E Epstein1, D Fischerova2, L Valentin3, A C Testa4, D Franchi5, P Sladkevicius3, F Frühauf2, P G Lindqvist6, F Mascilini4, R Fruscio7, L A Haak8, G Opolskiene9, M A Pascual10, J L Alcazar11, V Chiappa12, S Guerriero13, J W Carlson14, C Van Holsbeke15, F P G Leone16, B De Moor17, T Bourne18,19, B van Calster19, A Installe17, D Timmerman19,20, J Y Verbakel19,21, T Van den Bosch20. 1. Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden. 2. Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic. 3. Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Lund University, Sweden. 4. Department of Gynecological Oncology, Catholic University of the Sacred Heart, Rome, Italy. 5. Department of Gynecological Oncology, European Institute of Oncology, Milan, Italy. 6. Department of Obstetrics and Gynecology, Karolinska University Hospital Huddinge, Stockholm, Sweden. 7. Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy. 8. Institute for the Care of Mother and Child, Prague and Third Faculty of Medicine, Charles University, Prague, Czech Republic. 9. Center of Obstetrics and Gynecology, Vilnius University Hospital, Santariskiu Clinic, Vilnius, Lithuania. 10. Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain. 11. Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain. 12. Department of Obstetrics and Gynecology, National Cancer Institute, Milan, Italy. 13. Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy. 14. Department of Pathology, Karolinska University Hospital, Stockholm, Sweden. 15. Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium. 16. Department of Obstetrics and Gynecology, Clinical Sciences Institute, L. Sacco, Milan, Italy. 17. Department of Electrical Engineering, ESAT-SCD, STADIUS Center for Dynamical Systems, Signal Processing and Data Analysis, KU Leuven, and imec, Leuven, Belgium. 18. Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK. 19. Department of Development and Regeneration, KU Leuven, Leuven, Belgium. 20. Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium. 21. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Abstract
OBJECTIVE: To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: This was a prospective multicenter study of 1714 women with biopsy-confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high-end ultrasound equipment. Clinical and sonographic data were entered into a web-based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c-statistic. RESULTS: In total, 1538 women were included in the final analysis. Median age was 65 (range, 27-98) years, median body mass index was 28.4 (range 16-67) kg/m2 , 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High-risk tumors, compared with low-risk tumors, were less likely to have regular endometrial-myometrial junction (difference of -23%; 95% CI, -27 to -18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non-uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). CONCLUSION: Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high- and low-risk endometrial cancer.
OBJECTIVE: To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: This was a prospective multicenter study of 1714 women with biopsy-confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high-end ultrasound equipment. Clinical and sonographic data were entered into a web-based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c-statistic. RESULTS: In total, 1538 women were included in the final analysis. Median age was 65 (range, 27-98) years, median body mass index was 28.4 (range 16-67) kg/m2 , 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High-risk tumors, compared with low-risk tumors, were less likely to have regular endometrial-myometrial junction (difference of -23%; 95% CI, -27 to -18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non-uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). CONCLUSION: Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high- and low-risk endometrial cancer.
Authors: Sara Imboden; Denis Nastic; Mehran Ghaderi; Filippa Rydberg; Tilman T Rau; Michael D Mueller; Elisabeth Epstein; Joseph W Carlson Journal: PLoS One Date: 2019-03-27 Impact factor: 3.240
Authors: Norbert Stachowicz; Agata Smoleń; Michał Ciebiera; Tomasz Łoziński; Paweł Poziemski; Dariusz Borowski; Artur Czekierdowski Journal: Diagnostics (Basel) Date: 2021-03-04
Authors: L S E Eriksson; D Nastic; P G Lindqvist; S Imboden; H Järnbert-Pettersson; J W Carlson; E Epstein Journal: Ultrasound Obstet Gynecol Date: 2021-09 Impact factor: 7.299