Assessment of Myometrial Invasion in Endometrial Cancer by Transvaginal Sonography, Doppler Ultrasonography, Magnetic Resonance Imaging and Frozen Section

Abstract

Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.

Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy

“…Although myometrial invasion in endometrial cancer can be evaluated with high accuracy using intraoperative methods (gross examination: 85-89%, frozen sections: 91 -95%) (13,14,16,17), a preoperative method would have the advantage of preparing the patient for the extent of surgery needed, differentiating the level of surgical expertise present in the operating theater, allocating women to minimal invasive surgery, and preserving the option of radical hysterectomy for women with cervical involvement. Of preoperative methods, TVS has been evaluated with regard to determining deep myometrial invasion and accuracies of 78-87% have been reported, similar to the results of the present study (17)(18)(19). MRI can determine myometrial invasion with accuracies of 47-86% (17,(19)(20)(21)(22)(23).…”

Predictive Value of Magnetic Resonance Imaging in Assessing Myometrial Invasion in Endometrial Cancer

“…10Y14 There seems to be a trend toward greater accuracy in detecting deep invasion, with NPVs of 71% to 92.3%. 7,11,15 The interpretation of such a broad range of results is difficult, with some authors recommending full lymphadenectomy in all cases, 10 others recommending frozen section evaluation regardless of imaging, 16,17 and others suggesting treating MRI findings with caution. 13 A recent review of 96 patients found a high sensitivity for predicting myometrial invasion overall (94%) and a high NPV for deep invasion (91%), which may allow pretreatment categorization into high-and low-risk patients.…”

Preoperative MRI versus intraoperative frozen-section in the assessment of myometrial invasion in endometrioid type endometrial cancer

“…Nevertheless, intraoperative frozen-section and gross examination are more precise methods to assess the depth of myometrial invasion. Frozen-section can determine myometrial invasion with accuracies of 90-95% (18,(20)(21)(22)(23). It was also reported that frozen-section has higher sensitivity (73.1-92%) and specificity (92-100%) (16-18) than conventional imaging techniques such as MRI and US.…”