title: The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital.
abstract: OBJECTIVE
  To predict the myometrial invasion with three-dimensional (3D) ultrasonography in a cohort of patients with endometrial carcinoma by a previously described technique.
  
  
  METHODS
  The moyometrial infiltration was evaluated by 3D ultrasonography before surgery in 54 patients with endometrial carcinoma. After scanning the whole uterus by ultrasonography, three perpendicular planes were identified to find the shortest myometrial tumor-free distance to serosa (TDS) by examining the lateral, anterior, posterior, and fundal parts of the myometrium. Myometrial infiltration was also estimated by the subjective impression of the examiner. The reference standards consist of myometrial infiltration and TDS which are measured by an experienced pathologist.
  
  
  RESULTS
  Forty-five patients (age range 45-86 years) were included for the final analysis. Myometrial invasion was ˂50% in 36 and ≥50% in 9 cases at histologic sections. The TDS which is measured with 3D ultrasonography was positively correlated with histologically measured TDS (r=0.474, p=0.001). The best cut-off value for ultrasonographically measured TDS was 9 mm with a sensitivity of 89%, specificity of 61%, positive predictive value of 36%, and negative predictive value of 96%. Subjective impression has a sensitivity of 100%, specificity of 88%, positive predictive value of 69%, and negative predictive value of 100%. Cervical involvement was correctly identified in all 6 cases by subjective impression.
  
  
  CONCLUSIONS
  This validation study confirms the 3D ultrasonography as a valuable tool for the evaluation of myometrial infiltration in patients with endometrial carcinoma.
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Ergenoglu
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey. leventakman@gmail.com.
authors.forename: Levent
authors.initials: L
authors.lastname: Akman
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey.
authors.forename: Mustafa Cosan
authors.initials: MC
authors.lastname: Terek
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey.
authors.forename: Cem Yasar
authors.initials: CY
authors.lastname: Sanhal
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yeniel
authors.affiliation: Dokuz Eylul University, Faculty of Sciences, Department of Statistics, Izmir, Turkey.
authors.forename: Ozgul Vupa
authors.initials: OV
authors.lastname: Cilengiroglu
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey.
authors.forename: Ahmet Aydin
authors.initials: AA
authors.lastname: Ozsaran
authors.affiliation: Ege University Medical School, Department of Obstetrics and Gynecology, Izmir, Turkey.
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Dikmen
authors.affiliation: Ege University Medical School, Department of Pathology, Izmir, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Zekioglu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging* / Q000473:pathology*; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*