Abstract
<h3>Introduction/Background*</h3> In patients with early-stage, grade 1-2, endometrioid endometrial cancer, preoperative assessment of myometrial invasion is essential to define the need of pelvic and paraaortic lymph node dissection. Our aim was to evaluate the role of three-dimensional transvaginal ultrasound (3D-TVUS) and diffusion-weighted magnetic resonance imaging (DW-RMI) for the assessment of myometrial infiltration in patients with well-differentiated (G1) or moderately differentiated (G2) endometrioid endometrial carcinoma (EC). <h3>Methodology</h3> We performed a retrospective observational study. Myometrial infiltration was assessed by 3D-TVUS and DW-MRI in 152 women with G1 or G2 endometroid EC who underwent surgical treatment in a tertiary referral center between 2012 and 2019. Sensitivity, specificity, predictive values and accuracy for the two techniques and for a combination of both were computed. Definitive histopathological data in the surgical specimen regarding myometrial infiltration was used as ‘Gold Standard’. <h3>Result(s)*</h3> One hundred and fifty-two patients were included, 120 (79%) patients presented myometrial infiltration <50% in postoperative analysis of surgical specimen and 32 (21%) patients presented deep myometrial infiltration (>50%). 3D-TVUS and DW-MRI showed an agreement of 78.9% with a kappa index of 0.44 for the detection of deep myometrial infiltration. Sensitivity, specificity and accuracy of 3D-TVUS for the detection of deep myometrial infiltration were 71.0%, 80.5% and 78.5% respectively. Evaluation of myometrial infiltration with DW-MRI had a sensitivity, specificity and accuracy of 76.2%, 84.4% and 82.9% respectively. Association of both techniques increased sensitivity and specificity up to 84.6% and 93.2% and provided a low false negative rate (2.3%). <h3>Conclusion*</h3> The combination of 3D-TVUS and DW-RMI offers a high sensitivity and specificity to identify deep myometrial infiltration in patients with endometrioid G1 or G2 EC, thus these patients might benefit from performance of both techniques in preoperative evaluation.
Highlights
Introduction/Background* Ovarian cancer is the leading cause of mortality from gynaecological malignancy
Receiver operator characteristic (ROC) curves with area under the curve (AUC), sensitivity and specificity were calculated for cancer antigen 125 (CA125) and Human Epididymis 4 (HE4) both alone and in combination
At a threshold of 77pmol/L, HE4 alone had a better sensitivity than CA125 [89% (95%CI 81.2-94.4) vs 81%] but a worse specificity [75.6% (95%CI 73-78) vs 92.2% (95%CI 90.4-93.6)]
Summary
Introduction/Background* Ovarian cancer is the leading cause of mortality from gynaecological malignancy. Survival improves with early diagnosis, early detection in primary care is challenging. The current blood test, cancer antigen 125 (CA125), has limited sensitivity and specificity for early disease. We aimed to investigate the diagnostic accuracy and clinical utility of serum HE4 in a symptomatic primary care population. Methodology We conducted a prospective observational study testing HE4 on primary care serum CA125 samples from women with suspected ovarian cancer in Manchester, UK, between April 2018 and April 2019. Serum HE4 was measured using chemiluminescent enzyme immunoassays following routine CA125 testing for clinical care. Age adjusted HE4 thresholds were calculated with linear regression models. Conclusion* HE4 adds little to current diagnostic pathways in primary care. Age-adjusted thresholds may improve accuracy, but not sufficiently to recommend routine use at present
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