Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis
Alcázar JL(1), Orozco R(2), Martinez-Astorquiza Corral T(3), Juez L(1), Utrilla-Layna J(1), Mínguez JA(1), Jurado M(1).
(1) Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
(2) Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
(3) Department of Obstetrics and Gynecology, Hospital Universitario Cruces, Bilbao, Spain.
Transvaginal ultrasound (TVS) has been extensively used for assessing myometrial infiltration (MI) in endometrial cancer (EC). However, there is no clear evidence up to date about the overall diagnostic performance.
To perform a systematic review about the diagnostic accuracy of TVS in the preoperative detection of deep MI in patients with EC, comparing subjective and objective methods.
An extensive search was performed in Medline (Pubmed) and EMBASE from January 1989 to December 2014. Eligibility criteria were studies using TVS for preoperative assessment of MI subjective assessment and/or objective measurements, specifically Gordon's (the ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson's (endometrial tumor thickness/anterior-posterior uterine diameter ratio) approaches] in women with EC, using the surgical-pathologic data as a reference standard. Quality was assessed using PRISMA guidelines and QUADAS-2 tool.
Our extended search identified a total of 184 citations but we finally examined the full text of the 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration was 82% (95% CI, 76-87%), 81% (95 % CI, 76-85%), 4.3 (95% CI, 3.6-5.3) and 0.22 (95% CI, 0.16-0.30), respectively. We did not observed differences among all three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity for all three methods (I2 values ranging from 60.57 to 94.96). The main limitation was that very few studies compared different approaches in the same set of patients.
Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.
CITATION Ultrasound Obstet Gynecol. 2015 May 22. doi: 10.1002/uog.14905.