J Gynecol Oncol.  2015 Jul;26(3):201-207. 10.3802/jgo.2015.26.3.201.

Transvaginal/transrectal ultrasound for assessing myometrial invasion in endometrial cancer: a comparison of six different approaches

• Alcazar JL
• Pineda L
• Martinez-Astorquiza Corral T
• Orozco R
• Utrilla-Layna J
• Juez L
• Jurado M

• KMID: 2160806
• DOI: http://doi.org/10.3802/jgo.2015.26.3.201

Abstract

OBJECTIVE
To compare the diagnostic performance of six different approaches for assessing myometrial infiltration using ultrasound in women with carcinoma of the corpus uteri.
METHODS
Myometrial infiltration was assessed by two-dimensional (2D) transvaginal or transrectal ultrasound in 169 consecutive women with well (G1) or moderately (G2) differentiated endometrioid type endometrial carcinoma. In 74 of these women three-dimensional (3D) ultrasound was also performed. Six different techniques for myometrial infiltration assessment were evaluated. The impression of examiner and Karlsson's criteria were assessed prospectively. Endometrial thickness, tumor/uterine 3D volume ratio, tumor distance to myometrial serosa (TDS), and van Holsbeke's subjective model were assessed retrospectively. All subjects underwent surgical staging within 1 week after ultrasound evaluation. Definitive histopathological data regarding myometrial infiltration was used as gold standard. Sensitivity and specificity for all approaches were calculated and compared using McNemar test.
RESULTS
The impression of examiner and subjective model performed similarly (sensitivity 79.5% and 80.5%, respectively; specificity 89.6% and 90.3%, respectively). Both methods had significantly better sensitivity than Karlsson's criteria (sensitivity 31.8%, p<0.05) and endometrial thickness (sensitivity 47.7%, p<0.05), and better specificity than tumor/uterine volume ratio (specificity 28.3%, p<0.05) and TDS (specificity 41.5%, p<0.05).
CONCLUSION
Subjective impression seems to be the best approach for assessing myometrial infiltration in G1 or G2 endometrioid type endometrial cancer by transvaginal or transrectal ultrasound. The use of mathematical models and other objective 2D and 3D measurement techniques do not improve diagnostic performance.

Keyword

Endometrial Neoplasms; Myometrium; Neoplasm Invasion; Ultrasonography

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Endometrioid/pathology/*ultrasonography
Endometrial Neoplasms/pathology/*ultrastructure
Female
Humans
Imaging, Three-Dimensional
Middle Aged
Models, Theoretical
Myometrium/pathology/ultrasonography
Neoplasm Invasiveness/pathology/*ultrasonography
Prospective Studies
Retrospective Studies
Tumor Burden

Figure

• 

  Fig. 1 Transvaginal ultrasound showing measurement of tumor/anteroposterior uterine diameter ratio as proposed by Karlsson. In this case the ratio is ≥50% indicating myometrial infiltration of ≥50%.

• 

  Fig. 2 Transvaginal ultrasound showing measurement of tumor/anteroposterior uterine diameter ratio as proposed by Karlsson. In this case the ratio is <50% indicating myometrial infiltration of <50%.

• 

  Fig. 3 Three-dimensional ultrasound estimation of tumor (A) and uterine volumes (B). In this case the ratio is 0.118, indicating myometrial infiltration of <50%.

• 

  Fig. 4 Three-dimensional ultrasound estimation of shortest tumor distance to serosa (TDS). In this case TDS is 10.5 mm, indicating myometrial infiltration of <50%.

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