Transvaginal sonography of myometrial invasion in endometrial cancer: a reappraisal

Abstract

Purpose: A number of studies have suggested that transvaginal sonography can be successfully used in estimating the depth of myometrial invasion of endometrial cancers, thus permitting to tailor the surgical treatment to the needs of the patient. We undertook this study with the aim of evaluating, in a large group of patients, the accuracy of a well‐established method for preoperative sonographic staging of endometrial cancer.Patients and methods: A total of 136 patients with endometrial carcinoma consecutively admitted to the Department of Gynecology and Obstetrics from 1991 to 2000 underwent a transvaginal sonography within 7 days before surgery. The maximum thickness of endometrial echoes (d1) and the antero–posterior diameter of the uterus (d2) were recorded. As regards depth of myometrial invasion, staging was performed by means of calculating the ratio between the thickness of endometrial echoes and the antero–posterior diameter of the uterus (d1/d2).Results: Mean age of the study population was 63 years (35–88). Invasion of >50% of the myometrium was histologically found in 60 (44%) women. Transvaginal sonography demonstrated a sensitivity of 57% (34/60) and a specificity of 67% (51/76) for deep invasion, with a PPV of 58% (34/59) and a NPV of 66% (51/77). Overall accuracy was 62% (85/136).Conclusions: Although the technique for sonographic staging of endometrial cancer might be of value in the preoperative assessment of myometrial invasion, its diagnostic performance, when applied to a large group of patients, is not as good as that reported in the original publication.