Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
Department of Gynecologic Oncology, University of Palermo, Palermo, Italy.
J Obstet Gynaecol. 2021 Jul;41(5):779-784. doi: 10.1080/01443615.2020.1799342. Epub 2020 Oct 16.
Endometrial cancer is the most frequently diagnosed gynecological tumour. Transvaginal ultrasound has a leading role in the preoperative evaluation of endometrial cancer patients. The study aimed to identify factors that can worsen the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients. We retrospectively analysed 290 patients with histological diagnosis of endometrial adenocarcinoma. Two-dimensional (2D) gray-scale ultrasound and power Doppler imaging were performed. Age, menopause status, obesity, parity, Figo stage and benign uterine disorders were evaluated as possible factors worsening the diagnostic accuracy of the ultrasonography. FIGO stage IB was the main significant confounding factor in the univariate analysis ( = .004). Furthermore, 2D transvaginal ultrasound showed worse diagnostic accuracy in endometrial cancer patients with concomitant benign uterine pathologies.Impact statement Many studies have analysed the reliability and diagnostic accuracy of transvaginal ultrasound in predicting myometrial invasion, but few studies have underlined the importance of confounding factors. Shin et al. (2011) showed that diffuse fibromatosis is a quality ultrasound confounding factor. Furthermore, Fischerova et al. (2014) showed that body mass index (BMI) did not influence the diagnostic accuracy of ultrasound assessment. FIGO stage IB is the main factor worsening the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients ( = .004). Among the 82 patients with histologically proven FIGO stage IB, 27 (32.9%) had a wrong ultrasound prediction of myometrial infiltration. Twenty-one (36.2%) patients in whom there was no agreement between ultrasound prediction of myometrial infiltration and pathological analysis had fibromatosis and/or adenomyosis ( = 0.04). Two-dimensional ultrasound represents a useful tool in the correct pre-operative setting of patients with endometrial cancer. In FIGO stages IB endometrial cancer patients and in conjunction with benign uterine pathologies, 2D transvaginal ultrasound has less diagnostic accuracy. In these cases, MRI still plays a leading role.
子宫内膜癌是最常见的妇科肿瘤。经阴道超声在子宫内膜癌患者的术前评估中具有主导作用。本研究旨在确定可能降低经阴道超声诊断子宫内膜癌患者准确性的因素。我们回顾性分析了 290 例组织学诊断为子宫内膜腺癌的患者。进行二维（2D）灰阶超声和能量多普勒成像。评估年龄、绝经状态、肥胖、产次、FIGO 分期和良性子宫疾病等因素是否为超声诊断准确性恶化的可能因素。FIGO 分期 IB 是单因素分析中的主要显著混杂因素（= 0.004）。此外，2D 经阴道超声显示在伴有良性子宫病变的子宫内膜癌患者中诊断准确性较差。
很多研究已经分析了经阴道超声预测肌层浸润的可靠性和诊断准确性，但很少有研究强调混杂因素的重要性。Shin 等人（2011 年）表明弥漫性纤维瘤病是超声质量混杂因素。此外，Fischerova 等人（2014 年）表明体重指数（BMI）不影响超声评估的诊断准确性。FIGO 分期 IB 是降低子宫内膜癌患者经阴道超声诊断准确性的主要因素（= 0.004）。在 82 例组织学证实为 FIGO 分期 IB 的患者中，27 例（32.9%）超声预测肌层浸润错误。21 例（36.2%）超声预测肌层浸润与病理分析不一致的患者存在纤维瘤病和/或子宫腺肌病（= 0.04）。二维超声是正确术前设置子宫内膜癌患者的有用工具。在 FIGO 分期 IB 子宫内膜癌患者中，结合良性子宫病变，2D 经阴道超声的诊断准确性较低。在这些情况下，MRI 仍具有主导作用。
