Author:

Keywords:

Science & Technology, Technology, Life Sciences & Biomedicine, Acoustics, Obstetrics & Gynecology, Radiology, Nuclear Medicine & Medical Imaging, cervical invasion, endometrial cancer, measurement, myometrial invasion, ultrasound, TRANSVAGINAL SONOGRAPHY, PREOPERATIVE ASSESSMENT, PROGNOSTIC-FACTORS, ULTRASOUND, CARCINOMA, ULTRASONOGRAPHY, REPRODUCIBILITY, INTRAOBSERVER, INFILTRATION, THICKNESS, measurement; myometrial invasion, Aged, Cervix Uteri, Endometrial Neoplasms, Female, Humans, Middle Aged, Myometrium, Prospective Studies, Sensitivity and Specificity, Ultrasonography, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, 3202 Clinical sciences, 3215 Reproductive medicine

Abstract:

AIM: To compare the diagnostic accuracy of subjective ultrasound assessment to objective measurement techniques in the evaluation of myometrial and cervical invasion in women with endometrial cancer. METHODS: Prospective multicenter study including 144 women with endometrial cancer undergoing transvaginal ultrasound. Myometrial and cervical invasion was subjectively evaluated, and objectively measured in different ways: ;endometrial thickness, tumor/uterine anterio-posterior (AP) ratio, minimal tumor free margin, minimal tumor free margin/uterine AP diameter ratio, tumor volume (3D), tumor /uterine volume (3D) ratio, distance from outer cervical os to the lower margin of tumor (Dist-OCO). Histological assessment from hysterectomy was golden standard. RESULTS: The sensitivity (79%) and specificity (76%) of tumor/uterine AP diameter (at cut-off 0.53) was not significantly different from subjective evaluation (sensitivity 77%, p = 0.44, specificity 81%, p = 0.32), all other objective measurement techniques had either a significantly lower sensitivity or a lower specificity. Fixing sensitivity at the same level as subjective evaluation all objective measurement techniques, except minimal tumor free margin/uterine AP diameter ratio, had a significantly lower specificity. Dist-OCO was the only parameter that might have potential to predict cervical invasion, it had a non-significantly higher sensitivity than subjective evaluation (vs. 73%, vs. 54% p = 0.06), but a significantly lower specificity (63% vs. 93% p < 0.001). CONCLUSION: Subjective assessment of cervical and myometrial invasion is as good as or better than any objective measurement technique. The tumor/uterine AP ratio and minimal tumor free margin/uterine AP diameter ratio seem to be the best objective measurement techniques to predict deep myometrial invasion. It remains to be shown if objective measurements are useful to predict cervical invasion.