Combination IETA Ultrasonographic Characteristics Simple Scoring Method With Tumor Biomarkers Effectively Improves the Differentiation Ability of Benign and Malignant Lesions in Endometrium and Uterine Cavity

Abstract

ObjectivesTo evaluate International Endometrial Tumor Analysis (IETA) ultrasonographic characteristics simple scoring method and tumor biomarkers for the diagnosis of uterine cavity and endometrial lesions.MethodsWe classified and scored the normalized description of IETA ultrasonic characteristics, according to IETA expert consensus literature, previous IETA-related research articles, and the previous research experience of this project group. We conducted a retrospective analysis of the ultrasound images of 594 patients enrolled from January 2017 to June 2020, scored them item by item, and finally calculated the total score of each case. Meanwhile, we combined the results of seven tumor biomarkers. The objective was to evaluate the sensitivity, specificity, coincidence rate, and the area under receiver operating characteristic (ROC) curve of IETA ultrasonographic characteristics simple scoring method and tumor biomarkers for benign and malignant uterine cavity or endometrial lesions. The diagnostic efficiency between the combined method and the single method was compared.ResultsA total of 594 cases were confirmed by postoperative pathology or surgery records, including 475 benign lesions and 119 malignant lesions. In the simple ultrasound scoring method, the average score of benign lesions was 3.879 ± 1.279 and that of malignant lesions was 9.676 ± 4.491. If ≥6.5 points was taken as the cutoff value for the judgment of malignant lesions, the sensitivity, specificity, coincidence rate, and the area under receiver operating characteristic (ROC) curve (AUC) were 76.5%, 96.0%, 92.1%, and 0.935, respectively. The difference in tumor antigen 19-9 (CA19-9) and human epididymal protein 4 (HE4) between benign and malignant lesions was statistically significant (all p ≤ 0.01). The other five tumor biomarkers (CA125, CA15-3, SCC-Ag, AFP, and CEA) showed no statistically significant difference in benign and malignant lesions. If the value of CA19-9 ≥13.96 U/ml was taken as cutoff value, the sensitivity, specificity, and coincidence rate of the diagnosis of endometrial benign and malignant lesions were 54.8%, 74.7%, and 70.7%, respectively, and the AUC was 0.620. If the value of HE4 ≥ 39.075 pmol/L was taken as cutoff point, the sensitivity, specificity, coincidence rate, and AUC were 77.4%, 67.9%, 69.8%, and 0.796, respectively. The sensitivity was increased to 97.6% and the AUC was 0.939 when IETA ultrasound characteristics simple scoring method combined CA19-9 and HE4 in parallel test.ConclusionsIn IETA ultrasound characteristics simple scoring method, with ≥6.5 points as the cutoff value, it could quickly and accurately assess the benign and malignant in uterine cavity and endometrial lesions, with high diagnostic value. The diagnostic efficacy of seven tumor biomarkers was all mediocre. Combining with these two methods, the comprehensive diagnosis could improve sensitivity and accuracy and reduce the risk of missed diagnosis.

Effect of 3D laparoscopy versus traditional laparotomy on serum tumor markers and coagulation function in patients with early-stage endometrial cancer

“…Tumor markers, notably CA125, CA199, and HE4, play a pivotal role in EC's pathological trajectory. 19 Notably, CA125, an endometrial-secreted glycoprotein antigen, stands out as a primary EC diagnostic tool. Investigations by Kakimoto S et al 20 revealed markedly elevated serum CA125 levels in EC patients compared to a healthy control group.…”

IETA Ultrasonic Features Combined with GI-RADS Classification System and Tumor Biomarkers for Surveillance of Endometrial Carcinoma: An Innovative Study

“…The submucous myomas protruded from the myometrium to the uterine cavity, often resulting in interrupted echo at the endometrial–myometrial junction; it would be overestimated by ultrasound GI-RADS scoring system, resulting in false positives. We could distinguish these lesions from EC by combining the “circular vessels” vascular pattern (in this study, the pathological results of all cases with the circular vessels vascular pattern were submucosal myomas), the characteristics of hypoechoic lesions and pseudocapsule sign (EC were often hyperechoic or mixed echoic, and their boundaries were often unclear) [ 29 ]. However, in this study, we also found that EC lesions of the non-endometrioid adenocarcinoma type may also be hypoechoic, quasi-circular in shape, and had scarce blood flow, which may be misdiagnosed as submucous myomas.…”

“…In this study, we normalized the description of IETA ultrasonic features and classified them into GI-RADS classification system according to the IETA expert consensus literatures [ 9 , 10 , 18 ], the IOTA simple standard method, the criteria used for GI-RADS adnexal tumors classification [ 43 ], the previous research experience of our project team [ 29 ] and the correlation between ultrasound features defined by IETA and benign and malignant lesions. The objective was to use standard descriptions to help sonographers classify intrauterine and endometrial lesions to distinguish between benign and malignant lesions.…”

“…Moreover, at present, there is no structured ultrasound reporting standard for a uterine cavity or endometrial lesions. The inconsistent diagnostic level and description terms in these areas contributed to confusion in the interpretation of ultrasound reports by clinicians, and it was not conducive to the development of the professional level in this field [ 29 ].…”

Evaluating clinical features in intracavitary uterine pathologies among vietnamese women presenting with peri-and postmenopausal bleeding: A bicentric observational descriptive analysis

“…These modalities may be ultrasound, saline infusion sonography, computerized tomography scanner, magnetic resonance imaging, hysteroscopy, endometrial biopsy, etc. [ 14 15 16 17 18 ] However, some modalities remain expensive for assessment in low- and middle-income countries such as Vietnam. Meanwhile, the physician can firstly approach to initial features, evaluate carefully clinical symptoms, and classify the degree of anemia prior to investigate by additional diagnostic modalities as ultrasound, biopsy, and surgical procedures.…”