Ultrasound characteristics of endometrial cancer as defined by the International Endometrial Tumor Analysis (IETA) consensus nomenclature - A prospective multicenter study
Epstein E (1), Fischerova D (2), Valentin L (3), Testa AC (4), Franchi D (5), Sladkevicius P (3), Filip F (2), Lindqvist PG (6), Mascilini F (4), Fruscio R (7), Haak LA (8), Opolskiene G (9), Pascual MA (10), Alcazar JL (11), Chiappa V (12), Guerriero S (13), Carlson J (14), Van Holsbeke C (15), Leone FPG (16), De Moor B (17), Bourne T (18,19), van Calster B (19), Installe A (17), Timmerman D (19,20), Verbakel JY (19,21), Van den Bosch T (20).
(1) Department of Clinical Science and Education, Södersjukhuset and Department of Women's and Children's health Karolinska Institutet, Stockholm, Sweden.
(2) Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
(3) Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Lund University, Sweden.
(4) Department of Gynecological Oncology, Catholic University of Sacred Heart, Rome, Italy.
(5) Department of Gynecological Oncology, Milan, Italy.
(6) Department of Obstetrics and Gynecology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
(7) Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
(8) Institute for the Care of Mother and Child, Prague, Czech Republic and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
(9) Center of Obstetrics and Gynecology, Vilnius University Hospital, Santariskiu clinic, Lithuania.
(10) Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain.
(11) Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain.
(12) Department of Obstetrics and Gynecology, National Cancer Institute, Milan, Italy.
(13) Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy.
(14) Department of Pathology, Karolinska University Hospital, Stockholm, Sweden.
(15) Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.
(16) Department of Obstetrics and Gynecology, Clinical Sciences Institute, L. Sacco, Milan, Italy.
(17) Department of Electrical Engineering, ESAT-SCD, STADIUS Center for Dynamical Systems, Signal Processing and Data Analysis, KU Leuven, and imec, Leuven, Belgium.
(18) Department of Obstetrics and Gynaecology, Queen Charlottes and Chelsea Hospital, Imperial College London, UK.
(19) Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
(20) Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium.
(21) Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
To describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology.
Prospective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound examination by an experienced ultrasound examiner using a high-end ultrasound system. Clinical and sonographic data were entered into a web-based protocol. We assessed how strongly sonographic characteristics, according to IETA, were associated to outcome at hysterectomy, i.e. tumor stage, grade, and histological type.
After excluding 176 women (no or delayed hysterectomy, final diagnosis other than endometrial cancer, or incomplete data), 1538 women were included in our statistical analysis.
Median age was 65 years (range 27-98), and median BMI 28.4 (range 16-67), 1378 (89.7%) women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage. High-risk tumors (stage 1A, grade 3 or non-endometrioid or ≥ stage 1B) were less likely to have regular endometrial myometrial border (difference of -23%, 95% CI -27 to -18%), whilst they were larger (mean endometrial thickness; difference of +9 mm, 95% CI +8 to +11 mm), more frequently had non-uniform echogenicity (difference of +10%, 95% CI +5 to +15%), a multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high color score (difference of +22%, 95% CI +18 to +27%), than low-risk tumors.
Grayscale and color Doppler ultrasound features are associated with grade and stage, and differ between high and low risk endometrial cancer.
CITATION Ultrasound Obstet Gynecol. 2017 Sep 25. doi: 10.1002/uog.18909