The authors have stated explicitly that they have no conflicts of interest in connection with this article.
Main Research Article
Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy
Article first published online: 19 MAR 2013
© 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology
Acta Obstetricia et Gynecologica Scandinavica
Volume 92, Issue 5, pages 536–545, May 2013
How to Cite
Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy. Acta Obstet Gynecol Scand 2013; 92: 536–545., , , , , , , .
- Issue published online: 17 APR 2013
- Article first published online: 19 MAR 2013
- Accepted manuscript online: 9 FEB 2013 04:15AM EST
- Manuscript Accepted: 21 DEC 2012
- Manuscript Received: 17 SEP 2012
- Danish Cancer Society
- Haderslevs Fond
- Forsknings Initiative Århus Universitet
- FIGO Fonden
- Sanitorielæge Ellen Pedersens Fond
- Den Classenske Fideicommis Kirurgiske Fond
- Endometrial biopsy;
- endometrial cancer;
- magnetic resonance imaging;
- myometrial invasion;
- preoperative staging;
- tumor grade TVS
To evaluate the accuracy of different preoperative modalities for staging of endometrial cancer to restrict extensive surgery to patients at high risk of metastatic disease.
Aarhus University Hospital.
156 women referred in 2006–2011 because of atypical endometrial hyperplasia (G0) or endometrial cancer.
Patients were offered preoperative transvaginal ultrasonography (TVS), magnetic resonance imaging (MRI), and hysteroscopic-directed biopsies from the uterine tumor and cervix. Final pathology of the removed uterus was the reference standard. Patients were divided into low risk (<50% myometrial invasion, and grades 0, 1, 2, and no cervical invasion) or high risk (all others).
Main outcome measures
Accuracy, sensitivity, specificity, positive/negative predictive value.
Patients were aged 32–88 years, with a mean body mass index of 29. At final pathology 81% had cancer and 19% G0 or no residual tumor; 54% were high risk. Hysteroscopy-directed biopsies had a higher accuracy (92%) than endometrial biopsy (58%) for differentiating G0 from cancer (p < 0.001); grade 3 tumor identification had similar accuracy (93 vs. 92%). Deep myometrial invasion was estimated with higher accuracy by MRI (82%) than TVS (74%) (p < 0.02). For cervical involvement, hysteroscopy-directed biopsies had higher accuracy (94%) than MRI (84%,) and TVS (80%) (p < 0.02). Accuracy for identifying high-risk women was highest (83%) using a combination of MRI and hysteroscopic-directed biopsies, compared with TVS and endometrial biopsy (72%) (p < 0.05).
Preoperative staging with MRI and hysteroscopy-directed biopsy can identify eight of 10 women with high risk of lymph node metastases and spare eight of 10 low-risk women extended surgery.