis was used to assess the cutoff point and diagnostic performance․
Results:
Among 175 women, 157 (89.7%) had benign pathology and 18 (10.3%) had premalignant/malignant lesions. PI and RI were significantly lower in premalignant/malignant lesions. In perimenopausal women, PI and RI showed excellent diagnostic accuracy (area under the curve [AUC]: 0.946 and 0.973, respectively). In postmenopausal women, AUCs were 0.798 and 0.674, respectively. Optimal cutoffs were PI ≤1.12 and RI ≤0.425 for perimenopausal women and PI ≤1.77 and RI ≤0.575 for postmenopausal women. Combined assessment of ET, PI, and RI achieved the highest diagnostic performance (AUC 0.851).
Conclusions:
Uterine artery Doppler indices improve the ability of TVS to distinguish benign from premalignant/malignant endometrial pathology and may serve as a useful noninvasive risk stratification tool in women with AUB.