| Abstract: |
SUMMARYPostmenopausal bleeding presents a special diagnostic challenge. As the population grows and longevity increases, the number of postmenopausal women increases, and the gynecologic cancers will become more common. Persistent bleeding after negative initial evaluation should not be ignored, and should be investigated further, as at least 10 percent of patients will harbor disease.In this presentation, 50 patients were examined for postmenopausal bleeding using different diagnostic modalities, trying to reach the correct diagnosis with the least invasive imaging modality. Thirty patients showing benign lesions, the remaining twenty patients had malignant lesion.TVS was found to be rapid, acceptable and non-invasive method for early detection of endometrial pathology in postmenopausal women. The thickened endometrium during menopause is the most significant ultrasonographic criterion implicating its pathology. The vagino-sonographically measured thickness of 5 mm and less, gives a relatively safe prediction of endometrial atrophy, whereas the thickness above 5 mm requires explorative curettage and histopathologic examination of the endometrium, no matter if the woman has or has not uterine bleeding. Nevertheless that we determined border of 5 mm under which with great possibility there is no endometrial cancer, we don’t support authors who advise not make a D&C. Obviously, the lower the cut-off, the higher the sensitivity for detection of such abnormalities as endometrial cancer or its precursors, but at a cost of lower specificity.TVS missed endometrial abnormalities such as polyps; large masses either ovarian or uterine but MRI were most accurate for the evaluation of these conditions. We came to the conclusion that in diagnosing patients with abnormal uterine cavity, MR imaging may help differentiate malignant from benign disorders.TVS have significantly lower sensitivity than MRI in detecting enlarged pelvic lymph nodes (particularly in the obese patient) and in depicting intraperitoneal, omental, and mesenteric metastases. MRI also is superior to US in assessing pelvic sidewall extension and adjacent organ invasion.Magnetic resonance imaging offers several advantages in evaluation of postmenopausal bleeding. It is noninvasive technique, does not expose patients to radiation and can detect subtle tissue differential of the uterine, cervical and ovarian lesion. MR imaging is also used to clarify characteristics of adnexal structures when sonography is non-diagnostic.CONCLUSIONMRI in its ability to depict endometrial carcinoma and to provide information regarding myometrial, cervical and, perhaps, parametrial tumor invasion, however, TVS is unable to depict the entire intrapelvic or intra-abdominal anatomic regions adequately; therefore, TVS is not suitable for the comprehensive staging of endometrial carcinoma or cervical carcinoma.
|
|
|