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Jónsdóttir B, Marcickiewicz J, Borgfeldt C, Bjurberg M, Dahm-Kähler P, Flöter-Rådestad A, Hellman K, Holmberg E, Kjølhede P, Rosenberg P, Tholander B, Åvall-Lundqvist E, Stålberg K, Högberg T. Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer-A Swedish Gynecologic Cancer Group (SweGCG) study. Acta Obstet Gynecol Scand 2021; 100:1526-1533. [PMID: 33721324 DOI: 10.1111/aogs.14146] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Deep myometrial invasion (≥50%) is a prognostic factor for lymph node metastases and decreased survival in endometrial cancer. There is no consensus regarding which pre/intraoperative diagnostic method should be preferred. Our aim was to explore the pattern of diagnostic methods for myometrial invasion assessment in Sweden and to evaluate differences among magnetic resonance imaging (MRI), transvaginal sonography, frozen section, and gross examination in clinical practice. MATERIAL AND METHODS This is a nationwide historical cohort study; women with endometrial cancer with data on assessment of myometrial invasion and FIGO stage I-III registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) between 2017 and 2019 were eligible. Data on age, histology, FIGO stage, method, and results of myometrial invasion assessment, pathology results, and hospital level were collected from the SQRGC. The final assessment by the pathologist was considered the reference standard. RESULTS In the study population of 1401 women, 32% (n = 448) had myometrial invasion of 50% of more. The methods reported for myometrial invasion assessment were transvaginal sonography in 59%, MRI in 28%, gross examination in 8% and frozen section in 5% of cases. Only minor differences were found for age and FIGO stage when comparing methods applied for myometrial invasion assessment. The sensitivity, specificity, and accuracy to find myometrial invasion of 50% or more with transvaginal sonography were 65.6%, 80.3%, and 75.8%, for MRI they were 76.9%, 71.9%, and 73.8%, for gross examination they were 71.9%, 93.6%, and 87.3%, and for frozen section they were 90.0%, 92.7%, and 92.0%, respectively. CONCLUSIONS In Sweden, the assessment of deep myometrial invasion is most often performed with transvaginal sonography, but the sensitivity is lower than for the other diagnostic methods. In clinical practice, the accuracy is moderate for transvaginal sonography and MRI.
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Affiliation(s)
- Björg Jónsdóttir
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Janusz Marcickiewicz
- Department of Obstetrics and Gynecology, Varbergs Hospital, Region Halland, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Angelique Flöter-Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet. Stockholm, Sweden
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Gothenburg, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Rosenberg
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Bengt Tholander
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Thomas Högberg
- Department of Medical Oncology, Institute of Clinical Sciences, Lund University, Lund, Sweden
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Vieillefosse S, Huchon C, Chamming's F, Le Frère-Belda MA, Fournier L, Ngô C, Lécuru F, Bats AS. Assessment of different pre and intra-operative strategies to predict the actual ESMO risk group and to establish the appropriate indication of lymphadenectomy in endometrial cancer. J Gynecol Obstet Hum Reprod 2018; 47:517-523. [DOI: 10.1016/j.jogoh.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/04/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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Fernandez CM, Levine EM, Dini M, Bannon K, Butler S, Locher S. Predictive Value of Three-Dimensional Transvaginal Sonography for Staging of Endometrial Neoplasia. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318794177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this study was to compare the sonographic assessment of endometrial cancer diagnosis and staging using three-dimensional transvaginal sonography with the staging that was ultimately found at surgery. Three-dimensional transvaginal sonography was performed for 20 consecutive cases of presumptive endometrial cancer using power Doppler angiography, virtual organ computer-aided analysis, and volume contrast imaging. These results were compared with the surgical staging found for those identified cases. The sonographic findings predicted the correct minimum endometrial cancer staging in 100% of the 20 cases that were examined and correlated to surgical outcomes. The successful prediction of endometrial cancer staging demonstrated by others was replicated in the organization of this case series. The findings compared favorably with other imaging modalities used for this purpose. This study assists in demonstrating the value of using presurgical three-dimensional sonography to plan for the optimal surgical excision and overall treatment of endometrial cancer.
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Affiliation(s)
| | | | - Morteza Dini
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | | | - Stacy Butler
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Stephen Locher
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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The Diagnostic Accuracy of Ultrasound in Assessment of Myometrial Invasion in Endometrial Cancer: Subjective Assessment versus Objective Techniques. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1318203. [PMID: 28812010 PMCID: PMC5546069 DOI: 10.1155/2017/1318203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 01/02/2023]
Abstract
The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 and December 2011, were prospectively enrolled. Myometrial invasion was evaluated by subjective assessment using ultrasound (<50% or ≥50%) and calculated as deepest invasion/normal myometrium ratio (Gordon's ratio) and as tumor/uterine anteroposterior diameter ratio (Karlsson's ratio). Histological assessment from hysterectomy was considered the gold standard. Altogether 210 patients were prospectively included. Subjective assessment and two objective ratios were found to be statistically significant predictors of the myometrial invasion (AUC = 0.65, p value < 0.001). Subjective assessment was confirmed as the most reliable method to assess myometrial invasion (79.3% sensitivity, 73.2% specificity, and 75.7% overall accuracy). Deepest invasion/normal myometrium (Gordon's) ratio (cut-off 0.5) reached 69.6% sensitivity, 65.9% specificity, and 67.3% overall accuracy. Tumor/uterine anteroposterior diameter (Karlsson's) ratio with the same cut-off reached 56.3% sensitivity, 76.4% specificity, and 68.1% overall accuracy. The subjective ultrasound evaluation of myometrial invasion performed better than objective methods in nearly all measures but showed statistically significantly better outcomes only in case of sensitivity.
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Pineda L, Alcázar JL, Caparrós M, Mínguez JA, Idoate MA, Quiceno H, Solórzano JL, Jurado M. Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low-risk endometrioid carcinoma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:369-373. [PMID: 26033260 DOI: 10.1002/uog.14909] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low-risk endometrial cancer, and to estimate the agreement between the two methods. METHODS This was a single-center observational study comprising women with preoperative diagnosis of well- or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative TVS by a single examiner. According to the examiner's subjective impression, myometrial infiltration was stated as ≥ 50% or < 50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was performed by pathologists who were unaware of the ultrasound findings, and myometrial infiltration was stated as ≥ 50% or < 50%. Definitive histological diagnosis of myometrial infiltration was made by frozen section analysis and was used as the gold standard. Sensitivity and specificity with 95% CIs were calculated for TVS and intraoperative macroscopic inspection and compared using McNemar's test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's kappa index (κ) and percentage of agreement. RESULTS Of 209 eligible women, 152 were ultimately included. Mean (± SD) age was 60.9 ± 10.2 years, with a range of 32-91 years. Definitive histological diagnosis revealed that myometrial infiltration was < 50% in 114 women and ≥ 50% in 38 women. Sensitivity and specificity of TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively, whereas the respective values for intraoperative macroscopic examination were 78.9% and 90.4% (McNemar's test, P > 0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between methods was moderate with κ = 0.54 (95% CI, 0.39-0.69) and percentage of agreement of 82%. CONCLUSIONS Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration was only moderate, both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might reasonably be proposed as a method for assessing myometrial infiltration as an alternative to intraoperative macroscopic examination, especially when performed by an experienced examiner and image quality is not poor. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Pineda
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Caparrós
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M A Idoate
- Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - H Quiceno
- Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J L Solórzano
- Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Intraoperative Gross Examination and Intraoperative Frozen Section in Patients With Endometrial Cancer for Detecting Deep Myometrial Invasion. Int J Gynecol Cancer 2016; 26:407-15. [DOI: 10.1097/igc.0000000000000618] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Christensen JW, Dueholm M, Hansen ES, Marinovskij E, Lundorf E, Ørtoft G. Assessment of myometrial invasion in endometrial cancer using three-dimensional ultrasound and magnetic resonance imaging. Acta Obstet Gynecol Scand 2015; 95:55-64. [DOI: 10.1111/aogs.12806] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Julie W. Christensen
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Margit Dueholm
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | - Estrid S. Hansen
- Department of Histopathology; Aarhus University Hospital; Aarhus Denmark
| | | | - Erik Lundorf
- The MRI Center; Aarhus University Hospital; Aarhus Denmark
| | - Gitte Ørtoft
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
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Alcázar JL, Orozco R, Martinez-Astorquiza Corral T, Juez L, Utrilla-Layna J, Mínguez JA, Jurado M. Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:405-413. [PMID: 26011665 DOI: 10.1002/uog.14905] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of deep myometrial infiltration in patients with endometrial cancer, comparing subjective and objective methods. METHODS An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. The eligibility criterion was use of TVS for preoperative assessment of myometrial infiltration by subjective evaluation and/or objective measurements. Objective measurements included, specifically, the approaches of Gordon (ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson (endometrial tumor thickness/anteroposterior uterine diameter ratio), in women with endometrial cancer, using the surgical pathological data as a reference standard. Study quality was assessed using the QUADAS-2 tool. RESULTS Our extended search identified a total of 184 citations, among which we examined the full text of 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration were 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 observe differences among the three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity of all three methods (I(2) range, 60.6-95.0). The main limitation was that very few studies compared different approaches in the same set of patients. CONCLUSION Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - R Orozco
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - L Juez
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Invited commentary on American College of Radiology Appropriateness Criteria endometrial carcinoma. Ultrasound Q 2014; 30:29-31. [PMID: 24901776 DOI: 10.1097/ruq.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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