Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study

Epstein, Elisabeth; Fischerová, D.; Valentin, Lil; Testa, Antonia Carla; Franchi, D.; Sladkevicius, P.; Frühauf, F.; Lindqvist, Pelle G.; Mascilini, F.; Fruscio, Robert; Haak, L.A.; Opolskiene, G.; Pascual, M.; Alcázar, Juan Luis; Chiappa, Valentina; Guerriero, S.; Carlson, Joseph W.; Holsbeke, C. Van; Leone, Francesco; Moor, Bart De; Bourne, Tom; Calster, Ben Van; Installé, A.; Timmerman, Dirk; Verbakel, Jan Y; Bosch, T. Van den

doi:10.1002/uog.18909

Cited by 76 publications

(86 citation statements)

References 33 publications

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“…A total of 1714 patients were recruited in the IETA-4 cohort 12 , of whom 176 were excluded because: no hysterectomy was performed or hysterectomy was performed at another hospital or more than 120 days after the ultrasound examination (n = 118); the final diagnosis was other than endometrial cancer or carcinosarcoma (n = 25); assessment was not complete because the examiner did not fill out correctly the study protocol (n = 26); there were duplicate entries (n = 5); or there was an error in the identification key and the patient could not be identified (n = 2). Therefore, 1538 patients remained for analysis.…”

Section: Resultsmentioning

confidence: 99%

“…This was a prospective multicenter study of consecutive patients with endometrial cancer confirmed by biopsy who were examined using transvaginal ultrasound according to the International Endometrial Tumor Analysis (IETA)-4 study protocol 12 . Patients were recruited between 1 st January 2011 and 31 st December 2015 from 17 European ultrasound centers involving 26 ultrasound examiners.…”

Section: Methodsmentioning

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: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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“…On the other hand, a recent prospective multicenter study based on sonographic assessment emphasized that tumor size regarding endometrial thickness and volume was the single strongest ultrasound predictor of high risk disease. 26 Besides 3D ultrasound tumor volume studies, MR volumetry has also gained popularity in recent years; however, a comparative study regarding volume measurements is not present in the relevant literature according to our knowledge. In studies addressing the endometrial tumor volume based on MR imaging, different measurement methods have been used.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Magnetic Resonance Volumetry in Predicting Myometrial Invasion, Lymphovascular Space Invasion, and Tumor Grade: Is It Valuable in International Federation of Gynecology and Obstetrics Stage I Endometrial Cancer?

Şahin

Sarıoğlu

Bağci

et al. 2018

Int J Gynecol Cancer

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“…Women included in the prospective IETA multicenter study14 with endometrial cancer, undergoing pre-operative ultrasound staging, from the nine centers with 50 or more inclusions were invited to participate in the present study. The eight centers that agreed to participate were: Center A, Stockholm (Sweden); Center B, Rome (Italy); Center C, Prague 1 (Czech Republic); Center D, Milan 1 (Italy); Center E, Vilnius (Lithuania); Center F, Prague 2 (Czech Republic); Center G, Milan 2 (Italy); Center H, Barcelona (Spain).…”

Section: Methodsmentioning

confidence: 99%

Clinical and ultrasound characteristics of the microcystic elongated and fragmented (MELF) pattern in endometrial cancer according to the International Endometrial Tumor Analysis (IETA) criteria

Eriksson

Nastic

Frühauf

et al. 2019

Int J Gynecol Cancer

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ObjectivesTo describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer.Methods/materialsWe included 850 women with endometrioid endometrial cancer from the prospective IETA study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases.ResultsThe MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with MI ≥ 50% (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011).ConclusionsTumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.

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Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study

Abstract: Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high- and low-risk endometrial cancer. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Cited by 76 publications

References 33 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

Preoperative Magnetic Resonance Volumetry in Predicting Myometrial Invasion, Lymphovascular Space Invasion, and Tumor Grade: Is It Valuable in International Federation of Gynecology and Obstetrics Stage I Endometrial Cancer?

Clinical and ultrasound characteristics of the microcystic elongated and fragmented (MELF) pattern in endometrial cancer according to the International Endometrial Tumor Analysis (IETA) criteria

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