Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well or moderately differentiated endometrioid carcinoma of the endometrium
Alcázar JL(1), Pineda L(1), Caparrós M(1), Utrilla-Layna J(1), Juez L(1), Mínguez JA(1), Jurado M(1).
To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well (G1) or moderately (G2) differentiated endometrioid carcinoma of the endometrium.
Single center prospective observational cohort study comprising a consecutive series of women with preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound by a single examiner. According to subjective examiner's impression patients were considered at high-risk if myometrial infiltration was ≥ 50%, and/or cervical involvement and/or adnexal involvement was suspected. FIGO surgical staging was performed in all cases. Women were classified according to definitive histologic data regarding myometrial infiltration, cervical involvement and adnexal involvement as low-risk cases (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high-risk cases (myometrial infiltration >50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR) with 95% confidence intervals for transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated.
169 women out of 209 eligible were included in this study (patients' mean age: 60.7 years old, SD: 10.3, range: 32 to 91 years). Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR) of transvaginal/transrectal ultrasound for identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI: 63.7% to 88.0%), 89.1% (95% CI: 81.7% to 93.8%), 7.14 (95% CI: 4.19 to 12.18) and 0.25 (95% CI: 0.15 to 0.42), respectively.
Preoperative transvaginal/transrectal ultrasound may play a significant role for identifying high-risk cases in G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy and could be a useful test in this clinical setting.
CITATION Ultrasound Obstet Gynecol. 2016 Mar;47(3):374-9. doi: 10.1002/uog.14912