Transcript Preoperative local staging of endometrial cancer: transvaginal

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.
Ia
Ib
Ic
IIb
Results
Results
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
Thanks for Your Attention!!