Sawicki W, Spiewankiewicz B, Stelmachów J, Cendrowski K
Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Medical University of Warsaw, Poland.
Eur J Gynaecol Oncol. 2003;24(3-4):293-8.
To determine the efficiency of transabdominal and transvaginal ultrasonography (TAS and TVS) in the assessment of myometrial invasion, cervical involvement, pelvic lymph nodes, adnexal and omental metastases (preoperative staging) of endometrial cancer.
Transabdominal and transvaginal 2D, ultrasound were performed on 90 women to classify myometrial invasion, cervical involvement, pelvic lymph nodes and adnexal metastases in endometrial cancer. According to this 13 type E (invasion involving the endometrium), 41 type S (superficial, of less than 50% of myometrial infiltration), 36 type D (deep infiltration) and 22 cervical involvement were identified. There were 15 G1, 60 G2 and 15 G3 cases. Adnexal, omental and lymph-node metastases were found in 11, two and 15 cases, respectively. Endometrial cancer was diagnosed on the basis of dilatation and curettage. The degree of invasion was evaluated preoperatively. Ultrasonographic findings were compared to surgical staging and histopathology of the surgical specimen.
The median age of the 90 women was 63.3 +/- 12.3 years (range 32 to 86 years). The median thickness of malignant endometrium was 19.5 +/- 9.6 (range 7 to 54 mm). In type E the median thickness was 11.76 +/- 4.2, in type S 17.3 +/- 7.6, in type D 24.8 +/- 9.8 and in cases with cervical involvement 23.2 +/- 11 mm. Myometrial invasion evaluated by TVS was accurate in 76 of 90 cases (accuracy 84.4%). In type E sensitivity was 92.3%, specificity 87.0%, positive and negative predictive value, respectively, 63.1% and 98.6%. In type S these values were respectively: 78.0%, 93.9%, 91.4%, 80.0% and in type D--88.9%, 92.6%, 88.9% and 100.0%. Tumor extension to the cervix was properly assessed in 19 of 22 women in which it was present (sensitivity 86.4%, specificity 85.3%, positive predictive value 85.5%, negative predictive value 95.1%). Adnexal metastasis was correctly diagnosed in 8 of 11 cases in which it was present (sensitivity 72.7%, specificity 97.5%, positive predictive value 80%, negative predictive value 96.3%), and lymph-node metastasis in only 5 of 15 cases (sensitivity 33.3%, specificity 100%, positive predictive value 100%, negative predictive value 88.2%).
These results suggest that 2D TAS and TVS evaluation of endometrial cancer are reliable methods for preoperative assessment of selected prognostic factors, e.g. myometrial invasion, cervical involvement and adnexal metastases. However in assessing lymph-node metastases, TVS with its low sensitivity, did not provide additional information. Preoperative ultrasound examination should be speculated as an important tool in the establishment of different surgical choices which can be made after a correct pretreatment prognosis.
确定经腹超声（TAS）和经阴道超声（TVS）在评估子宫内膜癌肌层浸润、宫颈受累、盆腔淋巴结、附件及网膜转移（术前分期）方面的效能。
对90例女性患者进行经腹和经阴道二维超声检查，以对子宫内膜癌的肌层浸润、宫颈受累、盆腔淋巴结及附件转移进行分类。据此确定13例E型（累及子宫内膜）、41例S型（浅表型，肌层浸润小于50%）、36例D型（深层浸润）及22例宫颈受累病例。其中G1期15例、G2期60例、G3期15例。附件、网膜及淋巴结转移分别见于11例、2例和15例。根据刮宫诊断为子宫内膜癌。术前评估浸润程度。将超声检查结果与手术分期及手术标本的组织病理学结果进行比较。
90例女性患者的中位年龄为63.3±12.3岁（范围32至86岁）。恶性子宫内膜的中位厚度为19.5±9.6（范围7至54mm）。E型的中位厚度为11.76±4.2，S型为17.3±7.6，D型为24.8±9.8，宫颈受累病例为23.2±11mm。TVS评估肌层浸润在90例中有76例准确（准确率84.4%）。E型中，敏感性为92.3%，特异性为87.0%，阳性预测值和阴性预测值分别为63.1%和98.6%。S型中这些值分别为：78.0%、93.9%、91.4%、80.0%；D型中为：88.9%、92.6%、88.9%、100.0%。22例宫颈受累患者中有19例对肿瘤扩展至宫颈评估正确（敏感性86.4%，特异性85.3%，阳性预测值85.5%，阴性预测值95.1%）。11例附件转移患者中有8例诊断正确（敏感性72.7%，特异性97.5%，阳性预测值80%，阴性预测值96.3%），15例淋巴结转移患者中仅5例诊断正确（敏感性33.3%，特异性100%，阳性预测值100%，阴性预测值88.2%）。
这些结果表明，二维TAS和TVS评估子宫内膜癌是术前评估某些预后因素（如肌层浸润、宫颈受累及附件转移）的可靠方法。然而，在评估淋巴结转移方面，TVS敏感性低，未提供额外信息。术前超声检查应被视为确定不同手术选择的重要工具，这些选择可在正确的预处理预后后做出。
