Preoperative Transvaginal Ultrasound (TVS) in the Description of Pelvic Tumor Spread in Endometrial Cancer: Results of a Prospective Study

Abstract

Background: Various diagnostic methods are applied preoperatively in patients with suspected and histologically proven endometrial cancer, but no standard diagnostic tool exists for the accurate preoperative evaluation of tumor spread and staging. The aim of this study was to evaluate the diagnostic value of transvaginal sonography (TVS) as a staging tool, by determining tumor size and infiltration of the adjacent organs and correlating sonographic results to the respective intraoperative findings. Patients and Methods: Overall, thirty patients with endometrial cancer were included in the study prospectively. Systematic staging regarding tumor size (T), infiltration of the cervix (Cx) and ovaries (OV), peritoneal carcinomatosis (PC), bladder invasion (BI), intestinal invasion (II) and ascites (A) was assessed using TVS. Findings of B-mode ultrasound imaging were compared to intraoperative findings and histopathological results. Results: Preoperative diagnosis was correctly made by TVS in 93.4% of the patients [95% confidence interval (CI): 84%-100%]. Preoperative staging was correctly achieved by TVS for T in 73.3% [95% CI: 58%-89%], for Cx in 16.7% [95% CI: 13%-46%], for OV in 100%, for BI in 97% [95% CI: 90%-100%], for II in 97% [95% CI: 90%-100%], for PC in 90% [95% CI: 79%-100%] and for A in 100% . Conclusion: TVS is a sensitive and non-invasive method for preoperative diagnosis of suspected endometrial cancer. Of the tumors, 73% were correctly classified regarding size, whereas the detection rate of tumor spread in the ovaries and of ascites were high. Accuracy and sensitivity for the description of the infiltration of other adjacent organs, such as the bladder, intestine and peritoneal layers, were low. Further studies on the value of the combination of TVS and magnetic resonance imaging in the preoperative setting of patients with endometrial cancer are warranted.