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).
(1) Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
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.
CITA DEL ARTÍCULO Ultrasound Obstet Gynecol. 2015 May 29. doi: 10.1002/uog.14912.