P42.05: Endometrial carcinoma: 3D power doppler ultrasonographic findings

17th World Congress on Ultrasound in Obstetrics and Gynecology

P42.02 Ultrasonographic evaluation of the endometrium: transperineal versus endovaginal imaging S.Pinho, P.Reis, F.Mahomed, M. J.Bernardo, I.Dias, N.Assun¸cao ˆ Dona Estefania Hospital, Lisbon, Portugal Objectives: The aim of this study is to compare transperineal and endovaginal ultrasonography in the evaluation of the endometrium, assess for image quality and for a systematic difference in endometrial thickness measured by the two techniques. Methods: Transperineal and endovaginal ultrasonography evaluation of the endometrial thickness was performed on 58 women, in ˆ Dona Estefania Hospital, between November 2005 and March 2007. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the endometrial thickness. We identified two groups (G1 – visualized; G2 – not visualized). In G1 data were analyzed to determine if there is a correlation between the two approaches using the Spearman test, with a statistical significance of 5% (p < 0.05). In GI and G2 we concluded about the uterine position. Results: Fifty-eight women (average age 57.51) were divided in two groups (G1 n = 45; G2 n = 13). In G1 the Spearman test result was R = 0.933, which reveals a strong correlation between the two techniques. In this group 97.78% (44/45) of uterine position was anteversus or intermediary. In G2 the uterine positions were: anteversus 53.85% (7/13), intermediary 7.69% (1/13) and retroversus 38.46% (5/13). In the majority the transabdominal approach reveals worse quality images. Conclusions: Both transperineal and endovaginal ultrasonography can provide satisfactory images of the endometrium, but endovaginal images are frequently superior to transperineal images. With this study we can conclude that transperineal approach is correlated with endovaginal images for endometrial thickness evaluation, especially in anteversus and intermediary uterus. It had patient acceptance and tolerance, without the need for vaginal penetration, and could be a method of choice in virginal or in postmenopausal women with genital atrophy. This technique needs further study to validate its potential application.

P42.03 Does ibuprofen reduce the pain experienced in patients having outpatient hysteroscopy? A. Saba, S. Bell-Thomas, W. Jackson Nevill Hall Hospital, United Kingdom Objectives: Evaluate the effect of 400 mg ibuprofen given 2–3 hours before the procedure on women having outpatient hysteroscopy. Design: Retrospective cohort study. Setting: Outpatient Hysteroscopy Clinic at Nevill Hall Hospital, Abergavenny, Wales, UK. Subjects and methods: The study was based on analysis of the replies to anonymous printed questionnaires, completed by patients who attended the outpatient hysteroscopy clinic between September 2005 and December 2006. They had ultrasound scans just before being seen in this clinic, The patients were asked to describe their pain and to place a mark on a verified 100 mm Visual Analogue Scale to estimate their pain. The success of the procedure was also noted. The first 51 patients had the procedure without any pre-medication. The second group included 38 patients who had taken 400 mg ibuprofen 2–3 hours before the procedure. Results: The procedure was successful in 47 patients (92%) in the group without pre-medication and 36 patients (95%) in the group with ibuprofen. This is not statistically significant (P = 0.48 when using Fisher’s test). The average pain score in the first group was 37.06 mm with standard deviation of 23.20 mm. In the second group, the average pain score was 28.05 mm with standard deviation of 21.82 mm. The difference was 9.37 mm (95% CI, −0.064 to

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Poster abstracts

18.803) This was not quite statistically significant as the two-tailed P value equal to 0.0515 using unpaired t test. Conclusion: Using 400 mg ibuprofen two to three hours before outpatient hysteroscopy has reduced the pain experienced by the patients in our study, but this reduction was not quite statistically significant. There is a need for a bigger randomized study to clarify this matter.

P42.04 The differential diagnosis of bicornuate and septate uterine TM anomalies by three dimensional extended imaging (3D XI) S. J. Kim1 , G. S. R. Lee2 , J. C. Shin2 1 Holy Family Hospital Catholic University, Republic of Korea, 2 Catholic University, Republic of Korea

Objectives: The aim of our study was to describe potential value of 3DXI as a new method for the three-dimensional ultrasound examination in the differential diagnosis of the bicornuate and septate uterine anomalies. Methods: Examinations were performed by two trained observers from January 2004 to December 2005 in 716 cases. A ultrasound machine (Accuvix, Medison, Korea) equipped with a transvaginal 5–8-MHz volume transducer, which has a 100◦ field of view, was used. For each case, volume data were usually acquired from the mid sagittal plane of the uterus, a few data from the transverse view and those were stored on the built in hard disk of the 3D ultrasound machine, were analysed using the 3 D Xi as well as the classical three-dimensional planes mode. The differentiation between septal uteri and bicornuate uteri were made by the extent of the septum and fundal indentation. Results: 15 cases among 716 cases (7 cases of septal uteri, 8 cases of bicornuate uteri) were differentiated by the classical 3D and 3D TM XI . The OBV mode allowed examination of the coronal plane across the curvature of the endometrial cavity from cervix, and modulated straight line confirmed the junction of the two septum near cervix. The MSV mode were advantageous in identifying fundal indentation and showed multi sequential views in the same plane as in MRI with 0.5–3 mm interval. Conclusion: 3DXi can display the volume data in a different display from conventional three-dimensional ultrasound, and provide additional diagnostic tool in the differential diagnosis of the congenital uterine anomalies.

P42.05 Endometrial carcinoma: 3D power doppler ultrasonographic findings M. A. Pascual, F. Tresserra, B. Graupera, I. Rodriguez, L. Hereter, M. Fernandez-Cid Institut Universitary Dexeus, Spain Purpose: To evaluate the utility of 3D power Doppler ultrasonography in endometrial carcinoma. Methods: Descriptive study of 22 patients with endometrial carcinoma histologically proved who underwent transvaginal 3D power Doppler ultrasonography. The volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated for the endometrium (e) and a 2 mm subendometrium (se) TM using histogram of VOCAL software. Pearson’s linear correlation between endometrial and subendometrial vascular indices was calculated and the results of both areas were compared. Results: The three parameters showed a positive linear correlation between ‘‘se’’ and ‘‘e’’: VI 0.988, FI 0.995 and VFI 0.989. The higher was the endometrial vascularization, it was also higher in the subendometrium. The comparison between vascularization in both regions showed significant differences VIe vs. VIse (3.13 ± 2.33 vs. 2.96 ± 2.21, P < 0.05); FIe vs. FIse (35.88 ± 5.98 vs. 35.59 ± 6.17, P 8 mm at ultrasound scan. Forty-five cases of endometrial thickness > 8 mm have been found all of which underwent hysteroscopy and biopsy. Histopathological polyps were found in 25 patients, athrophy in 20. No case of endometrial cancer or athipical hyperplasia was found.

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