Department of Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Ultrasound Obstet Gynecol. 2013 Sep;42(3):353-8. doi: 10.1002/uog.12499.
To compare the diagnostic accuracy of subjective ultrasound assessment with that of objective measurement techniques in the evaluation of myometrial and cervical invasion in women with endometrial cancer.
This was a prospective multicenter study including 144 women with endometrial cancer undergoing transvaginal ultrasound. Myometrial and cervical invasion was evaluated subjectively, as well as objectively measured in different ways: endometrial thickness, tumor/uterine anteroposterior (AP) diameter ratio, minimal tumor-free margin, minimal tumor-free margin/uterine AP diameter ratio, tumor volume (three-dimensional (3D)), tumor/uterine volume (3D) ratio, and distance from outer cervical os to lower margin of tumor (Dist-OCO). Histological assessment following hysterectomy was the gold standard.
The sensitivity (72%) and specificity (76%) of tumor/uterine AP diameter (at cut-off, 0.53) were not significantly different from those of subjective evaluation (sensitivity, 77% (P = 0.44); specificity, 81% (P = 0.32)) for the prediction of deep myometrial invasion; all other objective measurement techniques had either a significantly lower sensitivity or a lower specificity. For all objective measurement techniques, except minimal tumor-free margin/uterine AP diameter ratio, fixing the sensitivity at the same level as that of subjective evaluation (i.e. 77%) gave a significantly lower specificity. Dist-OCO was the only parameter that might have potential to predict cervical invasion; it had a non-significantly higher sensitivity than did subjective evaluation (73% vs 54%, P = 0.06), but a significantly lower specificity (63% vs 93%, P < 0.001).
Subjective assessment of cervical and myometrial invasion is as good as or better than any objective measurement technique. The tumor/uterine AP diameter ratio and minimal tumor-free margin/uterine AP diameter ratio seem to be the best objective measurement techniques to predict deep myometrial invasion. It remains to be shown if objective measurements are useful to predict cervical invasion.
比较主观超声评估与客观测量技术在评估子宫内膜癌患者子宫肌层和宫颈浸润中的诊断准确性。
这是一项前瞻性多中心研究，纳入了 144 例接受经阴道超声检查的子宫内膜癌患者。子宫肌层和宫颈浸润情况进行了主观评估，并采用不同方法进行了客观测量：子宫内膜厚度、肿瘤/子宫前后径比、最小肿瘤无残留边界、最小肿瘤无残留边界/子宫前后径比、肿瘤体积（三维）、肿瘤/子宫体积（三维）比以及肿瘤下缘至宫颈外口的距离（Dist-OCO）。子宫切除术后的组织学评估为金标准。
肿瘤/子宫前后径比（截断值为 0.53）的敏感度（72%）和特异度（76%）与主观评估（敏感度 77%（P=0.44）；特异度 81%（P=0.32））相比，对预测深肌层浸润并无显著差异；所有其他客观测量技术的敏感度均较低或特异度较低。除最小肿瘤无残留边界/子宫前后径比外，将敏感度固定在与主观评估相同水平（即 77%）时，特异度显著降低。Dist-OCO 是唯一可能有预测宫颈浸润潜力的参数；其敏感度高于主观评估（73%比 54%，P=0.06），但特异度显著较低（63%比 93%，P<0.001）。
宫颈和子宫肌层浸润的主观评估与任何客观测量技术一样好或更好。肿瘤/子宫前后径比和最小肿瘤无残留边界/子宫前后径比似乎是预测深肌层浸润的最佳客观测量技术。客观测量是否有助于预测宫颈浸润仍有待证实。
