ABSTRACT
Context@#Endometrial cancer is the third most common malignancy of the female genital tract in the Philippines, following cervical and ovarian cancer. Ultrasound as the first line in imaging has a major role in preoperative treatment and planning.@*Aims@#To compare the diagnostic accuracy of subjective versus objective ultrasound measurement techniques in detecting cervical stromal invasion (CSI) and deep myometrial invasion (MI).@*Materials and Methods@#Fifty‑seven patients were enrolled in this cross‑sectional study. Deep MI and CSI were evaluated both subjectively and objectively by measuring tumor‑free distance (TFD), distance from the outer cervical os to lowest edge of the tumor border (Dist‑OCO), and distance from the internal cervical os to caudal tumor border (Dist‑ICO). Histopathological result used as the gold standard.@*Results@#Subjective assessment for deep (MI) had 79.3% sensitivity, 82.1% specificity, 82.1% positive predictive value (PPV), 82.1% negative predictive value (NPV), and 80.7%. Subjective assessment for CSI had a sensitivity, specificity, PPV, NPV, and overall accuracy of 80%, 90.4%, 44.4%, 97.9%, and 89.5%. Objective measurement (TFD ≤0.8 cm) to detect deep MI had 86.2% sensitivity, 57.1% specificity, 67.4% PPV, 80% NPV, and 71.9% overall accuracy. Adjusting TFD cutoff to 0.65 increased to 71.4% specificity, making it comparable with subjective assessment. Dist‑OCO (≤2.1 cm) yielded 100% sensitivity, 86.3% specificity, 30% PPV, 100% NPV, and 87% overall accuracy. Dist‑ICO was first used in this study, hence no cutoff yet. By using receiver operating characteristics, cutoff was 0.45 cm, which yielded a 60% sensitivity and 92% specificity (area under the curve 0.731, P = 0.09).@*Conclusions@#Subjective assessment of CSI and deep MI performs better than objective measurement techniques. TFD and Dist‑OCO as the objective measurements showed clinically comparable accuracy to subjective assessment by an expert. Dist‑ICO needs to be validated to a larger population to determine its clinical value in predicting CSI.
Subject(s)
Endometrial NeoplasmsABSTRACT
@#An ultrasound examination is undoubtedly one of the most commonly performed procedures in Obstetrics and Gynecology. This technology has been an important development in the diagnosis and management of many common disorders in obstetrics and gynecology. By reviewing its history, we appreciate how much it has revolutionized our clinical practice.
Subject(s)
Pregnancy , Female , Gynecology , TechnologyABSTRACT
Background@#Gestational trophoblastic neoplasia (GTN) is considered one of the most curable malignancies, especially when diagnosis and treatment are commenced early. Identifying predictors for the development of GTN will enable prompt management equating to an excellent prognosis.@*Objectives@#The objectives of this study were to determine the validity of uterine artery Doppler parameters (UADPs) as predictors for postmolar GTN, compare UADP values before and after evacuation, determine cutoff values and relationship with beta‑human chorionic gonadotropin (hCG) levels.@*Materials and methods@#This was a prospective cohort study, which included histopathologically confirmed hydatidiform mole (HM) patients who underwent suction curettage. UADPs (pulsatility index (PI), resistive index, and systolic/diastolic [S/D] ratio) were measured preevacuation, 4 weeks postevacuation, and 6 weeks postevacuation. Patients were followed up to determine whether they will develop postmolar GTN or not.@*Results@#A total of 31 HM patients were admitted during the study period, 84% (26/31) of whom underwent suction curettage. Of these, 92% (24/26) had histopathology of complete HM and were recruited. However, only 17 patients followed up and completed the study. Results showed that there was an increasing trend of the UADP from preevacuation to 6 weeks postevacuation and the trend between those with and without postmolar GTN was statistically significant. There was also an inverse relationship between the UADP and baseline β‑hCG values. UADP showed lower values among patients who developed postmolar GTN compared to those who did not. The cutoff values recommended by the area under curve (AUC) that can be a possible predictor were 4th‑week right PI of 2.14 (AUC = 0.71) and right S/D ratio of 2.60 (AUC = 0.73) and 6th‑week left PI of 2.80 (AUC = 0.70) and right PI of 2.53 (AUC = 0.74).@*Conclusion@#Neoangiogenesis, a hallmark of malignancy, is correlated with invasive disease and will show increased myometrial vascularization with lower uterine artery indices. Doppler ultrasound may be a useful tool for postmolar follow‑up and GTN diagnosis. However, the small sample size in this study is a limitation and a larger multicenter study is recommended.
Subject(s)
Gestational Trophoblastic Disease , Hydatidiform MoleABSTRACT
Background@#Myometrial invasion is one of the most important prognostic factors in the preoperative evaluation of patients with endometrial cancer. Several techniques have been used for the preoperative evaluation such as transvaginal ultrasound (TVS), magnetic resonance imaging (MRI) and computed tomography (CT). Transvaginal ultrasound has been shown to have comparable accuracy with MRI, cost effective and is widely available. @*Main Objective@#To determine the diagnostic accuracy of 2D transvaginal ultrasound in assessing myometrial infiltration by measuring the tumor free distance (TFD) and depth of invasion (DOI) among patients with endometrial cancer admitted for elective gynecologic surgery at Philippine General Hospital Department of Obstetrics and Gynecology.@*Methods@#This prospective validation study involved 49 patients with endometrial cancer admitted for elective surgery at the Department of Obstetrics and Gynecology of the Philippine General Hospital from October 1, 2016 to February 28, 2017. All patients had 2D transvaginal ultrasound at least within 1 week prior to schedule of surgery. The tumor free distance (TFD) and the depth of invasion (DOI) were prospectively measured and compared with the histopathologic result. Diagnostic accuracy in assessing myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound were computed and test of association was done using 2x2 Fischer Exact test at 0.05? while AUC-ROC was plotted. @*Results@#The association between transvaginal ultrasound and final histopathology in assessing the myometrial infiltration was statistically significant (p=0.004). Moreover, the transvaginal ultrasound for assessing myometrial infiltration demonstrated 94.4% sensitivity and 43.8% specificity in detecting >50% infiltration wherein a likelihood would likely to occur by 1.68 times higher than those with <50% based on the final histopathology. Moreover, the accuracy values of TVS reflected in the AUC index were as follows, a TFD cut off value of ?0.82cm showed a higher sensitivity (46.88%) and specificity (100%) in predicting >50% myometrial infiltration while a DOI ratio of 0.50 is the cut off value which initiated a sensitivity (16.7%) and a higher specificity (75%) in predicting >50% infiltration. Finally, TFD (AUC = 0.749) yielded a higher accuracy as compared with DOI (AUC = 0.388) in predicting myometrial infiltration.@*Conclusion@#Assessment of myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound among patients with endometrial cancer demonstrated clinically acceptable accuracy with higher sensitivity in detecting >50% myometrial infiltration. TFD (cut off value of ?0.82cm) has a higher accuracy compared with DOI in predicting >50% myometrial infiltration.