title: Transvaginal/transrectal ultrasound for assessing myometrial invasion in endometrial cancer: a comparison of six different approaches.
abstract: OBJECTIVE
  To compare the diagnostic performance of six different approaches for assessing myometrial infiltration using ultrasound in women with carcinoma of the corpus uteri.
  
  
  METHODS
  Myometrial infiltration was assessed by two-dimensional (2D) transvaginal or transrectal ultrasound in 169 consecutive women with well (G1) or moderately (G2) differentiated endometrioid type endometrial carcinoma. In 74 of these women three-dimensional (3D) ultrasound was also performed. Six different techniques for myometrial infiltration assessment were evaluated. The impression of examiner and Karlsson's criteria were assessed prospectively. Endometrial thickness, tumor/uterine 3D volume ratio, tumor distance to myometrial serosa (TDS), and van Holsbeke's subjective model were assessed retrospectively. All subjects underwent surgical staging within 1 week after ultrasound evaluation. Definitive histopathological data regarding myometrial infiltration was used as gold standard. Sensitivity and specificity for all approaches were calculated and compared using McNemar test.
  
  
  RESULTS
  The impression of examiner and subjective model performed similarly (sensitivity 79.5% and 80.5%, respectively; specificity 89.6% and 90.3%, respectively). Both methods had significantly better sensitivity than Karlsson's criteria (sensitivity 31.8%, p<0.05) and endometrial thickness (sensitivity 47.7%, p<0.05), and better specificity than tumor/uterine volume ratio (specificity 28.3%, p<0.05) and TDS (specificity 41.5%, p<0.05).
  
  
  CONCLUSIONS
  Subjective impression seems to be the best approach for assessing myometrial infiltration in G1 or G2 endometrioid type endometrial cancer by transvaginal or transrectal ultrasound. The use of mathematical models and other objective 2D and 3D measurement techniques do not improve diagnostic performance.
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain. jlalcazar@unav.es.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcazar
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Pineda
authors.affiliation: Department of Obstetrics and Gynecology, Hospital de Cruces, Bilbao, Spain.
authors.forename: Txanton
authors.initials: T
authors.lastname: Martinez-Astorquiza Corral
authors.affiliation: Department of Obstetrics and Gynecology, Hospital de la Arrixaca, Murcia, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Orozco
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Utrilla-Layna
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain.
authors.forename: Leire
authors.initials: L
authors.lastname: Juez
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain.
authors.forename: Matías
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; D016889:Endometrial Neoplasms / Q000473:pathology / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D008962:Models, Theoretical; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D047368:Tumor Burden; D014463:Ultrasonography
keywords: Endometrial Neoplasms; Myometrium; Neoplasm Invasion; Ultrasonography