Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy
Green RW (1), Valentin L (2), Alcazar JL (3), Chiappa V (4), Erdodi B (5), Franchi D (6), Frühauf F (7), Fruscio R (8), Guerriero S (9), Graupera B (10), Jakab A (5), di Legge A (11), Ludovisi M (11), Mascilini F (11), Pascual MA (10), van den Bosch T (12), Epstein E (13).
(1) Karolinska Institute, Department of Women's and Children's Health, Karolinska Universitetssjukhuset, Byggnad H2:00, 17165 Stockholm, Sweden.
(2) Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Lund University, Sweden.
(3) Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain.
(4) Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
(5) Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
(6) Department of Preventive Gynecology, European Institute of Oncology, Milan, Italy.
(7) Gynecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
(8) Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.
(9) Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, University of Cagliari, Cagliari, Italy.
(10) Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain.
(11) Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
(12) Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium.
(13) Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy.
Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ).
Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually.
Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.
CITATION Gynecol Oncol. 2018 Sep;150(3):438-445. doi: 10.1016/j.ygyno.2018.06.027