A comparative study of subjective and objective techniques using two‑dimensional ultrasound in the preoperative assessment of cervical and myometrial invasion in patients with endometrial cancer / Philippine Journal of Obstetrics and Gynecology

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.

Necessity of Radical Hysterectomy for Endometrial Cancer Patients with Cervical Invasion

To determine whether radical hysterectomy is necessary in the treatment of endometrial cancer patients with cervical involvement, we reviewed the medical records of women who underwent primary surgical treatment for endometrial carcinoma and selected patients with pathologically proven cervical invasion. Among 133 patients, 62 patients underwent extrafascial hysterectomy (EH) and 71 radical or modified radical hysterectomy (RH). The decision regarding EH or RH was made at the discretion of the attending surgeon. The sensitivity of pre-operative magnetic resonance imaging for cervical invasion was 44.7% (38/85). In RH patients, 10/71 (14.1%) patients had frankly histologic parametrial involvement (PMI). All were stage III or over. Eight of 10 patients had pelvic/paraaortic node metastasis and two showed extrauterine spread. In 74 patients with stage II cancer, RH was performed in 41 and PMI was not seen. Sixty-six (89.2%) patients had adjuvant radiation therapy and there were 3 patients who had developed recurrent disease in the RH group and none in the EH group (Mean follow-up: 51 months). Although these findings cannot conclusively refute or support the necessity of radical hysterectomy in patients with cervical extension, it is noteworthy that the risk of PMI seems to be minimal in patients with a tumor confined to the uterus without evidence of extrauterine spread.

Analysis of factors to affect on MR assessment of myometrial invasion and cervical involvement in endometrial cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to assess the depth of myometrial invasion and cervical involvement by endometrial cancer using magnetic resonance imaging (MRI). METHODS: Forty three patients with histological diagnosis of endometrial cancer were studied with the results of MRI at 1.5T and subsequently underwent staging operation. The MRI results were compared with pathologic results. Presence of large polypoid tumors, leiomyoma, adenomyosis, distension of uterine cavity by large tumor, atrophy of uteri, utetrine anomalies and tumor protruding into the cervical canal were analyzed. RESULTS: On review, the sensitivity for the detection of myometrial invasion was 93.5%, specificity 58.3%, positive predictive value (PPV) 85.3% and negative predictive value (NPV) 77.8%. For the detection of deep myometrial invasion, sensitivity was 87.5%, specificity 85.7%, PPV 58.3% and NPV 96.8%. For the detection of cervical involvement, sensitivity was 100%, specificity 92.9%, PPV 25%, NPV 100%. Distension of uterine cavity by large tumor (p=0.009) and adenomyosis (p=0.041) were associated with incorrect MRI assessment of myometrial invasion. For cervical involvement, tumor protruding into the cervical canal was associated but did not reach statistical significance (p=0.062). CONCLUSION: MRI scans as reported offered some clinical benefit in preoperative assessment of endometrial cancer, but for assessment of cervical involvement, showed low PPV. When present, distension of uterine cavity by large tumor and adenomyosis may make it difficult to assess myometrial invasion at MR imaging.

Preoperative assessment of cervical invasion in endometrial cancer:comparison of MRI and D&C / 中国癌症杂志

Background and purpose:A pre-surgery diagnosis of cervical invasion in endometrial cancer was usually determined by dilatations and curettage(D&C),so it could help in optimizing surgery,but the reliability of D&C still was controversial.This study was to compare MRI with D&C to estimate their accuracy for the diagnosis of cervical invasion in endometrial carcinoma respectively.Methods:34 endometrial cancer patients had been proved to have cervical invasion in endometrial cancer through examinations of either fractional dilatations and curettages(D&C),magnetic resonance imaging(MRI)before surgery or postoperative histopathologic examination.The results of D&C and MRI were compared with postoperative histopathologic examination,and the sensitivity,specificity were estimated for accuracy of cervical involvement in endometrial cancer.Results:21 of 34 patients were identified as having cervical invasion in endometrial cancer by histopathology after operation.D&C test matches 26.5% of them and MRI test matches 80%.The sensitivity was 35% vs.76.5% and the specificity 7.7% vs.100% for D&C and MRI methods respectively.All of them had significant statistical differences.Conclusions:MRI test is much better than D&C method for preoperative diagnosis of cervical invasion in endometrial carcinoma.

Comparison of MRI's Prediction of Myometrial, Cervical Invasion and Surgical Staging in Endometrial Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was accuracy evaluation of MRI in prediction of myometrial, cervical invasion in endometrial carcinoma by comparing with histopathologic findings and to find causes of inaccurate MRI readings. METHOD: Fifty patients with endometrial carcinoma who were evaluated with MRI imaging prior to surgery were reviewed. And then, we compared MRI findings and histopathologic findings in view of myometrial, cervical invasion. RESULTS: Overall accuracy of MRI in prediction of myometrial invasion was 48%. Sensitivity/specificity/ PPV/NPV in prediction of no myometrial invasion were 100%/42.9%/42.9%/100% respectively, in prediction of superficial myometrial invasion were 20.0%/86.7%/50.0%/61.9% respectively, in prediction of deep myometrial invasion were 33.3%/94.3%/71.4%/76.7%, respectively. Accuracy in prediction of cervical invasion was 84% and sensitivity/specificity/PPV/NPV were 50.0%/88.6%/37.5%/92.9% respectively. Among the probable causes of inaccurate MRI readings, polypoid tumor occupies large portion. CONCLUSION: MRI has some value in pre-operative evaluation of patients with endometrial carcinoma. We should cautiously accept the MRI readings when tumor shows polypoid growth.