Preoperative ultrasound preparation in endometrial cancer

Abstract

Purpose: The aim of this study was to determine the efficiency of transvaginal sonographic (TVS) in the assessment of myometrial invasion and cervical involvement (preoperative staging) of endometrial cancer as well as to evaluate the influence of myometrial invasion and cancer grading on uterine blood flow characteristics in endometrial cancer. Methods: Transvaginal 2D, color Doppler and pulsed Doppler ultrasound were performed on 97 women to classify endometrial cancer with respect to myometrial invasion and cervical involvement. According to the FIGO recommendation for surgical staging of endometrial cancer 11 stage IA, 33 stage IB, 37 stage IC, 7 stage II, 8 stage III, and 1 stage IV were identified. Endometrial cancer was diagnosed on the basis of dilatation and curettage. The degree of invasion and the uterine blood flow characteristics were evaluated preoperatively. Ultrasonographic findings were compared to the surgical staging and histopathology of the surgical specimen. Results: Myometrial invasion (more or less than 50%) evaluated by TVS was accurate in 87 of 97 cases (accuracy 90%, sensitivity 87%, specificity 93%, positive predictive value 92%, negative predictive value 85%). Tumor extension to the cervix was properly assessed in 9 of 14 women in which it was present (sensitivity 64%, specificity 97%, positive predictive value 82%, negative predictive value 94%). In 90 of the 97 patients with endometrial cancer, abnormal blood flow with low impedance levels (RI, 0.39 ± 0.08; PI, 0.51 ± 0.15) was found within the endometrial echo or very close to it. Uterine blood flow was not modified by the cancer grading. Moreover, there was no difference in impedance indices of the uterine arteries between myometrial invasion of <50 and >50%. Conclusion: These results suggest that 2D TVS evaluation of endometrial cancer is a reliable method for assessing myometrial invasion and cervical involvement. Uterine blood flow analysis could not predict the tumor staging and grading, however, it did provide additional discriminatory information on tumor vascularization which can be used with morphology for more accurate diagnosis. Preoperative ultrasound examination should be seen as an important tool in the establishment of individualized treatment programs for women with endometrial cancer.