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Intraoperative Ex Vivo High-Resolution Sonography: A Novel Technique for the Assessment of Myometrial Invasion in Endometrial Cancer
  1. Derman Basaran, MD*,
  2. Mehmet Coskun Salman, MD*,
  3. Gokhan Boyraz, MD*,
  4. Deniz Akata, MD,
  5. Mustafa Ozmen, MD,
  6. Alp Usubutun, MD,
  7. Nejat Ozgul, MD* and
  8. Kunter Yuce, MD*
  1. * From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
  2. Department of Radiology, and
  3. Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
  1. Address correspondence and reprint requests to Derman Basaran, MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Sihhiye 06100, Ankara, Turkey. E-mail: dermanbasaran{at}


Objective This study aims to assess the diagnostic performance of a novel intraoperative ex vivo ultrasonography technique in determining deep myometrial invasion (MI) in patients with apparently low-risk endometrial cancer (EC).

Methods This prospective study included patients with type I EC who underwent staging laparotomy at Hacettepe University Hospital from December 2011 to September 2014. After hysterectomy, a radiologist with special training in gynecology examined the uterus ex vivo using a 12-MHz superficial linear probe. The specimen was sent for intraoperative frozen section (FS) analysis. The results were compared with permanent section reports.

Results In total, 45 female patients were eligible for analysis. Intraoperative ex vivo high-resolution sonography (IEVHS) correctly assessed depth of MI in 39 of 45 cases (86.6%) and overestimated it in 5 cases (11.1%). Only 1 case with deep infiltration was underestimated by IEVHS as invasion of less than one half of the myometrium. Frozen section correctly identified depth of MI in 41 of 46 cases (91.1%), overestimated it in 1 case (2.2%), and underestimated it in 3 cases (6.6%). The sensitivity, specificity, positive predictive value, and negative predictive value of IEVHS and FS for assessment of deep MI were 87.5%, 86.4%, 58.3%, and 96.9%, and 62.5%, 97.3%, 83.3%, and 92.3%, respectively.

Conclusions Intraoperative ex vivo high-resolution sonography is a novel technique for assessing MI in EC. Its high sensitivity for deep MI could be useful as an adjunct to FS (enabling pathologists to obtain targeted FS slices) and could improve the accuracy of FS.

  • Endometrial cancer
  • Myometrial invasion
  • Ultrasonography
  • Frozen section

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  • The authors declare no conflicts of interest.

  • This study was presented in part at the 15th Biennial Meeting of the International Gynecologic Cancer Society, November 8–11, 2014, Melbourne, Australia (poster presentation IGCSM-0924).