S74 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

Results: The cytological results of FNAB were as followed; benign(856, 54.94%), malignant (262, 16.82%), indeterminate (238, 15.28%),and inadequate samples (202, 12.96%). In the univariate analysis, itshowed statistically significant (p�0.02, p�0.05 and p�0.0001, re-spectively) for the following facts: 1) echogenicity, 2) calcification, 3)final op pathology. In sub categorized calcifications, macro- puls egg-shell calcification group and eggshell calcification were more signifi-cant than others (p�0.02 and p�0.01). Among them malignant lesionon final op. pathology was the strong contributor. However, the fol-lowing factors did not make significant effects (p�0.06, p�0.70,p�0.65, p�0.74, p�0.97, p�0.18, p�0.41, p�0.65, p�0.12 andp�0.07 respectively): size, performing doctor, faculty vs. traineegroup, aspiration technique, composition, margin, shape, parenchymalechogenicity, vascularity and final assessment.Conclusion: Marked hypoechogenic nodule and malignant nodule tendto make more adequate FNAB samples, compared with others. On theother hand, inadequate sampling is more common in the nodule witheggshell or macro-calcification.

0520

The Diagnostic Role of Ultrasonographically GuidedPercutaneous Biopsy in Peritoneal LesionsJjianhong Wang, Department of Gastroenterology, Xijing Hospital,Fourth Military, ChinaJie Liang, Department of Gastroenterology, Xijing Hospital, FourthMilitary, ChinaBaojun Chen, Department of Gastroenterology, Xijing Hospital,Fourth Military, ChinaHua Zhang, Department of Gastroenterology, Xijing Hospital,Fourth Military, ChinaXian Wang, Department of Gastroenterology, Xijing Hospital,Fourth Military, ChinaYing Han, Department of Gastroenterology, Xijing Hospital, FourthMilitary, ChinaJie Liu, Department of Gastroenterology, Xijing Hospital, FourthMilitary, ChinaDaiming Fan, Department of Gastroenterology, Xijing Hospital,Fourth Military, China

Purpose: To evaluate the diagnostic role and safety of ultrasonographi-cally guided percutaneous biopsy in peritoneal lesions.Methods: The retrospective study was conducted on 153 patients (agerange, 11–75 years; mean age, 45.3 years) with ascites and/or abdom-inal distension with unclear causes. All of them underwent ultrasono-graphically guided percutaneous biopsy after ultrasonography showedthe abnormalities of peritoneum or greater omentum. Bard auto-biopsygun as well as 18 or 16 gauge biopsy needle were used.Results: Peritoneal and omental lesions which were accurately shownby ultrasonography are essential for biopsy. In this study, the biopsieswere performed on 153 patients, and the rate of success and satisfactionof tissue specimen in biopsy were 100%(153/153) and 91.5%(140/153)respectively. 142 cases of 153 got clearly histopathologic diagno-sis with the diagnostic accuracy 92.8%. Among them, 69 cases wereperitoneal metastatic adenocarcinoma, 49 cases were peritoneal tuber-culosis, 11 cases were peritoneal malignant mesothelioma, 8 cases werechronic peritoneal infections, 7 cases were peritoneal pseudomyxomaperitonei, and 5 cases were primary peritoneal lymphoma. Only 11cases could not get pathologic diagnosis because of less tissue speci-men. No serious complications occured.Conclusions: Among peritoneal lesions, peritoneal metastatic adeno-carcinoma has the highest incidence rate, while that of peritonealtuberculosis is the second highest.Percutaneous biopsy with ultrasono-graphic guidance is a convenient, safe and effective method with high

diagnostic rate. It makes the accurate pathologic diagnosis of ascites

and/or abdominal distension with unclear causes available and offers aremarkable help for clinical therapy.Keywords: Ultrasonography, guidance; Biopsy; Peritoneal lesions;Omental lesions

0522

Post Menopausal Bleeding. How Reliable is TransvaginalUltrasound in Excluding Endometrial Cancer?Steven Goldstein, NYU Medical Center, United States

Cancer of the endometrium is the most common gynecologic cancer.Vaginal bleeding will be the presenting sign in more than 90% ofpostmenopausal patients with endometrial carcinoma. The majority ofpatients who have postmenopausal vaginal bleeding do so secondary toatrophic changes of the vagina or endometrium. Depending on age andrisk factors 1-14% of patients with postmenopausal bleeding willactually have endometrial carcinoma. However all such patients mustbe approached as “endometrial carcinoma until proven otherwise”. Inthe past D&C or endometrial biopsy have been the mainstay of suchevaluation. Transvaginal ultrasound has been explored as an alternativetechnique to indirectly visualize the endometrium. Endometrial thick-ness is measured on a long axis transvaginal view of the uterus. Earliestreports consistently found that an endometrial thickness � 4-5mm inpatients with postmenopausal bleeding reliably excluded endometrialcancer. Since that time a number of confirmatory multicentered trialshave been completed. The risk of a patient having endometrial cancerwhen the endometrial thickness � 4mm has been found to be 1 in 917patients. Furthermore in patients with endometrial atrophy blind endo-metrial sampling will often yield lack of significant tissue or inabilityto obtain tissue. Thus, in postmenopausal patients with bleeding, whenthe endometrial echo on transvaginal ultrasound is thin, distinct, andtechnically capable of being adequately assessed, it is a reasonable firstapproach to exclude endometrial cancer.

0524

Do We Need 3D Ultrasound to Scan Adnexal Masses?Povilas Sladkevicius, Malmo University Hospital, Sweden

The aim was to assess the value of three-dimensional (3D) ultrasoundto distinguish between benign and malignant endometrium in womenwith postmenopausal bleeding (PMB).Methods: 62 patients with PMB and endometrial thickness �4.5 mmunderwent transvaginal 3D ultrasound examination. The volume, vas-cularization index (VI), flow index (FI), and vascularization-flow index(VFI) were calculated for the endometrium and a 2 mm “shell” sur-rounding the endometrium using VOCALTM software. Histologicaldiagnosis was obtained. Receiver operating characteristic (ROC)curves were drawn to evaluate an ability of measurements to distin-guish between benign and malignant endometrium. Logistic regressionanalysis was used to predict endometrial malignancy.Results: There were 49 benign and 13 malignant endometria. Endo-metrial thickness and volume were larger and flow indices were higherboth in the endometrium and in the endometrial shell in malignantendometria than in benign endometria (p�0.05). The best cut-ff valuefor endometrial thickness to predict malignancy was 11.8 mm (sensi-tivity 0.85, specificity 0.71, LR� 3.0, LR- 0.2). Endometrial thicknesshad an area under the ROC curve of 0.82. The best logistic regressionmodel to predict malignancy contained endometrial thickness (oddsratio 1.2, p�0.009) and VI in the endometrial shell (odds ratio 1.1,p�0.016) as predicting variables. The area under the ROC curve for thebest logistic regression model was 0.86, and the best risk cut-off for thismodel (0.22) had a sensitivity of 0.69, a specificity of 0.86, LR� 4.8,

LR- 0.4.