Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Int J Gynecol Cancer. 2019 Jan;29(1):119-125. doi: 10.1136/ijgc-2018-000045.
To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer.
METHODS/MATERIALS: We included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases.
The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion (≥ 50%) (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011).
Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.
根据国际子宫内膜肿瘤分析（IETA）标准，描述肌层浸润（MI）的微囊性拉长和碎裂（MELF）模式的超声特征；评估 MELF 模式对 MI 术前超声评估的影响；并确定 MELF 模式与子宫内膜样子宫内膜癌患者更晚期（≥IB）和淋巴结转移的关系。
方法/材料：我们纳入了前瞻性 IETA 4 研究中的 850 名子宫内膜样子宫内膜癌患者。超声专家根据 IETA 方案进行所有超声检查。参考病理学家评估 MELF 模式的存在与否。比较存在和不存在 MELF 模式的病例的超声特征和 MI 超声评估的准确性。将 MELF 模式与更晚期（≥IB）和淋巴结转移相关联。
197（23.2%）名女性存在 MELF 模式。在术前超声成像中，子宫内膜较厚（p = 0.031），血管更丰富（p = 0.003），呈多灶性血管模式（p < 0.001），并且腺肌病的评估更不确定（p < 0.001）。MELF 模式的存在与否并不影响 MI 评估的准确性。MELF 模式与深层肌层浸润（≥50%）（p < 0.001）、宫颈基质浸润（p = 0.037）、更晚期（≥IB）（p < 0.001）和淋巴结转移（p = 0.011）相关。
MELF 模式的肿瘤稍大，血管更丰富，呈多灶性血管模式，超声成像对腺肌病的评估更不确定。MELF 模式并没有增加术前超声分期低估 MI 的风险。MELF 模式的肿瘤更有可能处于更晚期（≥IB）和淋巴结转移。
