title: Assessing myometrial infiltration by endometrial cancer: uterine virtual navigation with three-dimensional US.
abstract: OBJECTIVE
  To describe and analyze the diagnostic performance of uterine virtual navigation with three-dimensional (3D) ultrasonography (US) for the assessment of the depth of myometrial infiltration by endometrial cancer.
  
  
  METHODS
  Institutional review board approval was obtained; patients gave oral informed consent. Women with endometrial cancer were evaluated by using 3D US prior to surgical staging. A 3D volume of the whole uterus was obtained and analyzed by using software. Virtual navigation through three orthogonal planes was performed to identify the shortest myometrial tumor-free distance to serosa (TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the myometrium. Myometrial infiltration was also assessed by subjective impression of an examiner. Histologic findings of myometrial infiltration and TDS measured by a pathologist were used as the reference standard. A receiver operating characteristic curve was plotted to identify the best cutoff for TDS for identifying myometrial infiltration of 50% or more.
  
  
  RESULTS
  Ninety-six women (mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included in the study. At histologic analysis, myometrial invasion was found to be less than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with US was positively correlated with histologically measured TDS (r = 0.649; 95% confidence interval: 0.52, 0.76). The best cutoff for US-measured TDS was 9.0 mm (sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a specificity of 82.3%, a negative predictive value of 96.6%, and a positive predictive value of 67.7%.
  
  
  CONCLUSIONS
  Uterine virtual navigation with 3D US is a reliable method for the assessment of myometrial infiltration in patients with endometrial cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Avenida Pio XII, 36, 31008 Pamplona, Spain. jlalcazar@unav.es
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcázar
authors.forename: Rosendo
authors.initials: R
authors.lastname: Galván
authors.forename: Sonia
authors.initials: S
authors.lastname: Albela
authors.forename: Sergio
authors.initials: S
authors.lastname: Martinez
authors.forename: Jaume
authors.initials: J
authors.lastname: Pahisa
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
authors.forename: Guillermo
authors.initials: G
authors.lastname: López-García
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging* / Q000473:pathology*; D009361:Neoplasm Invasiveness; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D014584:User-Computer Interface