الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Postmenopausal bleeding is an early clinical sign of endometrial malignancy. The finding of a thin (<5 mm) endometrium at transvaginal ultrasound examination in women with postmenopausal bleeding rules out about 99% of endometrial cancers (Smith-Bindman et al., 1998).
Therefore, endometrial sampling is usually considered necessary only in women with postmenopausal bleeding and endometrial thickness >5 mm (Gull et al., 2003).
However, many women with postmenopausal bleeding and endometrial thickness >5 mm do not have pathology at all but will still undero, perhaps unnecessarily, interventional diagnostic procedures such as dilatation and curettage (D&C) or hysteroscopy (Epstein et al., 2002; Opolskiene et al., 2010 and Bradley, 2011).
The aim of this work was to study the value of 3D-PD ultrasound parameters (endometrial thickness, endometrial volume, endometrial vascular indices, VI, FI, FVI) in prediction of endometrium malignancy in the patients with postmenopausal bleeding and to compare it with the hysteroscopy findings and histopathological evaluation of the endometrial samples.
Our study included 140 patients with postmenopausal bleeding. Their age ranged from 48-82 years with a medium of 55 y, with BMI range from 22-49 kg/m2, with a medium parity of 4 found that 64 (45.7%) were diabetic and 51 (45.7%) hypertensive based on histopathological examination of endometrial samples during hysteroscopy. Out of the 140 studied patients 47 (33.6%) proved to have malignant endomaterial lesions.
When these patients subjected to 3D-PD U/S examination we found that the median levels of ET and EV were higher in those with malignant endometrial lesions compared to those with benign lesions but with high predictive value of ET compared to the EV.
Furthermore all the vascular indices of the endometrium (VI, FT and VFI) were significantly higher in those with malignant endometrium compared to those with benign endometrial lesions. The FI had the highest predictive value.
When the hysteroscopic findings were compared to the histopathological results the highest specificity was in the diagnosis of intrauterine mass with the hypervascularity (100%) of hypervascular polyp (95.7%) compared to the lowest specificity for thick endometrium (49.5%).
Our study supports the suggestion of previous authors who believe in the use of TV ultrasound as the first line of evaluation of patients with postmenopausal bleeding, >4.5 mm endometrial thickness, being a non-invasive and safe method.
The invasive methods as hysteroscopy or D&C are indicated in the patients with thicker endometrium and high vascular indices.
Our results were in agreement with many authors in that the endometrial malignancy in patients with postmenopausal bleeding, is more prevalent in older patients, obese patients, diabetics and hypertensive patients.