Assessment of myometrial invasion in endometrial cancer using three-dimensional ultrasound and magnetic resonance imaging.
BACKGROUND
Preoperative knowledge of myometrial invasion in endometrial cancer is important for surgical planning. This study aimed to assess the diagnostic efficiency of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasonography (TVS) with and without saline infusion (SIS) and magnetic resonance imaging (MRI) for assessment of myometrial invasion in endometrial cancer.


METHODS
110 women with atypical endometrial hyperplasia or endometrial adenocarcinoma underwent preoperative 2D- and 3D-TVS with and without SIS and MRI. Offline 3D-TVS measurement was performed of the minimal tumor-free margin in relation to myometrial thickness expressed as deep (≥ 50%) myometrial invasion and subjective impression of cervix involvement. The quality of images was also evaluated. Diagnostic efficiencies were calculated for myometrial and cervical involvement for each method. The pathologist's final diagnosis served as the reference standard.


RESULTS
For myometrial involvement, MRI showed greater accuracy than 3D-TVS or 2D-TVS (83, 71 and 75%, respectively). The efficiency of 3D-TVS was not superior to 2D-TVS and did not improve with SIS. The sensitivities of 2D-TVS and 3D-TVS were similar to that of MRI, and the efficiency of 3D-TVS improved when volumes of inadequate quality (39%) were excluded. For evaluating cervical involvement, the accuracy of 3D-TVS was 85%, comparable to the results of 2D-TVS (80%) and MRI (85%). The results did not improve when saline was added.


CONCLUSIONS
3D-TVS or 3D-SIS was not more efficient than 2D-TVS or MRI for assessment of myometrial invasion in endometrial cancer. 3D-TVS assessment without 2D-TVS was impeded by difficulties in obtaining 3D-TVS volumes of sufficient quality.
Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Julie W
http://orcid.org/0000-0003-2680-0121
JW
Christensen
Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Margit
http://orcid.org/0000-0002-2577-7903
M
Dueholm
Department of Histopathology, Aarhus University Hospital, Aarhus, Denmark.
Estrid S
http://orcid.org/0000-0002-7808-908X
ES
Hansen
The MRI Center, Aarhus University Hospital, Aarhus, Denmark.
Edward
http://orcid.org/0000-0003-4279-7188
E
Marinovskij
The MRI Center, Aarhus University Hospital, Aarhus, Denmark.
Erik
http://orcid.org/0000-0003-2938-2172
E
Lundorf
Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Gitte
http://orcid.org/0000-0002-5817-4092
G
Ørtoft
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012965:Sodium Chloride
D012965:Sodium Chloride
Endometrial neoplasms; imaging; magnetic resonance imaging; myometrium; three-dimensional; ultrasonography