Dynamic contrast‐enhanced ultrasound improves diagnostic performance in endometrial cancer staging

Abstract

Objectives To compare the sensitivity and specificity of conventional two‐dimensional transvaginal ultrasound/power Doppler (2D‐TVU/PD) alone and 2D‐TVU/PD combined with dynamic contrast‐enhanced ultrasound (DCE‐US) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) in women with endometrial cancer (EC), and to assess the association of DCE‐US semiquantitative and qualitative variables with International Federation of Gynecology and Obstetrics (FIGO) Stage ≥ IB and ‘high‐risk’ cancer. Methods This was a prospective study of 101 consecutive women with biopsy‐confirmed EC, undergoing expert ultrasound examination at Karolinska University Hospital, a tertiary referral center. All consenting women underwent DCE‐US using a 1.5–2.5‐mL intravenous bolus of SonoVue contrast agent, as well as conventional 2D‐TVU/PD examination. DCE‐US videoclips were analyzed with regard to filling (global or focal), wash‐in (prior, simultaneous or after) and wash‐out (global or focal) patterns of the contrast agent in the tumor compared with the surrounding tissue, as well as semiquantitative DCE‐US parameters (wash‐in slope, time‐to‐peak, peak intensity and area under the time–intensity curve (TIC)) obtained from a TIC. The study cohort was compared with a control cohort of women with EC examined at our center according to the International Endometrial Tumor Analysis protocol using 2D‐TVU/PD only, matched at a ratio of 3:1 for FIGO stage and grade. The sensitivity and specificity of 2D‐TVU/PD alone in the control cohort and in combination with DCE‐US in the study cohort in the diagnosis of deep MI, CSI and high‐risk cancer (defined as FIGO Stage ≥ IB and/or Grade 3 endometrioid and/or non‐endometrioid histology) were compared, using pathological evaluation after hysterectomy as the ‘gold standard’. Results After exclusions, 93 women were included in the study cohort and were matched to 279 women in the control cohort. The prevalence of FIGO Stage IA, Grade 1–2 EC was 52% in both cohorts. The sensitivity of 2D‐TVU/PD with DCE‐US in the study cohort was higher than that of 2D‐TVU/PD alone in the control cohort in diagnosing both deep MI (0.74 vs 0.62; P = 0.036) and CSI (0.75 vs 0.51; P < 0.001), whereas the specificity was not significantly different (0.87 vs 0.85 and 0.96 vs 0.95, respectively). Compared with 2D‐TVU/PD alone, the specificity of 2D‐TVU/PD with DCE‐US was higher in detecting high‐risk cancer (0.94 vs 0.85; P = 0.024) but the sensitivity did not differ (0.73 vs 0.71). High‐risk cancer and FIGO Stage ≥ IB were characterized by a ‘focal’ filling pattern, with a ‘prior’ wash‐in pattern and a ‘focal’ wash‐out pattern on subjective assessment of DCE‐US videoclips. All semiquantitative DCE‐US parameters were significantly predictive of FIGO Stage ≥ IB but not of high‐risk cancer, despite a clear trend. Conclusions Compared with 2D‐TVU/PD alone, combining 2D‐TVU/PD with DCE‐US can significantly improve the detection of deep MI and CSI in women with EC, without increasing the false‐positive...

Contrast-Enhanced Ultrasound Imaging of Uterine Disorders: A Systematic Review

“…The principal findings were that enhancement of malignant lesions was in general earlier and with greater intensity than that of normal myometrium and endometrium. 17,18,20,21,25 Compared with surrounding tissue, contrast-enhancement was first observed in 57% to 82% of the tumors, 18,20,25 with most lesions (61%) being hyper-echogenic, 27% was iso-echogenic, and 11% hypo-echogenic. 17 In 77% the feeding vessels of the tumor were enhanced first and then branched into the endometrial cancer.…”

“…Endometrial carcinoma is the most common gynecological malignancy. 18 This is reflected in the higher number of studies evaluating CEUS for this malignancy: one case-control 17 and seven prospective cohort studies, 18,[20][21][22][23][24][25] with histology-proven endometrial carcinoma. These studies did show different enhancement patterns between malignant and healthy tissue.…”

“…The average accuracy of CEUS as diagnostic tool for staging endometrial carcinoma is 81%, with an average sensitivity of 0.78 and specificity of 0.81. 17,18,[20][21][22][23][24][25] The numbers of the individual studies are shown in Table 3. The additional value of combined 2D-and 3D-CEUS imaging (diagnostic accuracy 84%) over 2D-CEUS alone (diagnostic accuracy 75%) was demonstrated in 68 patients with clinically suspected endometrial carcinoma, of which 26 cases were confirmed by histology.…”

Ultrasound‐based risk model for preoperative prediction of lymph‐node metastases in women with endometrial cancer: model‐development study

“…A recent publication shows that the addition of dynamic contrast-enhanced ultrasound improved the detection of deep myometrial invasion and cervical stromal invasion without any increase in the false positive rate 176 and hence has the possibility to improve preoperative risk classification.…”

The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

“…To date, there have been some reports of an association between fetal abdominal wall thickness at midpregnancy ultrasound and prediction of gestational diabetes later in pregnancy; however, such findings need to be interpreted cautiously given the inherent difficulty of ensuring that women diagnosed with diabetes for the first time in pregnancy are truly those with gestational diabetes and not cases of undiagnosed type 2 diabetes which might otherwise explain the increased thickness of subcutaneous fetal fat [ 23 ]. In other preliminary work from our group, there does appear to be a difference in the abdominal wall thickness of fetuses exposed to pregestational type 2 diabetes: fetuses exposed to diabetes in utero have significantly thicker subcutaneous abdominal wall fat than those born to healthy controls [ 24 ]. The goal of this study was to evaluate the utility of fetal abdominal wall thickness (AWT) in the third trimester for predicting intrapartum complications amongst mothers with known pregestational type 2 diabetes.…”