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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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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
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.
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.
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.
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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.
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