Bakirkoy Women's and Children's Teaching Hospital, Department of Obstetrics and Gynecology, Turkey.
Gynecol Oncol. 2011 Sep;122(3):600-3. doi: 10.1016/j.ygyno.2011.05.041. Epub 2011 Jun 22.
To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in preoperative assessment of the depth of myometrial infiltration and the presence of cervical invasion in endometrial carcinoma.
298 consecutive patients with a diagnosis of endometrial cancer were evaluated by TVS within 3 days of surgical intervention. The depth of myometrial invasion was classified into two groups: no or <50% invasion and ≥50% invasion. Invasion of cervix was diagnosed when the neoplastic tissue distended the cervix and showed ill-defined borders with the cervical stroma.
The sensitivity, specifity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy of TVS in evaluation of the depth of myometrial infiltration were 68.4%, 82%, 65.1%, 84.1% and 77.5%, respectively. While the sensitivity and PPV were significantly higher among grade 3 tumors, the specifity, NPV and accuracy were significantly higher among grade 1 tumors. The sensitivity, specifity, PPV, NPV, and overall diagnostic accuracy of TVS in assessment of the presence or absence of neoplastic tissue in cervix were 76.5%, 99.3%, 86.7%, 98.2% and 98%, respectively. While the sensitivity and PPV were significantly higher among grade 1 tumors, the NPV and accuracy were significantly lower among grade 3 tumors.
TVS can be considered as a feasible, economical and simple imaging modality with a high diagnostic accuracy for the prediction of cervical involvement. However, it is not a reliable method in estimating the depth of myometrial infiltration.
评估经阴道超声（TVS）在术前评估子宫内膜癌肌层浸润深度和宫颈侵犯中的诊断准确性。
298 例经手术干预确诊为子宫内膜癌的患者在手术前 3 天内接受 TVS 检查。肌层浸润深度分为两组：无或<50%浸润和≥50%浸润。当肿瘤组织膨出宫颈且与宫颈基质边界不清晰时，诊断为宫颈侵犯。
TVS 评估肌层浸润深度的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总诊断准确性分别为 68.4%、82%、65.1%、84.1%和 77.5%。3 级肿瘤的敏感性和 PPV 显著较高，而 1 级肿瘤的特异性、NPV 和准确性显著较高。TVS 评估宫颈是否存在肿瘤组织的敏感性、特异性、PPV、NPV 和总诊断准确性分别为 76.5%、99.3%、86.7%、98.2%和 98%。1 级肿瘤的敏感性和 PPV 显著较高，而 3 级肿瘤的 NPV 和准确性显著较低。
TVS 可作为一种可行、经济、简单的成像方式，具有较高的诊断准确性，可预测宫颈受累情况。然而，它不是一种可靠的方法，无法准确估计肌层浸润深度。
