Detection of endometrial cancer in postmenopausal women by transvaginal ultrasonography and colour flow imaging.

About 3700 new cases of endometrial cancer are reported in the United Kingdom each year. The incidence of the disease increases considerably during the fifth decade of life and reaches a peak between the ages of 60 and 65. Uterine bleeding is the most common initial symptom after the menopause and necessitates invasive investigation (for example, dilatation and curettage). About a tenth of women with postmenopausal bleeding have endometrial cancer. A less invasive technique with a high rate of detection of the disease and a low rate of false positive diagnoses would be of value for selecting those women who require diagnostic surgery. Pelvic ultrasonography yields detailed images of the uterus. Although a thick endometrium may be a sign of pathological processes, no morphological features that are unique to malignant disease have been identified.1 Recently the use of transvaginal pulsed Doppler probes, with and without colour flow imaging, has shown that uterine blood flow changes during the menstrual cycle.2 Furthermore, trans vaginal ultra? sonography with colour flow imaging has shown that the presence of intratumoral vascularisation with a low impedance to blood flow can be used as an end point in screening programmes for early ovarian cancer.34 We report the use of these techniques to measure the impedance to uterine arterial and intra? tumoral blood flow and hence detect endometrial cancer in women with postmenopausal bleeding.