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Efficacy of transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial invasion in patients with endometrioid endometrial cancer: a prospective comparative study

Anis Cerovac
Anis Cerovac
, 
Dzenita Ljuca
Dzenita Ljuca
, 
Lejla Arnautalic
Lejla Arnautalic
, 
Dubravko Habek
Dubravko Habek
, 
Gordana Bogdanovic
Gordana Bogdanovic
, 
Jasminka Mustedanagic-Mujanovic
Jasminka Mustedanagic-Mujanovic
 and 
Gordana Grgic
Gordana Grgic
   | Feb 11, 2022
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Article Category: Research Article
Published Online: Feb 11, 2022
Page range: 37 - 45
Received: Sep 03, 2021
Accepted: Dec 13, 2021
DOI: https://doi.org/10.2478/raon-2022-0005
© 2022 Anis Cerovac, Dzenita Ljuca, Lejla Arnautalic, Dubravko Habek, Gordana Bogdanovic, Jasminka Mustedanagic-Mujanovic, Gordana Grgic, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Assessment of myometrial invasion in patients with transvaginal ultrasonography (TVUS). Stage IA endometrial cancer in a 61-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Karlsson’s method indicating infiltration of superficial muscle (29%) (A). Stage IA endometrial cancer in a 53-year-old postmenopausal woman. Gordon’s method indicating infiltration of superficial muscle (35%) (B).
Assessment of myometrial invasion in patients with transvaginal ultrasonography (TVUS). Stage IA endometrial cancer in a 61-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Karlsson’s method indicating infiltration of superficial muscle (29%) (A). Stage IA endometrial cancer in a 53-year-old postmenopausal woman. Gordon’s method indicating infiltration of superficial muscle (35%) (B).

Figure 2

Assessment of myometrial invasion in patients with transvaginal ultrasonography (TVUS). Stage IB endometrial cancer in a 78-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Karlsson’s method indicating infiltration of deep muscle (58%) (A). Stage IB endometrial cancer in an 83-year-old postmenopausal woman. Gordon’s method indicating infiltration of deep muscle (73%) (B).
Assessment of myometrial invasion in patients with transvaginal ultrasonography (TVUS). Stage IB endometrial cancer in a 78-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Karlsson’s method indicating infiltration of deep muscle (58%) (A). Stage IB endometrial cancer in an 83-year-old postmenopausal woman. Gordon’s method indicating infiltration of deep muscle (73%) (B).

Figure 3

Assessment of myometrial invasion in patients with MRI, sagittal T2-weighted. Stage IA endometrial cancer in a 68-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Arrow shows blurring of the junctional zone and the infiltration of superficial muscle (20%) (A). Stage IB endometrial cancer in a 58-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Arrows refers to deep myometrial infiltration (60%) (B).
Assessment of myometrial invasion in patients with MRI, sagittal T2-weighted. Stage IA endometrial cancer in a 68-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Arrow shows blurring of the junctional zone and the infiltration of superficial muscle (20%) (A). Stage IB endometrial cancer in a 58-year-old postmenopausal woman, correctly diagnosed by TVUS and MRI. Arrows refers to deep myometrial infiltration (60%) (B).

Figure 4

Receiver operating characteristics (ROC) analysis for percentage assessment of myometrial invasion (MI) with transvaginal ultrasound (TVUS) by Gordon’s and Karlsson’s, and with MRI
Receiver operating characteristics (ROC) analysis for percentage assessment of myometrial invasion (MI) with transvaginal ultrasound (TVUS) by Gordon’s and Karlsson’s, and with MRI

Myometrial invasion in endometrial cancer according to histopathology, transvaginal ultrasonography and magnetic resonance imaging

Histopathology TVUS (Gordon) TVUS (Karlsson) MRI Total N(%)
≤ 50% N(%) > 50% N(%) ≤ 50% N(%) > 50% N(%) ≤ 50% N(%) > 50% N(%)
≤ 50% N (%) 30 (88.2) 4 (11.8) 30 (88.2) 4 (11.8) 29 (85.3) 5 (14.7) 34 (100)
> 50% N(%) 6 (23.1) 20 (76.9) 8 (30.8) 18 (69.2) 1 (3.8) 25 (96.2) 26 (100)
Total 36 (60) 24 (40) 38 (63.3) 22 (36.7) 30 (50) 30 (50) 60 (100)

Demographic and clinical characteristics of 60 women with histologically confirmed endometrial cancer

Characteristics Value (%)
Age (years) 60 (40–83)
Body mass index (kg/m2) 32.05 (21.6–49.2)
Postmenopausal 45 (75)
Myometrial invasion
Superficial (≤ 50 %) 34 (56.7)
Deep (> 50%) 26 (43.3)
Hystological grade
Grade 1 18 (30)
Grade 2 35 (58)
Grade 3 7 (12)

Diagnostic performance of transvaginal ultrasonography and magnetic resonance imaging in predicting myometrial invasion in endometrial cancer

Diagnostic test measure TVUS (Gordon) TVUS (Karlsson) MRI
%, (95% CI) %, (95% CI) %, (95% CI)
Accuracy 83 (70–92) 80 (67–88) 90 (78–93)
Sensitivity 77 (62–87) 69 (54–79) 97 (83–99)
Specificity 88 (77–96) 88 (77–96) 85 (75–88)
Positive predictive value 83 (67–94) 82 (64–93) 83 (72–87)
Negative predictive value 83 (72–90) 79 (69–86) 97 (85–99)
Likelihood Ratio of a Positive Test 6.54 (2.65–19.00) 5.89 (2.30–18.17) 6.54 (3.31–8.37)
Likelihood Ratio of a Negative Test 0.26 (0.14–0.50) 0.35 (0.22–0.60) 0,05 (0.002–0.23)

Representation of the areas below the receiver operating characteristics (ROC) curve (AUC) for percentage assessment of MI with transvaginal ultrasound (TVUS) by Gordon and Karlsson, and with MRI

Method of assessment AUC P 95% CI for AUC
Lower limit Upper limit
TVUS (Gordon) 0.872 < 0.001 0.769 0.965
TVUS (Karlsson) 0.865 < 0.001 0.766 0.964
MRI 0.911 < 0.001 0.833 0.989
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