Transvaginal sonography vs. hysteroscopy in the preoperative staging of endometrial carcinoma

Abstract

The aim of this study was to evaluate the diagnostic accuracy of transvaginal sonography vs. hysteroscopy in the preoperative staging of endometrial carcinoma, in order to establish the most appropriate surgical therapy. Transvaginal sonography and hysteroscopy were used preoperatively in 67 women with histologically proven endometrial carcinoma. Deep myometrial invasion (> 50%) was present at postoperative pathology in 26/67 (39%) women and spread to the cervix occurred in 11/67 (16%) women. Transvaginal sonographic examination was initially directed at assessing myometrial invasion, which was correctly predicted in 52/67 (78%) women. Transvaginal sonography demonstrated a sensitivity of 88% (23/26) and a specificity of 71% (29/41) for deep invasion, with a positive predictive value (PPV) of 66% (23/35) and a negative predictive value (NPV) of 91% (29/32). The accuracy of transvaginal sonography in detecting cervical involvement was 82% (55/67), and that of hysteroscopy was 72% (48/67): transvaginal sonography was slightly less sensitive (54% vs. 64%), but more specific (87% vs. 73%) than hysteroscopy. When cervical invasion was present, the PPVs of transvaginal sonography and hysteroscopy were 46% (6/13) and 32% (7/22), respectively, while the NPV was 91% for both techniques (49/54; 41/45). Our data show that the accuracy of transvaginal sonography was comparable with that of hysteroscopy in detecting cervical involvement. Therefore, in the majority of cases, when both techniques showed that disease was limited, the appropriately limited type of surgery would be performed. Conversely, detection of a myometrial invasion of > 50% or an extension to the cervix would lead to an unnecessarily extensive operation if this was the sole criterion used for making the decision.

Preoperative selection of patients with low-stage endometrial cancer at high risk of pelvic lymph node metastases

“…Our results were similar to those of earlier studies: sensitivity was 79% and NPV 86% with a lower specificity (72%) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) . In contrast with the other studies, ours was performed in several clinics as part of the routine workup by sonographers or gynecologists.…”

“…Transvaginal sonography (TVS) has been used during the past few years to preoperatively determine the myometrial infiltration of endometrial cancer (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) . The present study was undertaken to evaluate preoperative TVS for myometrial invasion assessment in daily practice in various university and nonuniversity hospitals.…”

Comparative study of transvaginal ultrasonography and CA 125 in the preoperative evaluation of myometrial invasion in endometrial carcinoma

“…Analyzed separately, our results regarding TVS are similar to those of previous studies [16][17][18]25,33,34 , showing a high sensitivity and specificity. We had two cases of overestimation of myometrial invasion.…”

“…Magnetic resonance imaging (MRI) has been demonstrated to be highly accurate, with sensitivity ranging from 56 to 91% [29][30][31][32] . TVS has also been found to be accurate, with sensitivity ranging from 78 to 93% [16][17][18]25,33,34 . Some studies have demonstrated that TVS is as accurate as MRI 35,36 .…”

Comparative Study of Transvaginal Ultrasonography and CA 125 in the Preoperative Evaluation of Myometrial Invasion in Endometrial Carcinoma

“…In our study we have compared the diagnostic performance of TVS and CA 125 in detecting myometrial invasion in patients with endometrial cancer. Analyzed separately, our results regarding TVS are similar to those of previous studies [16][17][18]25,33,34 , showing a high sensitivity and specificity. We had two cases of overestimation of myometrial invasion.…”