Ultrasound Diagnostics in Patients with Endometrial Carcinoma
DOI:
https://doi.org/10.6000/1927-7229.2012.01.01.4Keywords:
Endometrial carcinoma, ultrasound diagnostics, myometrial invasion, cervical inclusionAbstract
Introduction: Endometrial carcinoma is diagnosed by histopathological assessment of the sampled endometrium. After establishing the diagnosis the patient needs to be further evaluated in order to establish an optimal treatment. The most important factors that determine the treatment plan include: age, reproduction status, the depth of myometrial invasion, cervical invasion, histopahological type of tumor, histological and nuclear grade. Surgery is the most common treatment. The choice of optimal surgical procedure may include various imaging methods. Aim of the study: Testing the usefulness of applying the ultrasound diagnostics in preoperative evaluation of patients diagnosed with endometrial carcinoma. Method: The prospective study included 61 patients diagnosed with endometrial carcinoma. The ultrasound was used to estimate the presence and depth of invasion of the uterine muscle and cervical inclusion. The obtained parameters were compared to histopathological findings from surgically removed uterus. Results: The sensitivity of the ultrasound method in the estimation of myometrial invasion in the tested sample was 77.59%, specificity was 100.00%, predictive value of the positive test was 79.03%. The sensitivity of the ultrasound method in the estimation of cervical invasion in the tested sample was only 11.11%, specificity was 90.91%, predictive value of the positive test was 33.33%, predictive value of the negative test was 71.43%, whereas total accuracy of the method was 67.74%. Conclusion: Ultrasound diagnostics can be used in the assessment of the depth myometrial invasion but not in the assessment of cervical inclusion.
References
Sankaranarayanan R, Felay J. Word-wide burden of gynecological cancer: the size problem. Best Pract& res Clin Obstet Gynecol 2006; 20: 207-25.
Jemal A, Bray F, Center M, Ferlay J, Ward E, Forman D. Global cancer statistics. CA:Cancer J Clin 2011; 61(2): 69-90. http://dx.doi.org/10.3322/caac.20107
Cancer incidence and Mortality in Central Serbia 2004. Cancer registry of Central Serbia. Report No 5 Beograd, 2007.
Milenković V, Sparić R, Atanacković J. Methods of screening for endometrial cancer. Srp Arh Celok Lek 2005; 133(3-4): 199-201.
Stojanović S, Djorđević B, Ljubenović N, Pavlović Z. Preoperativni i postoperativni histopatološki nalaz kod pacijentkinja sa karcinomom endometrijuma. Apolinem medicum et aesculapium 2008; 3-4(6): 37-42.
Schmeler K, Soliman P, Sun C, Slomovitz B, Gershenson, D, Lu K. Endometrial cancer in young, normal-weight women. Gynecol Oncol 2005; 99( 2): 388-92. http://dx.doi.org/10.1016/j.ygyno.2005.06.029
Parslov M, Lidegaard O, Klintorp S, et al. Risk factors among young women with endometrial cancer: a Danish case-control study. Am J Obstet Gynecol 2000; 182(1): 23-9. http://dx.doi.org/10.1016/S0002-9378(00)70486-8
Manchana T, Khemapech N. Endometrial Adenocarcinoma in Young Thai Women. Asian Pacific J Cancer Prev 9: 283-86.
Gallup DG, Stock RJ. Adenocarcinoma of the endometrium in women under 40 years ago and younger. Obstet Gynecol 1984; 64: 417-20.
Mahovlić V. Endometrij U, Ćorušić A, Babić D, Šamija M, Šobat H. Ginekološka onkologija. Medicinska Naklada Zagreb 2005; 42-47.
Pavlović S. Citopatologija tela materice. U:Pavlović S. Citopatologija ženskih genitalija. Niš 1980; pp. 218-34.
Broso P. Cervico-vaginal and endometrial cytology in the screening for endometrial cancer. Minerva Ginecol 1995; 47(11): 503-7.
Smith-Bindman R, Kerlikowske K, Feldstein VA, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998; 280(17): 1510-7. http://dx.doi.org/10.1001/jama.280.17.1510
Ćurčić A, Đurđević S, Mladenović–Segedi LJ, Grujić Z, Višnjevac N. Ultrazvučni skrining karcinoma endometrijuma kod žena u postmenopauzi bez simptoma. Med Pregl 2009; LXII (5-6): 263-67.
Langer RD, Pierce JJ, O Hanlan, Johnson S, et al. Transvaginal ultrasonography compared with endometrial biopsy for detection of endometrial disease. N Engl J Med 1997; 337: 1792-98. http://dx.doi.org/10.1056/NEJM199712183372502
Fleischer AC, Wheeler JE, Lindsay Y, et al. An assesment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms. Am J Obstet Gynecol 2001; 184: 70-75. http://dx.doi.org/10.1067/mob.2001.111088
Lo SS, Cheng DK, NgTY,Wong LC, Ngan Hy. Prognostic significance of tumor markers in endometrial cancer. Tumor Biol 1997; 18 (4): 241-9. http://dx.doi.org/10.1159/000218037
Takano M, Kikuchi Y, Asakawa T, et al. Identification of potential serum markers for endometrial cancer using protein expression profiling. J Canc Res Clin Oncol 2010; 136(3): 475-81. http://dx.doi.org/10.1007/s00432-009-0680-7
Grahovac S. Komparacija pre-i postoperativnog histopatološkog nalaza kod pacijentkinja sa histerektomijom. Magistarski rad, Niš, Srbija. Univerzitet u Nišu, 2006.
Kurman RJ, (Ed). Blaustein´ pathology of the female genital tract, 5th ed. New York:Springer-Verlag. 2002; pp. 501-56.
Obermair A, Geramou M, Gucer F, et al. Endometrial cancer :accuracy of the finding of a well diferentiated tumor at dilatation and curettage compared to the findings at subsequent hysrectomy. Int J Gynecol Cancer 1999; 9: 383-6. http://dx.doi.org/10.1046/j.1525-1438.1999.99050.x
Ilić-Forko J. Karcinom trupa materice. U: Ćorušić A, Babić D, Šamija M, Šobat H. Ginekološka onkologija. Medicinska naklada Zagreb 2005; 229-34.
Simonds I. Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer. Rev Gynecol Perinatal Pract 2003; 3(1): 11-15.
Bradley WH, Boente MP, Brooker D, et al. Hysteroscopy and cytology in endometrial cancer. Obstet Gynecol 2004; 104: 1030-3. http://dx.doi.org/10.1097/01.AOG.0000143263.19732.18
Gutman G, Almong B, Lessing J, Bar-Am A, Grisaru D. Diagnosis of endometrial cancer by hysteroscopy does not increase the risk for microscopic extrauterine spread in early- stage disease. Gynecolo Surg 2005; 2: 21-23.
Kong A, Simera I, Collingwood M. Adjuvant radiotherapy for stage I endometrial cancer:systematic reiview and meta analysis. Ann Oncol 2007; 18: 1595-4. http://dx.doi.org/10.1093/annonc/mdm066
Ruangvutilert P, Sutanawibul A, Sunsaneevithayakul P, Borioonhirunsam D, Chuenchom T. Accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma. J Med Assos Thai 2004; 87(1): 47-52.
Szabo I, Szantho A, Nemet J, Csapo Z, Szirmai K, Papp Z. Assessment of myometrial invasion in endometrial cancer by transvaginal ultarsonography. Orv Hetil 1997; 138(21): 1323-7.
Creasman WT, Odicino F, Maisoneuve P, et al. 26 th Annual Report on the results of treatment in Gynecelogical cancer. Int J Gynecol obstetr 2006; 95(1): 105-44.
Creasman WT, Morow CP, Bundy BN, Homesly HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer in the eldery. GOG 033. Cancer 1987; 60: 2035-41. 95
Abeler WM, Kjorstad KE. Endometrial adenocarcinoma in Norway. A study of total population. Cancer 1991; 67: 3093- 4003. http://dx.doi.org/10.1002/1097-0142(19910615)67:12<3093::AID-CNCR2820671226>3.0.CO;2-L
Stanojević Z. Maligni tumori genitalnih organa žene. U: Osnovi kliničke onkologije 2009; 196-206.
Taylor RR, Zeller J, Lieberman RW, O Connor DM. An analysisis of the two versus three grades for Endometrial carcinoma. Gynecol Oncol 1999; 74: 3-6. http://dx.doi.org/10.1006/gyno.1999.5422
Scholten A, Creutyberg CL, Noordijk EM, Smit VM. Long term outcome in endometrial carcinoma favors a two -instead of three-tiered grading system. Int J Radiat Oncol Biol Phys 2002; 52 (4): 1067-74. http://dx.doi.org/10.1016/S0360-3016(01)02710-9
Creasmann WMD. Controversis in FIGO staging of corpus cancer. J Gynecol Oncol 2001; 6: 257-59.
Kesić V. Odeđivanje stadijuma i prognostički faktori za endometrijalni karcinom. Zbornik predavanja Karcinom endometrijuma, 30 mart, 2007, Beograd Srbija.
Aaron W, Sightler S, Markoe A, et al. The prognoctic significance of surgical staging for carcinoma of the endometrium. Gynecol Oncol 1992; 45(2): 142-46. http://dx.doi.org/10.1016/0090-8258(92)90276-O
Goff BA, Rise LW. Assesment of depht of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990; 38: 46-48.
Rose P. Endometrial carcinoma. N Engl J Med 1996; 9(335): 640-49. http://dx.doi.org/10.1056/NEJM199608293350907
Fleischer AC, Kalemeris GC, Machin JE, Entman SS, James JR. Sonographic deciption of normal and abnormal endometrium with histopathologic correlation. J Ultrasound Med 1986; 8( 5): 445-52.
Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding a Nordic multicenter study. Am J Obstet Gynecol 1995; 172: 1488-94. http://dx.doi.org/10.1016/0002-9378(95)90483-2
Goldstein SR. The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium. Am J Obstet Gynecol 2009; 201(1): 5-11. http://dx.doi.org/10.1016/j.ajog.2009.02.006
Kurjak A, Kupešič S,Bauman R,eds. Zloćudni tumori materice u : Kurjak A i suradnici. Ultrazvuk u ginekologiji i porodništvu Zagreb 2000; pp. 43-58.
Savelli L, Ceccarini M, Ludovisi M, et al. Preoperative local staging of endometrial cancer : transvaginal sonography vs. magnetic resonance imaging . Ultrasound Obstet Gynecol 2008; 31: 560-66. http://dx.doi.org/10.1002/uog.5295
MolinaG, Dell’Elce C, Libanori E, Preziuso F, Trompeo P. Transvaginal echographic evaluation of myometrial invasion in patients in patients with endometrial cancer. Minerva Ginecol 1996; 48(6): 239-42.
Fishman A, Altaras M, Bernheim J, Cohen I, Beyth Y, Tepper R. The value of transvaginal sonography in the preoperative assesment of myometrial invasion in high and low grade endometrial cancer and in comparasion to frosen section in grade 1 disease. Eur J Gynaecol Oncol 2000; 21(2): 128-30.
Sawicki W, Spiewankiewicz B, Steinmachow J, Cendrowski K. The value if ultrasonography in preoperative assessment of selected prognostic factor in endometrial cancer. Eur J Gynaecol Oncol 2001; 24(3-4): 293-8.
Baekelandt M, Castiglione M. Endometrial carcinoma: ESMO Clinical recommendations for diagnosis, treatment and follow–up. Ann Oncol 2009; 20(4): 29-31.
Ayhan A, Taskiran C, Celik C, Yuce K. The long term surwival of women with surgical stage II endometroid type endometrial cancer. Gynecol Oncol 2004; 93(1): 9-13. http://dx.doi.org/10.1016/j.ygyno.2003.11.018
Kaku T, Yoshikawa H, Tsuda H, et al. Conservative therapy for adenocarcinoma ans atypical endometrial hyperplasia of the endometrium in young women:central pathologic review and treatment outcome. Cancer Lett 2001; 167(1): 39-41. http://dx.doi.org/10.1016/S0304-3835(01)00462-1
Kurjak BF, Kupešić S, Kurjak A, Eds. Anatomija male zdjelice u žene. Ultrazvuk u ginekologiji i porodništvu Zagreb 200: 1-11.
Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North Am 2003; 41(4): 769-80. http://dx.doi.org/10.1016/S0033-8389(03)00060-5
Teefey SA, Stahl JA, Middleton WD, et al. Local staging of transvaginal and intraoperative sonography and gross visual inspection. Am J Rentgenol 166: 547-52.
Goff BA, Rise LW. Assesment of depht of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990; 38: 46-48.
Noumoff JS, Menzin A, Mikuta J, Lusk EJ, Morgan M, LiVolsi VA. The ability to evaluate prognostic variables on frozen section in hysterectomies performed for endometrial carcinoma. Gynecol Oncol 1991; 42: 202-208. http://dx.doi.org/10.1016/0090-8258(91)90346-7
Eltabbakh GH, Shamonki J, Mount SL. Surgical stage, final grade, and survival of women with endometrial carcinoma whose preoperative endometrial biopsy shows well-differentiated tumors. Gynecol Oncol 2005; 99(2): 309-12. http://dx.doi.org/10.1016/j.ygyno.2005.06.010
Ramirez PT, Frumovitz M, Budurka DC, Sun CC, Levenback C. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol 2004; 95(1): 133. http://dx.doi.org/10.1016/j.ygyno.2004.06.045
Mao Y, Wan X, Chen Y, Lv W, Master XX. Outcomes of conservative therapy for young women with early endometrial adenocarcinoma. Fertylity and sterility 2010; 91(1): 283-85.
