title: Combined use of preoperative transvaginal ultrasonography and intraoperative gross examination in the assessment of myometrial invasion in endometrial carcinoma.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of gross examination and transvaginal ultrasonography in the assessment of the depth of myometrial infiltration when they are used alone or together as a combined test.
  
  
  METHODS
  The data of 219 consecutive patients with a diagnosis of endometrial cancer were evaluated retrospectively. Transvaginal ultrasound was carried out as a part of the routine preoperative work-up within three days of surgical intervention in all cases. All patients underwent hysterectomy with bilateral salpingo-oophorectomy and routine surgical staging and all uterine specimens were examined immediately after hysterectomy. The depth of myometrial invasion was classified into two groups: no or <50% invasion and ≥50% invasion. The findings of ultrasound and intraoperative gross examination were compared with the final histopathological results. The data of these two methods were integrated to evaluate the diagnostic performance of the combined test. If the results of myometrial invasion evaluation were different for the same patient, the deeper one (the depth of invasion ≥50%) was accepted.
  
  
  RESULTS
  Sensitivity, specificity, PPV, NPV and accuracy of preoperative ultrasonography in predicting myometrial infiltration ≥50% were 62%, 81%, 60%, 82%, and 75% respectively. The corresponding rates for intraoperative gross examination were 61%, 88%, 70%, 83% and 79%, respectively. For the combined test they were 78%, 76%, 60%, 88% and 70% respectively. There was no statistically significant difference in sensitivity and specificity between ultrasound and gross examination. The sensitivity of the combined test was significantly higher than that of ultrasound and gross examination (p=0.001 and p<0.0001, respectively). The specificity of the combined test was significantly lower than that of TVS and gross examination (p=0.008 and p<0.0001, respectively).
  
  
  CONCLUSIONS
  Combining ultrasonography and intraoperative gross examination may be a good option to assess the depth of myometrial invasion, as it has a higher sensitivity and negative predictive value in comparison to using these methods alone.
authors: Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
authors: Ozgur
authors: O
authors: Akbayir
authors: Aytul
authors: A
authors: Corbacioglu
authors: Ceyhun
authors: C
authors: Numanoglu
authors: B Pinar Cilesiz
authors: BP
authors: Goksedef
authors: Hakan
authors: H
authors: Guraslan
authors: Gokce
authors: G
authors: Akagunduz
authors: Fatmagul
authors: F
authors: Sencan
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity