Transvaginal Ultrasound Versus Magnetic Resonance Imaging for Assessing Myometrial Infiltration in Endometrioid Low Grade Endometrial Cancer

Abstract

Objective-To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for assessing myometrial infiltration (MI) in patients with low grade endometrioid endometrial cancer.Methods-Observational prospective study performed at a single tertiary care center from 2016 to 2020, comprising 156 consecutive patients diagnosed by endometrial sampling as having an endometrioid grade 1/grade 2 endometrial cancer. TVS and MRI were performed prior to surgical staging for assessing MI, which was estimated using subjective examiner's impression and Karlsson's method for both TVS and MRI. During surgery, intraoperative assessment of MI was also performed. Definitive pathological study considered as reference standard. Diagnostic accuracy for ultrasound, MRI, and intraoperative biopsy was estimated and compared.Results-Sensitivity and specificity of TVS for detecting deep MI were 75 and 73.5% for subjective impression and 65 and 70% for Karlsson method, respectively (P = .54). Sensitivity and specificity of MRI for detecting deep MI were 80 and 87% for subjective impression and 70 and 71.3% for Karlsson method. MRI subjective impression showed a significant better specificity than MRI Karlsson method (P = .03). MRI showed better specificity than TVS when subjective impression was considered (P <.05), but not for Karlsson method. Sensitivity and specificity of intraoperative were 75 and 97%, respectively. Intraoperative biopsy showed better specificity than ultrasound and MRI either using examiner's impression or Karlsson method (P <.05).Conclusions-MRI revealed a significant higher specificity than TVS when assessing deep myometrial infiltration. However, the intraoperative biopsy offers a significant better diagnostic accuracy than preoperative imaging techniques.

Efficacy of transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial invasion in patients with endometrioid endometrial cancer: a prospective comparative study

“…1,5 Recent studies reported for Karlsson's method sensitivity from 56.3% to 86.8%, specificity from 64.4% to 76.4%, PPV from 62.8% to 83.6%, NPV from 70% to 71.2% and overall accuracy 68.1%. 5,6,19,21 Besides, current study did not find statistical differences between Gordon's and Karlsson's method. Although both TVUS objective calcula-tions, Gordon's and Karlsson's method, had similar accuracy, the approach published by Gordon et al have better sensitivity and accuracy in preoperative assessment of MI in EC.…”

“…In analysed studies diagnostic performance for MRI reached sensitivity from 70% to 92.6%, specificity from 71% to 95%, PPV from 65% to 92.2%, NPV from 70% to 98%, and overall accuracy from 74% to 89%. [7][8][9][10][12][13][14][15][20][21][22] We have shown that two imaging modalities (contrast-enhanced MRI and TVUS) perform equally well in the assessment of MI, differences in the performance were not statistically significant.…”

“…Recent studies reported for Karlsson’s method sensitivity from 56.3% to 86.8%, specificity from 64.4% to 76.4%, PPV from 62.8% to 83.6%, NPV from 70% to 71.2% and overall accuracy 68.1%. 5 , 6 , 19 , 21 …”

“…In analysed studies diagnostic performance for MRI reached sensitivity from 70% to 92.6%, specificity from 71% to 95%, PPV from 65% to 92.2%, NPV from 70% to 98%, and overall accuracy from 74% to 89%. 7 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 20 , 21 , 22 …”

Transvaginal ultrasound versus magnetic resonance imaging in local staging of endometrial cancer

“…This fact might bias the results and could overestimate the actual diagnostic accuracy of both TVS and MRI in low‐risk cases, where preoperative assessment of myometrial and cervical invasion makes sense from the point of view of the gynecologic oncologist. Some recent studies focusing of low risk histology cases have shown that TVS and MRI have similar diagnostic performance for identifying myometrial infiltration in such cases 6–8 …”