title: Gray-scale and color Doppler ultrasound characteristics of endometrial cancer in relation to stage, grade and tumor size.
abstract: OBJECTIVE
  To describe the gray-scale and vascular characteristics of endometrial cancer in relation to stage, grade and size using two-dimensional (2D)/three-dimensional (3D) transvaginal ultrasound.
  
  
  METHODS
  This was a prospective multicenter study including 144 women with endometrial cancer undergoing transvaginal ultrasound before surgery. The sonographic characteristics assessed were echogenicity, endometrial/myometrial border, fibroids, vascular pattern, color score and tumor/uterus anteroposterior (AP) ratio. Histological assessment of tumor stage, grade, type and growth pattern was performed.
  
  
  RESULTS
  Hyperechoic or isoechoic tumors were more often seen in Stage IA cancer, whereas mixed or hypoechoic tumors were more often found in cancers of Stage IB or greater (P = 0.003). Hyperechogenicity was more common in Grade 1-2 tumors (i.e. well or moderately differentiated) (P = 0.02) and in tumors with a tumor/uterine AP ratio of < 50% (P = 0.002), whereas a non-hyperechoic appearance was more commonly found in Grade 3 tumors (i.e. poorly differentiated) and in tumors with a tumor/uterine AP ratio of ≥ 50%. Multiple global vessels were more often seen in tumors of Stage IB or greater than in Stage IA tumors (P = 0.02), in Grade 3 tumors than in Grade 1 and 2 tumors (P = 0.02) and in tumors with a tumor/uterine AP ratio of ≥ 50% (P < 0.001). A moderate/high color score was significantly more common in tumors of higher stage (P = 0.03) and larger size (P = 0.001).
  
  
  CONCLUSIONS
  The sonographic appearance of endometrial cancer is significantly associated with tumor stage, grade and size. More advanced tumors often have a mixed/hypoechoic echogenicity, a higher color score and multiple globally entering vessels, whereas less advanced tumors are more often hyperechoic and have no or a low color score.
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden. elisabeth.epstein@karolinska.se
authors.forename: E
authors.initials: E
authors.lastname: Epstein
authors.forename: C
authors.initials: C
authors.lastname: Van Holsbeke
authors.forename: F
authors.initials: F
authors.lastname: Mascilini
authors.forename: A
authors.initials: A
authors.lastname: Måsbäck
authors.forename: P
authors.initials: P
authors.lastname: Kannisto
authors.forename: L
authors.initials: L
authors.lastname: Ameye
authors.forename: D
authors.initials: D
authors.lastname: Fischerova
authors.forename: G
authors.initials: G
authors.lastname: Zannoni
authors.forename: V
authors.initials: V
authors.lastname: Vellone
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.forename: A C
authors.initials: AC
authors.lastname: Testa
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology; D018615:Ultrasonography, Doppler, Color