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Reporter: Supervisor: Medical student: 吳長哲 Attending: 陳志堯醫師

Preoperative local staging of endometrial cancer: Transvaginal sonography vs. Magnetic resonance imaging. L. SAVELLI, et al. Ultrasound Obstet Gynecol 2008; 31 : 560–566. Reporter: Supervisor: Medical student: 吳長哲 Attending: 陳志堯醫師.

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Reporter: Supervisor: Medical student: 吳長哲 Attending: 陳志堯醫師

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  1. Preoperative local staging of endometrial cancer:Transvaginal sonography vs. Magnetic resonance imaging L. SAVELLI, et al. Ultrasound Obstet Gynecol 2008; 31: 560–566 Reporter: Supervisor: Medical student:吳長哲Attending:陳志堯醫師

  2. Introduction • Endometrial carcinoma is the most frequent female pelvic malignancy, with a further rise in its incidence. • Definitive staging is based on surgical pathology, 20% of clinical estimation is incorrect. • Accurate pre-op staging assists in planning the appropriate treatment, turning for specialized center, counseling properly, and avoiding unnecessary morbidities. • This issue is more relevant as less invasive laparoscopy is emerging.

  3. Introduction • Myometrial infiltration & cervical involvement • MRI, CT, Transvaginal sonography (TVS) • A meta-analysis in Radiology (1999) • Transvaginal probes with higher frequencies (5.0-9.0 MHz), and thus better resolution. • Prospective study comparing high-frequency TVS and contrast-enhanced MRI in pre-op staging of endometrial carcinoma.

  4. Methods • 74 patients with histological diagnosis were enrolled prospectively. All of them received MRI and TVS, then underwent surgical staging. • Both MRI and TVS were performed by expert specialists, with consensus on techniques and reading criteria. Both groups were blinded to each other.

  5. Ia Ib Ic IIb

  6. Results

  7. Results

  8. Discussion • Contrast-enhanced MRI and TVS perform equally well in evaluation of myometrial invasion, whereas TVS shows a trend towards better performance in detection of cervical tumor spread. • TVS could potentially be first-line imaging modality in pre-op local staging of endometrial cancer, when MRI would be second-line technique in patients with poor quality of TVS or the need for precise staging.

  9. Discussion • Strengths of this study: • Prospective design • Relative large number of patients • Expert specialists and operator blindedness • Consensus on criteria and techniques • Possible confounding factors: • Obesity • Presence of myomas or adenomyosis • Uterine corpus axial or retroverted in relation to the cervix

  10. Thanks for Your Attention!!

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