Preoperative ultrasound assessment of myometrial invasion in endometrial cancer and prediction of surgical stage

AbstractThe aim of the study was to determine the performance of two-dimensional transvaginal ultrasonography (TVUS) in the preoperative assessment of myometrial invasion and cervical stromal invasion (CSI) in women diagnosed with endometrial cancer. Two-dimensional transvaginal ultrasound was performed prior to the diagnostic procedure and before surgical treatment. Myometrial invasion was assessed by measuring the ratio between the endometrial thickness and the antero-posterior diameter of the uterus in the midsagittal plane, by measuring of the smallest tumor-free margin of myometrium and was modified by the subjective assessment of the investigator. Cervical stromal invasion of the tumor was assessed by measuring the distance between the lowest detectable point of the tumor and the internal cervical os. Patients were operated by open surgery, laparoscopic or robot-assisted methods. No statistical difference was found between the number of preoperatively assessed patients (n = 161/180, 89.4%) and those with confirmed diagnosis after surgery (n = 144/180, 80%), (p > 0.05). Before surgery, 55.9% (n = 90/161) of cases were assessed with invasion 50% before surgery were 44.1% (n = 71/161). Surgery confirmed 43.8% (n = 63/144) of cases. No myometrial invasion was found preoperatively in 19 cases, using TVUS as a diagnostic tool. After surgery, in 36 cases no myometrial invasion was found. We found more cases with Grade 1 tumor (n = 29/81, 35.8%) when myometrial invasion was less than 50% compared to predominance of Grade 2 (n = 45/63, 71.4%) and Grade 3 (n = 15/63, 23.8%) tumor when invasion was more than 50% (p < 0.01)