The Role of Three-dimensional Ultrasound in the Diagnosis and Treatment of Uterine Pathology

This thesis investigated the role of three – dimensional transvaginal ultrasound in the identification, classification and management of uterine pathology. We performed serial measurements of fibroids over a period of time to examine their natural history. We found that fibroids tend to grow at a relatively fast average rate in pre-menopausal women, which is influenced by the initial fibroid volume and patients’ demographic characteristics. Our findings could help to rationalise the follow up and plan better the treatment of women with fibroids. Our results also provided novel insights into the possible pathogenesis of fibroids. 3D – SIS has been previously demonstrated to be equivalent to hysteroscopy to measure the degree of submucous fibroids protrusion into the endometrial cavity. However compared to hysteroscopy, 3D – SIS provides additional information including objective measurement of fibroid size and position. We evaluated these additional ultrasonic variables and identified diameter and size of the intramural portion as predictive of complete resection at a single TCRF. GnRH analogues have been given to women with submucous fibroids before transcervical resection to improve the chance of complete resection. However evidence for this practice is limited and the treatment is associated with significant side effects. We carried out a double - blind , placebo – controlled, randomized trial which did not demonstrate a benefit in the preoperative administration of GnRH analogues in women scheduled for TCRF. <br/>This thesis also investigated the role of 3D ultrasound in the diagnosis and treatment of endometrial cancer. Currently women with postmenopausal bleeding are investigated by transvaginal ultrasound to measure endometrial thickness. This results in a substantial 22 number of women needing endometrial biopsy to confirm benignity. We evaluated the ability of three 3D - PDA with objective quantification of vascularity indices to differentiate between benign and malignant lesions in women at high risk of endometrial cancer. We found that this shows promise but does not eliminate the need for biopsy. Currently women diagnosed with cancer undergo surgical staging that increases surgical morbidity. We investigated the usefulness of endometrial volume measurement in such patients to predict cancer stage which may be used in preoperative planning. <br/>

Name dc:type.qualificationname

Doctor of Medicine

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

King's College London

Year dc:date.issued

2012

Author dc:creator

• Mavrelos, Dimitrios

Advisor dc:contributor.advisor

• Nicolaides, Kypros Herodotou

Language dc:language

eng

Identifier

oai:kclpure.kcl.ac.uk:studenttheses/36cb7b0f-9020-44de-b8e9-f5d93904e3b4

OAI identifier oai:identifier

oai:kclpure.kcl.ac.uk:studenttheses/36cb7b0f-9020-44de-b8e9-f5d93904e3b4