The role of untrasound assessment of adverse prognostic factors for surgical procedure tailoring in endometrial cancer patients

Objectives: Preoperative ultrasound including assessment of local extent of disease in uterus, adnexal involvement and pelvic spread is recommended staging examination in patients with endometrial cancer. It is routinely based on subjective assessment by experienced sonographists. The main aim of the study was to assess if the objective methods based on simple measurements and calculations have diagnostic performance comparable to that of subjective evaluation in detection of deep myometrial invasion. Two traditional objective techniques were tested - (1) deepest invasion / normal myometrium width ratio proposed by Gordon and (2) tumor / uterine anteroposterior diameter ratio introduced by Karlsson. Methods: The prospective diagnostic accuracy study was initiated at Gynecologic Oncology Centre. All consecutive patients with histologically verified endometrial cancer undergoing transvaginal or transrectal sonography using predefined study protocol followed by surgical staging procedure were prospectively enrolled . Local staging of each endometrial tumor was subjectively evaluated by one of experienced sonographists, myometrial invasion was assessed as deep (≥ 50 %) or superficial (˂ 50 %) and cervical stromal involvement as present or absent. Concurrently, the depth of myometrial invasion was..