Analysis of ultrasound results in patients with stage I endometrioid carcinoma

Objective. To evaluate the capabilities of transvaginal ultrasound in diagnosing the presence and depth of tumor invasion into the myometrium in patients suffering from well-differentiated stage I endometrioid carcinoma.
Materials and methods. The material for the retrospective study was the data of patients with morphologically verified well-differentiated stage I endometrioid carcinoma who underwent diagnostics, including transvaginal ultrasound (TV ultrasound) and treatment including panhysterectomy with bilateral salpingo-ophrectomy or extended hysterectomy (with pelvic lymph node dissection) at the Republican Scientific Practical Center for OMR named after N. N. Alexandrov in 2011—2015, a total of 343 patients. The median age was 55 years, the minimum was 24 years, and the maximum was 77 years.
The research methods included calculation of operational characteristics of TV ultrasound for diagnosing the presence and depth of tumor invasion into the myometrium. The method of binary logistic regression and the Mann — Whitney test were used. All p values were two-sided, and differences were considered statistically significant at p<0,05.
Results. The diagnostic sensitivity (DS) of TV ultrasound for determining the depth of tumor invasion into the myometrium for patients with G1 endometrioid carcinoma was 87,5 %, diagnostic specificity (DS) — 94,5 %, diagnostic accuracy (DT) — 94,2 %, predictive value positive result (PCR) — 43,8 %, negative predictive value (NPV) — 99,4 %. When deciding on the extent of surgical intervention based on TV ultrasound data, only 4,1 % (95 % CI (2,3—6,8)) of patients will receive excessive surgical treatment, insufficient — 0.6 % (95 % CI (0,07—2,1)).
The frequency of TV ultrasound to determine the presence of tumor invasion into the myometrium for patients of reproductive age with G1 endometrioid carcinoma was 58 %, DS — 77 %, DT — 72 %, PCPR — 50 %, PCOR — 82 %. When making a decision on organ-preserving treatment for the implementation of the reproductive function of these patients based on the results of TV ultrasound, 50 % of patients for whom organ-preserving treatment is possible will be unreasonably denied it, 18 % (95 % CI (8,8—29,9)) of patients will be offered organ-preserving treatment that does not correspond to the degree of cancer risk.
Conclusion. For patients with morphologically verified well-differentiated stage I endometrioid carcinoma, TV ultrasound demonstrates high efficiency in determining the depth of tumor invasion into the myometrium. The accuracy of diagnosing the presence of tumor invasion into the myometrium in patients of reproductive age is 71,6 % (95 % CI (61,0—81,0)), which cannot be considered sufficient and it is necessary to study the use of more accurate diagnostic methods.

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