Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy

摘要: Objectives To evaluate the accuracy of different preoperative modalities for staging endometrial cancer to restrict extensive surgery patients at high risk metastatic disease. Setting Aarhus University Hospital. Population 156 women referred in 2006–2011 because atypical hyperplasia (G0) or cancer. Methods Patients were offered transvaginal ultrasonography (TVS), magnetic resonance imaging (MRI), and hysteroscopic-directed biopsies from uterine tumor cervix. Final pathology removed uterus was reference standard. Patients divided into low (<50% myometrial invasion, grades 0, 1, 2, no cervical invasion) (all others). Main outcome measures Accuracy, sensitivity, specificity, positive/negative predictive value. Results Patients aged 32–88 years, with a mean body mass index 29. At final 81% had 19% G0 residual tumor; 54% risk. Hysteroscopy-directed higher (92%) than biopsy (58%) differentiating (p < 0.001); grade 3 identification similar (93 vs. 92%). Deep invasion estimated by MRI (82%) TVS (74%) (p < 0.02). For involvement, hysteroscopy-directed (94%) (84%,) (80%) Accuracy identifying high-risk highest (83%) using combination biopsies, compared (72%) (p < 0.05). Conclusion Preoperative can identify eight 10 lymph node metastases spare low-risk extended surgery.