Essay Instructions: Write a research paper on “The Role of Color Doppler Sonography in Diagnosis of Endometrial Malignancies”. In writing the paper defines endometrial malignancy, the cause of the disease, the risk factors, the symptoms and manifestations of the disease. Then discuss in detail traditional ultrasonography diagnosis methods which are in use to date giving special emphasis on Endovaginal ultrasound and Transvaginal Sonography (TVS),
Here discuses the benefits and limitations of these techniques and then use the information to analyze the role played by Color Doppler Sonographic features in excluding endometrial cancer from other uterus masses, malignancies and malignant processes like polyps, hematometra and masses like sub mucosal fibroids.
In writing the paper you can use the following materials and other medical journals. But make sure that each quotations and parenthetical citations are matched with proper references. And other people’s works are given credits. You can back your writing with limited quotations in small paragraph forms with no more than three for the entire paper.
Here I have cut and paste you information some of the information I found from the internet. So if you decide to use them make sure you give credit to the writers.
The Paper should follow APA style and have reference list of no more that ten.
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Color Doppler Sonography of Endometrial Masses
Arthur C. Fleischer, MD, Heidi W. Shappell, MD, Lynn P. Parker, MD and Cynthia W. Hanemann, MD
Departments of Radiology (A.C.F., C.W.H.), Obstetrics and Gynecology (A.C.F., L.P.P.), and Pathology (H.W.S.), Vanderbilt University Medical Center, Nashville, Tennessee.
Address correspondence and reprint requests to Arthur C. Fleischer, MD, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1116 21st Ave S, Nashville, TN 37232-2675.
Abstract
Objective. To correlate the color Doppler sonographic features of endometrial masses with histologic characteristics and microvessel density. Methods. We performed a retrospective analysis of 10 postmenopausal and 5 premenopausal women with abnormal bleeding who had color Doppler sonography and histologic studies of endometrial masses. Results. Endometrial masses that contained multiple branches on color Doppler sonography were more likely carcinomas, even though both polyps and carcinomas were vascular on color Doppler sonography and their microvessel densities were similar. On color Doppler sonography, polyps averaged 1.2 detectable vessels versus 3.4 for carcinomas. Conclusions. Color Doppler sonography may be useful in distinguishing carcinomas from polyps in women with thickened endometria.
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Endovaginal Ultrasound to Evaluate Endometrial Abnormalities
To the Editor: Dr Smith-Bindman and colleagues1 report the results of a meta-analysis evaluating the role of endovaginal ultrasound (EVUS) in excluding endometrial cancer and other endometrial abnormalities. The other endometrial abnormalities include endometrial polyps and submucous leiomyomata, both common causes of postmenopausal bleeding. We agree that using an endometrial thickness threshold of 5 mm results in a high sensitivity and specificity for endometrial cancer. We believe that using EVUS alone is not adequate to exclude benign causes of postmenopausal bleeding and routinely perform hysterosonography in these patients.2
In a recently completed multicenter trial, we evaluated 124 patients who presented with postmenopausal bleeding. Each patient underwent endometrial biopsy, EVUS, and hysterosonography; 106 patients had the definitive diagnosis established with dilation and curettage (D&C), hysteroscopy, or hysterectomy. The remaining patients who had negative findings had 6-month follow-up with absence of disease and cessation of symptoms. Sixty percent of the patients were receiving hormone replacement therapy, most often a daily combination of estrogen and progesterone. Twenty-eight percent of the hysterosonography findings were normal, while the remainder demonstrated primarily benign abnormalities. Forty-three percent of the patients had endometrial polyps, and there were 4 cases of cancer. The positive predictive value of hysterosonography was 93%. The mean endometrial diameter of the 54 patients whose endometrium was measured on conventional EVUS and who had a pathologically proven endometrial polyp or submucous leiomyoma was 7.3 mm, and 22 (41%) had endometrial thickness of 5 mm or less.
Most of the studies in the meta-analysis use D&C as the criterion standard for presence or absence of endometrial pathology. Grimes3 asserts that D&C lacks the ability to confirm the presence of benign disorders, particularly polyps, although it is quite accurate at detecting carcinoma. The "Nordic Trial" results, which account for 25% of the patients in the meta-analysis, used curettage alone as the criterion standard.4 A recent prospective, controlled clinical trial confirms the high incidence of benign pathology identifiable with hysterosonography compared with endometrial biopsy and a 5-mm endometrial thickness threshold with EVUS.5
Why is it important to identify benign causes of postmenopausal bleeding when EVUS and endometrial biopsy are excellent tools to exclude endometrial cancer? Compliance with long-term hormone replacement therapy in postmenopausal patients is directly related to patient perceptions of the risk-benefit relationship of the therapy. Patients who experience vaginal bleeding while taking hormone replacement therapy are much more likely to discontinue use, particularly when an anatomic cause for the bleeding is not discovered.6 Hysterosonography has been able to discover many more anatomic causes for bleeding than prior conventional ultrasound procedures, and its use can have important future public health implications.
