With the increasing incidence and mortality of endometrial cancer (EC) , early and effective screening for EC has become a hot research topic.

To investigate the value of three-dimensional (3D) ultrasonography with a malignancy risk model for screening for EC with postmenopausal bleeding (PMB) .

A total of 168 patients who visited the Second Affiliated Hospital of Zhengzhou University for PMB between January 2019 and December 2020 were selected, and 136 of them were found with benign endometrial lesion, other 32 with EC by histopathological examination. All of them underwent 3D transperineal ultrasonography, and parameters such as endometrial volume, vascularization index (VI) , flow index (FI) , and vascularization-flow index (VFI) were calculated using VOCAL software. Clinical data were retrospectively collected, in which endometrial thickness, recurrent vaginal bleeding, age, body mass index (BMI) , and history of diabetes mellitus were included in a malignancy risk model and scored for predicting EC with PMB. The ROC curve was plotted and the area under which (AUC) was calculated to measure the performance of 3D transperineal ultrasonography, malignancy risk model, and the combination of them in predicting EC with PMB.

Compared with those with benign endometrial lesion, EC patients had greater average BMI, and higher rate of vaginal bleeding (P<0.05) . Moreover, they also had thicker average endometrial thickness, greater average endometrial volume as well as higher average VI, FI, and VFI (P<0.05) . In predicting EC with PMB, 3D transperineal ultrasonography (the combination of EV, VI, FI and VFI parameters) combined with the malignancy risk model had a greater AUC than did 3D transperineal ultrasonography { 0.949 〔95%CI (0.908, 0.989) 〕vs 0.883〔95%CI (0.817, 0.949) 〕} (Z=4.762, P=0.032) , and the malignancy risk model { 0.949〔95%CI (0.908, 0.989) 〕 vs 0.723〔95%CI (0.629, 0.817) 〕} ( Z=2.613, P=0.018) . The sensitivity, specificity, and Youden index of the combined use of 3D transperineal ultrasonography and malignancy risk model for predicting EC with PMB were 84.4%, 96.3%, and 0.807, respectively.

The combined use of 3D transperineal ultrasonography and malignancy risk model for predicting EC with PMB has high accuracy, which could be used to initially triage patients.

随着子宫内膜癌（EC）发病率和病死率的升高，如何早期有效筛查EC成为研究热点。

探讨三维超声联合恶性风险模型在绝经后出血（PMB）女性EC筛查中的应用价值。

选取2019年1月至2020年12月于郑州大学第二附属医院因PMB就诊的患者168例。根据组织病理学检查结果将患者分为子宫内膜良性病变组136例和EC组32例。患者均行阴道三维超声检查，使用VOCAL软件计算子宫内膜体积（EV）、血管形成指数（VI）、血流指数（FI）和血管形成-血流指数（VFI）。回顾性收集患者的临床资料，并根据子宫内膜厚度（ET）、阴道出血、年龄、体质指数（BMI）和糖尿病史计算恶性风险模型评分。绘制三维超声、恶性风险模型、二者联合预测PMB女性EC的受试者工作特征曲线（ROC曲线），并计算ROC曲线下面积（AUC）。

EC组患者BMI、反复出血频率高于子宫内膜良性病变组（P<0.05）；EC组患者ET、EV大于子宫内膜良性病变组，VI、FI、VFI高于子宫内膜良性病变组（P<0.05）。三维超声（即EV、VI、FI、VFI联合）、恶性风险模型及二者联合预测PMB女性EC的AUC分别为0.883〔95%CI（0.817，0.949）〕、0.723〔95%CI（0.629，0.817）〕、0.949〔95%CI（0.908，0.989）〕。三维超声联合恶性风险模型预测PMB女性EC的AUC高于三维超声、恶性风险模型（Z值分别为4.762、2.613，P值分别为0.032、0.018）。三维超声联合恶性风险模型预测PMB女性EC的灵敏度、特异度、约登指数分别为84.4%、96.3%、0.807。

三维超声联合恶性风险模型预测PMB女性EC的价值较高，在临床筛查工作中可以初步分流部分患者。