scholarly journals The Diagnostic Accuracy of Ultrasound in Assessment of Myometrial Invasion in Endometrial Cancer: Subjective Assessment versus Objective Techniques

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Filip Frühauf ◽  
Michal Zikan ◽  
Ivana Semeradova ◽  
Pavel Dundr ◽  
Kristyna Nemejcova ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Reliable Method ◽  
Myometrial Invasion ◽  
Subjective Assessment ◽  
Diameter Ratio ◽  
Anteroposterior Diameter ◽  
Ultrasound Evaluation ◽  
Better Than

The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 and December 2011, were prospectively enrolled. Myometrial invasion was evaluated by subjective assessment using ultrasound (<50% or ≥50%) and calculated as deepest invasion/normal myometrium ratio (Gordon’s ratio) and as tumor/uterine anteroposterior diameter ratio (Karlsson’s ratio). Histological assessment from hysterectomy was considered the gold standard. Altogether 210 patients were prospectively included. Subjective assessment and two objective ratios were found to be statistically significant predictors of the myometrial invasion (AUC = 0.65, p value < 0.001). Subjective assessment was confirmed as the most reliable method to assess myometrial invasion (79.3% sensitivity, 73.2% specificity, and 75.7% overall accuracy). Deepest invasion/normal myometrium (Gordon’s) ratio (cut-off 0.5) reached 69.6% sensitivity, 65.9% specificity, and 67.3% overall accuracy. Tumor/uterine anteroposterior diameter (Karlsson’s) ratio with the same cut-off reached 56.3% sensitivity, 76.4% specificity, and 68.1% overall accuracy. The subjective ultrasound evaluation of myometrial invasion performed better than objective methods in nearly all measures but showed statistically significantly better outcomes only in case of sensitivity.

EP470 Accuracy of ultrasound evaluation of endometrial cancer for assessing myometrial invasion and cervical stromal involvement

2019 ◽  
Author(s):  
RM Alvarez Lopez ◽  
E Arevalo Reyes ◽  
MD Rodriguez Garnica ◽  
M Martin Blanco ◽  
MV Rodriguez Tabares ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Myometrial Invasion ◽  
Ultrasound Evaluation

Diagnostic Accuracy of Magnetic Resonance Imaging in Endometrial Cancer

2012 ◽  
Vol 22 (6) ◽  
pp. 1020-1025 ◽  
Author(s):  
Mark H. McComiskey ◽  
W. Glenn McCluggage ◽  
Arthur Grey ◽  
Ian Harley ◽  
Stephen Dobbs ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Endometrial Cancer ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Myometrial Invasion ◽  
Preoperative Assessment ◽  
Tumor Board ◽  
Resonance Imaging ◽  
Outer Half

ObjectivesThe objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging.MethodsThis was a diagnostic accuracy study of prospective cases in conjunction with STARD guidelines using collected data from a tumor board within a cancer network. Consecutive series of all endometrial cancers in Northern Ireland over a 21-month period was discussed at the Gynaecological Oncology Multidisciplinary Team/tumor board meeting. This study concerns 183 women who met all the inclusion criteria. Main outcome measure was the correlation between the depth of myometrial invasion suggested by preoperative MRI study and the subsequent histopathological findings following examination of the hysterectomy specimen. Secondary end point was how MRI changed management of women who required surgery to be performed at a central cancer center.ResultsFor the detection of outer-half myometrial invasion, overall sensitivity of MRI was 0.73 (95% confidence interval [CI], 0.59–0.83), and specificity was 0.83 (95% CI, 0.76–0.89). The positive predictive value was 0.63 (95% CI, 0.50–0.74), and negative predictive value was 0.89 (95% CI, 0.82–0.93). Positive likelihood ratio was 4.35 (95% CI, 2.87–6.61), and negative likelihood ratio was 0.33 (95% CI, 0.21–0.52). Magnetic resonance imaging improved the sensitivity and negative predictive value of endometrial biopsy alone in predicting women with endometrial cancer who require full surgical staging (0.73 vs 0.65 and 0.80 vs 0.78, respectively).ConclusionsPreoperative pelvic MRI is a moderately sensitive and specific method of identifying invasion to the outer half of myometrium in endometrial cancer. Addition of MRI to preoperative assessment leads to improved preoperative assessment, triage, and treatment.

scholarly journals Diagnostic Accuracy of Transthoracic Echocardiography and Transesophageal Echocardiography for Ruptured Chordae Tendineae: A Meta-Analysis

2020 ◽  
Author(s):  
Lisi Liao ◽  
Fa-jin DONG ◽  
Jie-ying ZENG ◽  
Bo-bo SHI ◽  
Xiao-fang ZHONG ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Transesophageal Echocardiography ◽  
Transthoracic Echocardiography ◽  
Gold Standard ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Chordae Tendineae ◽  
Prior Probabilities ◽  
Highly Sensitive ◽  
Better Than

Abstract Background Echocardiography is significant for the diagnosis of ruptured chordae tendineae (RCT) for which transesophageal echocardiography (TEE) is always better than transthoracic echocardiography (TTE), but the diagnostic accuracy of TTE still remains confusing. Methods A meta-analysis of included papers was performed to evaluate the diagnostic accuracy of TTE and TEE, with surgical findings of RCT as the gold standard of patients with suspected RCT. Results The literature search yielded 862 papers, 6 met the inclusion criteria, included 505 patients, for detecting RCT, the sensitivity and specificity of TTE were 48% (95% CI: 35–62%) and 98% (95% CI: 89–100%), and those of TEE were 99% (95% CI: 64–100%) and 94% (95% CI: 87–98%), respectively. The summary + LR, -LR of TTE were 22.40 (95%CI: 4.89–102.62), 0.53(95%CI:0. 41–0.68), respectively. The summary + LR, -LR of TEE were 17.62(95%CI: 7.16–43.39), 0.02(95%CI:0. 00-0.57), respectively. For TTE, the area under SROC was 84% (95%CI:92%-96%),and that of TEE is 98%. The pooled + LR and -LR were calculated by setting the prior probabilities of 20% in both TTE and TEE. Conclusions TTE is not highly sensitive for the detection of RCT but is highly specific, so there is a potential of missing diagnosis, and subsequent TEE is almost required in highly suspected patients.

scholarly journals The added value of diffusion-weighted imaging in the preoperative assessment of endometrial cancer

2019 ◽  
Vol 52 (4) ◽  
pp. 229-236
Author(s):  
Rui Tiago Gil ◽  
Teresa Margarida Cunha ◽  
Mariana Horta ◽  
Ines Alves
Keyword(s):  
Endometrial Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diffusion Weighted Imaging ◽  
Myometrial Invasion ◽  
Preoperative Assessment ◽  
Added Value ◽  
P Value ◽  
Dce Mri ◽  
Diffusion Weighted

Abstract Objective: To evaluate the added value of diffusion-weighted imaging (DWI) in the preoperative assessment of myometrial invasion in endometrial cancer, in comparison with T2-weighted imaging (T2WI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and Methods: This was a retrospective study involving 44 women with endometrial cancer who underwent preoperative 1.5 T MRI. Two radiologists, both of whom were blinded to the histopathology reports, performed a consensus interpretation of the depth of myometrial invasion and of the stage of the cancer, considering three sets of sequences: T2WI, DCE-MRI+T2WI, and DWI+T2WI. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each set. The accuracy was compared with p-value adjustment by the Benjamini-Hochberg procedure. Results: Among the 44 patients evaluated, DWI+T2WI demonstrated better diagnostic performance in assessing deep myometrial invasion and correctly staged more patients (n = 41) than did DCE-MRI+T2WI (n = 34) and T2WI (n = 22). The superior diagnostic accuracy of DWI+T2WI was statistically significant in comparison with T2WI (p < 0.05) but not in comparison with DCE-MRI+T2WI (p > 0.05). Conclusion: The addition of DWI apparently improves the diagnostic accuracy of MRI in the preoperative assessment of the depth of myometrial invasion in endometrial cancer, which may be particularly helpful in patients for whom contrast agents are contraindicated.

scholarly journals Staging of Endometrial Cancer Using Fusion T2-Weighted Images with Diffusion-Weighted Images: A Way to Avoid Gadolinium?

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 384
Author(s):  
Teresa Resende Neves ◽  
Mariana Tomé Correia ◽  
Maria Ana Serrado ◽  
Mariana Horta ◽  
António Proença Caetano ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Diagnostic Accuracy ◽  
Myometrial Invasion ◽  
Acquisition Time ◽  
Pelvic Mri ◽  
Diffusion Weighted Images ◽  
Diffusion Weighted ◽  
Experienced Radiologist ◽  
Mri Protocol ◽  
T2 Weighted Images

Endometrial cancer is the eighth most common cancer worldwide, and its prognosis depends on various factors, with myometrial invasion having a major impact on prognosis. Optimizing MRI protocols is essential, and it would be useful to improve the diagnostic accuracy without the need for other sequences. We conducted a retrospective, single-center study, which included a total of 87 patients with surgically confirmed primary endometrial cancer, and who had undergone a pre-operative pelvic MRI. All exams were read by an experienced radiologist dedicated to urogenital radiology, and the depth of myometrial invasion was evaluated using T2-Weighted Images (T2WI) and fused T2WI with Diffusion-Weighted Images (DWI). Both results were compared to histopathological evaluations. When comparing both sets of imaging (T2WI and fused T2WI-DWI images) in diagnosing myometrial invasion, the fused images had better accuracy, and this difference was statistically significant (p < 0.001). T2WI analysis correctly diagnosed 82.1% (70.6–88.7) of cases, compared to 92.1% correctly diagnosed cases with fused images (79.5–97.2). The addition of fused images to a standard MRI protocol improves the diagnostic accuracy of myometrial invasion depth, encouraging its use, since it does not require more acquisition time.

scholarly journals Disease Free Survival of Stage I Endometrial Cancer after Surgery with or without Adjuvant Treatment

2021 ◽  
Vol 55 (1) ◽  
pp. 37
Author(s):  
Woraluk Moradokkasem ◽  
Nungrutai Saeaib ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Treatment ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Stage I ◽  
Rank Test ◽  
Free Survival ◽  
Factors Associated ◽  
Disease Free ◽  
Better Than

This study aimed to define the disease free survival (DFS) and factors associated with recurrence in stage I endometrial cancer after surgery with and without adjuvant treatment. The demographic data, pathological results, adjuvant treatment (AT) and the outcome of patients with endometrial cancer stage I after surgery in Songklanagarind Hospital between January 2002 and July 2014 were collected. The DFS was analyzed by survival analysis and represented by Kaplan–Meier curves. The difference of DFS between AT and non-adjuvant treatment (NAT) groups was tested by the log-rank test. Distributions of risk factors by AT and recurrent status were analyzed using chi-square or Fisher exact tests for discrete factors, and unpaired t or Wilcoxon rank-sum tests for continuous factors. The 5-year DFS was; 91.6%, from a total of 268 patients. DFS in the NAT group was significantly better than that in the AT group (95.2 versus 86.5%, p-value = 0.01). Factors associated with recurrence in the NAT group were age, tumor grading, tumor size, and presence of lymphovascular involvement. Among the AT group, age and ratio of myometrial invasion were associated with recurrence. DFS in NAT was better than in AT and the potential factors associated with recurrence, after surgery with or without AT, were not the same.

scholarly journals Disease Free Survival of Stage I Endometrial Cancer after Surgery with or without Adjuvant Treatment

2019 ◽  
Vol 55 (1) ◽  
pp. 37
Author(s):  
Woraluk Moradokkasem ◽  
Nungrutai Saeaib ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Treatment ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Stage I ◽  
Rank Test ◽  
Free Survival ◽  
Factors Associated ◽  
Disease Free ◽  
Better Than

This study aimed to define the disease free survival (DFS) and factors associated with recurrence in stage I endometrial cancer after surgery with and without adjuvant treatment. The demographic data, pathological results, adjuvant treatment (AT) and the outcome of patients with endometrial cancer stage I after surgery in Songklanagarind Hospital between January 2002 and July 2014 were collected. The DFS was analyzed by survival analysis and represented by Kaplan–Meier curves. The difference of DFS between AT and non-adjuvant treatment (NAT) groups was tested by the log-rank test. Distributions of risk factors by AT and recurrent status were analyzed using chi-square or Fisher exact tests for discrete factors, and unpaired t or Wilcoxon rank-sum tests for continuous factors. The 5-year DFS was; 91.6%, from a total of 268 patients. DFS in the NAT group was significantly better than that in the AT group (95.2 versus 86.5%, p-value = 0.01). Factors associated with recurrence in the NAT group were age, tumor grading, tumor size, and presence of lymphovascular involvement. Among the AT group, age and ratio of myometrial invasion were associated with recurrence. DFS in NAT was better than in AT and the potential factors associated with recurrence, after surgery with or without AT, were not the same.

A randomized phase-III study on adjuvant treatment with radiation (RT) ± chemotherapy (CT) in early-stage high-risk endometrial cancer (NSGO-EC-9501/EORTC 55991)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5503-5503 ◽  
Author(s):  
T. Hogberg ◽  
P. Rosenberg ◽  
G. Kristensen ◽  
C. F. de Oliveira ◽  
R. de Pont Christensen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Phase Iii ◽  
Absolute Difference ◽  
Carboplatin Auc ◽  
Better Than

5503 Background: Adjuvant therapy for early stage high-risk endometrial cancer remains controversial. Methods: Patients with surgical stage I, II, IIIA (positive peritoneal fluid cytology only), or IIIC (positive pelvic lymph nodes only) were eligible if they, according to departmental guidelines, had a sufficiently high risk for micrometastatic disease to qualify for adjuvant therapy. Most patients had two or more of the risk factors: grade 3, deep myometrial invasion, or DNA non-diploidy, while some patients had only one of these. Patients with serous, clear cell, or anaplastic carcinomas were eligible regardless of risk factors. Patients with para-aortic metastases were not eligible. Lymph node exploration at staging surgery was optional. Pelvic RT ± vaginal brachytherapy was given to a dose =44 Gy. CT was given before or after RT. Before August 2004 CT consisted of four courses of cisplatin =50 mg/m2 + doxorubicin 50 mg/m2 or epirubicin 75 mg/m2 (AP). Thereafter several CT regimens were allowed, of which AP, paclitaxel 175 mg/m2 + epirubicin 60 mg/m2 + carboplatin AUC 5, and paclitaxel 175 mg/m2 + carboplatin AUC 5–6 were used. Progression-free survival (PFS) was the primary end-point. The study was terminated before the aimed goal of 400 patients because of slow recruitment. We decided to make an early analysis since new studies on endometrial cancer are presently discussed. Results: 372 patients were entered between May 1996 and Oct 2006. Of 367 evaluable patients 190 were randomized to RT and 177 to RT+CT. Risk factors were well balanced between the randomization arms. The median follow-up time was 3.5 years. The hazard ratio for PFS was 0.58 in favor of RT+CT (95 % confidence interval (CI) 0.34 - 0.99; p=0.046). This translates to an estimated 7 % absolute difference in 5-year PFS from 75 % (95 % CI 67 % - 82 %) to 82 % (95 % CI 73 % - 88 %). Conclusion: RT+CT was better than RT alone. Next question is if RT+CT is better than CT alone. No significant financial relationships to disclose.

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