Development and external validation of new ultrasound‐based mathematical models for preoperative prediction of high‐risk endometrial cancer

Holsbeke, C. Van; Ameye, Lieveke; Testa, Antonia Carla; Mascilini, F.; Lindqvist, Pelle G.; Fischerová, D.; Frühauf, F.; Fransis, Sabine; Jonge, Eric de; Timmerman, Dirk; Epstein, Elisabeth

doi:10.1002/uog.13216

Cited by 20 publications

(47 citation statements)

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“…We also validated on our dataset two two-step strategies for the prediction of high-risk cancer published previously 10 . Based on the two-step strategies, patients with a Grade-3 endometrioid or mucinous cancer or with other non-endometrioid malignancy on preoperative biopsy are classified as having a high-risk tumor (first step), while the remaining patients (Grade 1 and Grade 2) are classified using a prediction model (second step).…”

Section: Methodsmentioning

confidence: 99%

“…The 'subjective prediction model' includes biopsy grade (Grade 1 vs Grade 2) and subjective assessment of deep MI or CSI (present or absent) as variables. The 'objective prediction model' includes biopsy grade (Grade 1 vs Grade 2) and minimal tumor-free margin as variables 10 .…”

Section: Methodsmentioning

confidence: 99%

“…However, there is no consensus on whether subjective assessment of images should be preferred over ultrasound measurements or vice versa. Mathematical models to predict high-risk endometrial cancer have also been developed 10 . Published studies are small, and the ability of ultrasound to predict deep MI in endometrioid cancer Grades 1 and 2 has been examined in only one study 11 .…”

Section: Introductionmentioning

confidence: 99%

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Validation of ultrasound strategies to assess tumor extension and to predict high‐risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)‐4 cohort

Verbakel

Mascilini

Wynants

et al. 2019

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Subjective assessment of ultrasound images is the best method of predicting deep myometrial invasion and cervical stromal invasion of endometrial cancer, especially in patients with a Grade-1 or -2 tumor. To predict high-risk disease, mathematical models may be useful, but the best strategy is to combine subjective assessment with biopsy grade or to use the subjective two-step strategy. What are the clinical implications of this work?Ultrasound imaging has a central role in the preoperative evaluation of patients with endometrial cancer. In the hands of experienced ultrasound examiners, subjective assessment of extension of endometrial cancer performs better than does any ultrasound measurement or published risk-prediction model. ABSTRACTObjectives To compare the performance of ultrasound measurements and subjective ultrasound assessment (SA) in detecting deep myometrial invasion (MI) and cervical stromal invasion (CSI) in women with endometrial cancer, overall and according to whether they had low-or high-grade disease separately, and to validate published measurement cut-offs and prediction models to identify MI, CSI and high-risk disease . MethodsThe study comprised 1538 patients with endometrial cancer from the International Endometrial Tumor Analysis (IETA)-4 prospective multicenter study, who underwent standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the tumor/uterine anteroposterior (AP) diameter ratio for detecting deep MI and that of the distance from the lower margin of the tumor to the outer cervical os (Dist-OCO) for detecting CSI. We also validated two two-step strategies for the prediction of high-risk cancer; in the first step, biopsy-confirmed Grade-3 endometrioid or mucinous or non-endometrioid cancers were classified as high-risk cancer, while the second step encompassed the application of 116 Verbakel et al.a mathematical model to classify the remaining tumors. The 'subjective prediction model' included biopsy grade (Grade 1 vs Grade 2) and subjective assessment of deep MI or CSI (presence or absence) as variables, while the 'objective prediction model' included biopsy grade (Grade 1 vs Grade 2) and minimal tumor-free margin. The predictive performance of the two two-step strategies was compared with that of simply classifying patients as high risk if either deep MI or CSI was suspected based on SA or if biopsy showed Grade-3 endometrioid or mucinous or non-endometrioid histotype (i.e. combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard. ResultsIn 1275 patients with measurable lesions, the sensitivity and specificity of SA for detecting deep MI was 70% and 80%, respectively, in patients with a Grade-1 or -2 endometrioid or mucinous tumor vs 76% and 64% in patients with a Grade-3 endometrioid or mucinous or a non-endometrioid tumor. The corresponding values for the ...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of ultrasound strategies to assess tumor extension and to predict high‐risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)‐4 cohort

Verbakel

Mascilini

Wynants

et al. 2019

Ultrasound in Obstet & Gyne

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“…If a stratification of patients for surgery were based solely on the preoperative biopsy, then 64 % of high-risk patients would be erroneously underestimated according a multicentre study of Holsbeke et al [30].…”

Section: Endometrial Cancermentioning

confidence: 99%

Ultrasound in Gynecological Cancer: Is It Time for Re-evaluation of Its Uses?

Fischerová

Cibula

2015

Curr Oncol Rep

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Ultrasound is the primary imaging modality in gynecological oncology. Over the last decade, there has been a massive technology development which led to a dramatic improvement in the quality ultrasound imaging. If performed by an experienced sonographer, ultrasound has an invaluable role in the primary diagnosis of gynecological cancer, in the assessment of tumor extent in the pelvis and abdominal cavity, in the evaluation of the treatment response, and in follow-up. Ultrasound is also a valuable procedure for monitoring patients treated with fertility-sparing surgery. Furthermore, it is an ideal technique to guide tru-cut biopsy for the collection of material for histology. Taking into consideration that besides its accuracy, the ultrasound is a commonly available, non-invasive, and inexpensive imaging method that can be carried out without any risk or discomfort to the patient; it is time to reconsider its role in gynecologic oncology and to allocate resources for a specialized education of future experts in ultrasound imaging in gynecology.

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“…Alcazar et al compared the diagnostic performance of six different approaches (impression of examiner, Karlsson's criteria, endometrial thickness, tumor/uterine 3D volume ratio, TDS and von Holsbeke's subjective model) for assessing myometrial infiltration using transvaginal/ transrectal US in endometrial carcinoma [22,23]. The study showed that the subjective impression seems to be the best approach for assessing myometrial infiltration in grade 1 or 2 endometrioid carcinoma and the use of mathematical models and other objective 2D and 3D measurement techniques do not improve diagnostic performance.…”

Section: Myometrial Infiltrationmentioning

confidence: 99%

The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital.

et al. 2016

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Aim: To predict the myometrial invasion with three-dimensional (3D) ultrasonography in a cohort of patients with endometrial carcinoma by a previously described technique. Material and methods: The moyometrial infiltration was evaluated by 3D ultrasonography before surgery in 54 patients with endometrial carcinoma. After scanning the whole uterus by ultrasonography, three perpendicular planes were identified to find the shortest myometrial tumor-free distance to serosa (TDS) by examining the lateral, anterior, posterior, and fundal parts of the myometrium. Myometrial infiltration was also estimated by the subjective impression of the examiner. The reference standards consist of myometrial infiltration and TDS which are measured by an experienced pathologist. Results: Forty-five patients (age range 45-86 years) were included for the final analysis. Myometrial invasion was ˂50% in 36 and ≥50% in 9 cases at histologic sections. The TDS which is measured with 3D ultrasonography was positively correlated with histologically measured TDS (r=0.474, p=0.001). The best cut-off value for ultrasonographically measured TDS was 9 mm with a sensitivity of 89%, specifity of 61%, positive predictive value of 36%, and negative predictive value of 96%. Subjective impression has a sensitivity of 100%, specifity of 88%, positive predictive value of 69%, and negative predictive value of 100%. Cervical involvement was correctly identified in all 6 cases by subjective impression. Conclusion: This validation study confirms the 3D ultrasonography as a valuable tool for the evaluation of myometrial infiltration in patients with endometrial carcinoma.

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Development and external validation of new ultrasound‐based mathematical models for preoperative prediction of high‐risk endometrial cancer

Abstract: Objectives

Cited by 20 publications

References 20 publications

Validation of ultrasound strategies to assess tumor extension and to predict high‐risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)‐4 cohort

Validation of ultrasound strategies to assess tumor extension and to predict high‐risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)‐4 cohort

Ultrasound in Gynecological Cancer: Is It Time for Re-evaluation of Its Uses?

The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital.

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