title: Preoperative transvaginal ultrasonography and intraoperative gross examination for assessing myometrial invasion by endometrial cancer.
abstract: OBJECTIVE
  Endometrial cancer is the most common gynecologic malignancy. The cornerstone of treatment remains surgery according to International Federation of Gynecology and Obstetrics staging. The aim of this study was to evaluate the concordance between myometrial infiltration detected by ultrasonography and gross examination with respect to definitive histologic examination and to select a population in which lymphadenectomy could be excluded. We also evaluated the concordance for the degree of tumor differentiation between diagnostic biopsy and final histologic results.
  
  
  METHODS
  Our study included 75 patients with International Federation of Gynecology and Obstetrics stage I endometrial cancer. We evaluated preoperative and definitive grading and myometrial infiltration detected by ultrasonography and gross examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the procedures under study were determined with the Bayes theorem. To determine the predictive value of preoperative transvaginal ultrasonography and intraoperative gross examination for myometrial invasion, we used a multiple logistic regression model with a statistical software package.
  
  
  RESULTS
  Our study showed 60% concordance between biopsy and histologic results. In 80% of the cases with discordant results, the tumor was undergraded. Ultrasonography had diagnostic accuracy of 73%, whereas gross examination correctly determined myometrial invasion in 82.6% of the patients, with sensitivity of 62% and specificity of 79%.
  
  
  CONCLUSIONS
  Preoperative transvaginal ultrasonography and macroscopic gross examination appear to be simple, fast, and reliable methods to predict in myometrial invasion in patients with a low risk for lymph node metastasis, for which lymphadenectomy can reasonably be avoided.
authors.affiliation: Department of Obstetrics and Gynecology, University of Parma, Via A. Gramsci 14, 43100 Parma, Italy. rberretz@tin.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Berretta
authors.forename: Carla
authors.initials: C
authors.lastname: Merisio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Piantelli
authors.forename: Martino
authors.initials: M
authors.lastname: Rolla
authors.forename: Giovanna
authors.initials: G
authors.lastname: Giordano
authors.forename: Mauro
authors.initials: M
authors.lastname: Melpignano
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D001706:Biopsy; D018269:Carcinoma, Endometrioid / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014621:Vagina