[The role of transvaginal ultrasound and sonohysterography in the diagnosis and staging of endometrial adenocarcinoma].
OBJECTIVE
The aim of this study is to evaluate the accuracy of sonohysterography in early diagnosis of endometrial tumor lesions and in the detection of myometrial infiltration for staging.


METHODS
We performed sonohysterography as a preoperative test in 24 patients with an hystologic diagnosis of endometrial adenocarcinoma obtained by hysteroscopy and biopsy. The mean age of the patient was between 50 and 82 years. The sonohysterographic examination was performed by using 5.0 and 6.0 MHz transvaginal probes and a 5 or 7 French hysteroinjectors with inflating balloon. 19 of the 24 patients were enrolled in the study: in 2 cases the examination was not technically performable, 2 patients refused surgical treatment and 1 patient had a cervical adenocarcinoma with extension to the myometrium. In each patient we evaluated the number and the size of the lesions and the degree and the depth of myometrial infiltration. Each parameter was compared with the final histopathologic examination.


RESULTS
Sonohysterography showed a single lesion in 15 patients, whereas in 4 patients it showed multiple lesions; in 1 of these patients it showed 3 lesions which were, in reality, a single lesion that infiltrated the first half of the myometrium. Myometrial infiltration was correctly evaluated by the examination in 17 of the 19 women (89.4%): 16 positive and 1 negative case. The sensitivity was 88%, the specificity 100%, the positive predictive value 100% and the negative predictive value 33%. The sonohysterography allowed to evaluate exactly the depth of myometrial invasion in 15 of the 16 cases (93.7%), in which a myometrial infiltration was suspected. With regard to this parameter the sensitivity was 85.7%, the specificity was 100%, the positive predictive value 100% and the negative predictive value 90.9%.


CONCLUSIONS
Although the introduction of transvaginal ultrasonography in clinical practice allows to obtain an early diagnosis of endometrial adenocarcinoma, about half patients seems to present already at the diagnosis myometrial invasion. Moreover 50% of these patients seems to have pelvic lymphonodes and about 29% positive paraaortic lymphonodes. Currently myometrial invasion is evaluated by the extemporary frozen test and confirmed by the definitive hystologic examination. It would be helpful to have a technique able to detect and evaluate infiltration before surgery. The results of this study suggest that sonohysterography could have a role in preoperative staging. However these data need to be confirmed by further studies.
Valenzano
M
M
Dipartimento di Ginecologia e Ostetricia, Università degli Studi, Ospedale S. Martino, Padiglione 1, Genova, Italy.
Podestà
M
M
Giannesi
A
A
Corticelli
A
A
Nicoletti
L
L
Costantini
S
S
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014621:Vagina