title: Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low-risk endometrioid carcinoma.
abstract: OBJECTIVE
  To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low-risk endometrial cancer, and to estimate the agreement between the two methods.
  
  
  METHODS
  This was a single-center observational study comprising women with preoperative diagnosis of well- or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative TVS by a single examiner. According to the examiner's subjective impression, myometrial infiltration was stated as ≥ 50% or < 50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was performed by pathologists who were unaware of the ultrasound findings, and myometrial infiltration was stated as ≥ 50% or < 50%. Definitive histological diagnosis of myometrial infiltration was made by frozen section analysis and was used as the gold standard. Sensitivity and specificity with 95% CIs were calculated for TVS and intraoperative macroscopic inspection and compared using McNemar's test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's kappa index (κ) and percentage of agreement.
  
  
  RESULTS
  Of 209 eligible women, 152 were ultimately included. Mean (± SD) age was 60.9 ± 10.2 years, with a range of 32-91 years. Definitive histological diagnosis revealed that myometrial infiltration was < 50% in 114 women and ≥ 50% in 38 women. Sensitivity and specificity of TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively, whereas the respective values for intraoperative macroscopic examination were 78.9% and 90.4% (McNemar's test, P > 0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between methods was moderate with κ = 0.54 (95% CI, 0.39-0.69) and percentage of agreement of 82%.
  
  
  CONCLUSIONS
  Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration was only moderate, both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might reasonably be proposed as a method for assessing myometrial infiltration as an alternative to intraoperative macroscopic examination, especially when performed by an experienced examiner and image quality is not poor. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Pineda
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Alcázar
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Caparrós
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Mínguez
authors.affiliation: Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Idoate
authors.affiliation: Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Quiceno
authors.affiliation: Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Solórzano
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Jurado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D019160:Endosonography / Q000379:methods; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: endometrial carcinoma; myometrium; pathology; ultrasound