Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):284-8. doi: 10.1016/j.ejogrb.2012.07.005. Epub 2012 Jul 20.
To evaluate the diagnostic performance of gross examination and transvaginal ultrasonography in the assessment of the depth of myometrial infiltration when they are used alone or together as a combined test.
The data of 219 consecutive patients with a diagnosis of endometrial cancer were evaluated retrospectively. Transvaginal ultrasound was carried out as a part of the routine preoperative work-up within three days of surgical intervention in all cases. All patients underwent hysterectomy with bilateral salpingo-oophorectomy and routine surgical staging and all uterine specimens were examined immediately after hysterectomy. The depth of myometrial invasion was classified into two groups: no or <50% invasion and ≥50% invasion. The findings of ultrasound and intraoperative gross examination were compared with the final histopathological results. The data of these two methods were integrated to evaluate the diagnostic performance of the combined test. If the results of myometrial invasion evaluation were different for the same patient, the deeper one (the depth of invasion ≥50%) was accepted.
Sensitivity, specificity, PPV, NPV and accuracy of preoperative ultrasonography in predicting myometrial infiltration ≥50% were 62%, 81%, 60%, 82%, and 75% respectively. The corresponding rates for intraoperative gross examination were 61%, 88%, 70%, 83% and 79%, respectively. For the combined test they were 78%, 76%, 60%, 88% and 70% respectively. There was no statistically significant difference in sensitivity and specificity between ultrasound and gross examination. The sensitivity of the combined test was significantly higher than that of ultrasound and gross examination (p=0.001 and p<0.0001, respectively). The specificity of the combined test was significantly lower than that of TVS and gross examination (p=0.008 and p<0.0001, respectively).
Combining ultrasonography and intraoperative gross examination may be a good option to assess the depth of myometrial invasion, as it has a higher sensitivity and negative predictive value in comparison to using these methods alone.
评估单独使用或联合使用经阴道超声检查和大体检查评估子宫肌层浸润深度的诊断性能。
回顾性评估了 219 例连续诊断为子宫内膜癌的患者的数据。所有病例均在手术干预前 3 天内作为常规术前检查进行经阴道超声检查。所有患者均接受子宫切除术、双侧附件切除术和常规手术分期，所有子宫标本均在子宫切除术后立即检查。子宫肌层浸润深度分为两组：无或<50%浸润和≥50%浸润。将超声和术中大体检查的结果与最终组织病理学结果进行比较。整合这两种方法的数据来评估联合试验的诊断性能。如果同一患者的肌层浸润评估结果不同，则接受较深的结果（浸润深度≥50%）。
术前超声预测肌层浸润≥50%的敏感性、特异性、PPV、NPV 和准确性分别为 62%、81%、60%、82%和 75%。术中大体检查的相应率分别为 61%、88%、70%、83%和 79%。联合试验的相应率分别为 78%、76%、60%、88%和 70%。超声和大体检查的敏感性和特异性无统计学差异。联合试验的敏感性明显高于超声和大体检查（p=0.001 和 p<0.0001）。联合试验的特异性明显低于超声和大体检查（p=0.008 和 p<0.0001）。
联合使用超声和术中大体检查可能是评估子宫肌层浸润深度的一种较好的方法，因为与单独使用这些方法相比，它具有更高的敏感性和阴性预测值。
