A comparative study of pre-operative procedures to assess cervical invasion by endometrial carcinoma.
OBJECTIVE
To compare the accuracy of different diagnostic procedures currently used to assess cervical involvement in endometrial carcinoma.


METHODS
Retrospective observational study.


METHODS
Department of Obstetrics and Gynecology, Shinshu University Hospital, Matsumoto, Japan.


METHODS
Sixty-four patients with endometrial carcinoma were evaluated pre-operatively for cervical involvement by six different diagnostic procedures: cervical cytology, endocervical curettage, transvaginal ultrasonography, hysteroscopy, magnetic resonance imaging, and serum levels of CA125. The number of positive and negative diagnoses of cervical invasion by each of these procedures were correlated with the actual invasion determined by histological examination.


RESULTS
Cervical invasion was confirmed in 12 (18.8%). Endocervical curettage showed high sensitivity (91%), the highest negative predictive value (96%), and the lowest negative likelihood ratio (0.14). Hysteroscopy showed high positive likelihood ratio (8.2) and low negative likelihood ratio (0.20). Magnetic resonance imaging showed the highest positive predictive value (75%) and the highest positive likelihood ratio (12.5). Magnetic resonance imaging was excellent for predicting stromal invasion, whereas hysteroscopy was superior for assessing mucosal involvement to magnetic resonance imaging.


CONCLUSIONS
Endocervical curettage is a good test for excluding cervical involvement by endometrial carcinoma. Hysteroscopy is a good test in making both positive and negative diagnoses for cervical involvement. Magnetic resonance imaging is an excellent test for detecting cervical involvement, especially when the stroma is invaded.
Toki
T
T
Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.
Oka
K
K
Nakayama
K
K
Oguchi
O
O
Fujii
S
S
D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D018394:CA-125 Antigen