{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:15:04Z","timestamp":1789578904521,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2007,8,10]],"date-time":"2007-08-10T00:00:00Z","timestamp":1186704000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2007,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine which endometrial morphology characteristics as assessed by gray\u2010scale ultrasound and which endometrial vessel characteristics as assessed by power Doppler ultrasound are useful for discriminating between benign and malignant endometrium in women with postmenopausal bleeding (PMB) and sonographic endometrial thickness \u2265 4.5 mm and to develop logistic regression models to calculate the individual risk of endometrial malignancy in women with PMB, endometrial thickness \u2265 4.5 mm, good visibility of the endometrium and detectable Doppler signals in the endometrium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of 223 consecutive patients with PMB and sonographic endometrial thickness \u2265 4.5 mm, 120 fulfilled our inclusion criteria. They underwent transvaginal gray\u2010scale and power Doppler ultrasound examination, which was videotaped for later analysis by two examiners with more than 15 years' experience in gynecological ultrasonography. They independently assessed endometrial morphology and vascularity using predetermined criteria. Their agreed\u2010upon description was compared with the histological diagnosis. Univariate and multivariate logistic regression analyses were used. The best diagnostic test was defined as the one with the largest area under the receiver\u2013operating characteristics curve (AUC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty (25%) endometria were malignant. Inter\u2010observer agreement for the description of endometrial morphology and vascularity was moderate to good (Kappa 0.49\u20130.78). The best ultrasound variables to predict malignancy were heterogeneous endometrial echogenicity (AUC 0.83), endometrial thickness (AUC 0.80), and irregular branching of endometrial blood vessels (AUC 0.77). A logistic regression model including endometrial thickness and heterogeneous endometrial echogenicity had an AUC of 0.91. Its mathematically best risk cut\u2010off yielded a positive likelihood ratio of 4.4, and a negative likelihood ratio of 0.1. Adding Doppler information to the model improved diagnostic performance marginally (AUC 0.92).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In selected high\u2010risk women with PMB and an endometrial thickness of \u2265 4.5 mm, calculation of the individual risk of endometrial malignancy using regression models including gray\u2010scale and Doppler characteristics can be used to tailor management. These models would need to be tested prospectively before introduction into clinical practice. Copyright \u00a9 2007 ISUOG. 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