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Clinical and ultrasound characteristics of the microcystic elongated and fragmented (MELF) pattern in endometrial cancer according to the International Endometrial Tumor Analysis (IETA) criteria
  1. Linda S E Eriksson1,2,
  2. Denis Nastic3,
  3. Filip Frühauf4,
  4. Daniela Fischerova4,
  5. Kristyna Nemejcova5,
  6. Francesca Bono6,
  7. Dorella Franchi7,
  8. Robert Fruscio8,
  9. Mariacristina Ghioni9,
  10. Lucia A Haak10,11,
  11. Vaclav Hejda12,
  12. Raimundas Meskauskas13,
  13. Gina Opolskiene14,
  14. M Angela Pascual15,
  15. Antonia Testa16,
  16. Francisco Tresserra17,
  17. Gian Franco Zannoni18,
  18. Joseph W Carlson3 and
  19. Elisabeth Epstein2,19
  1. 1 Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
  2. 2 Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Pathology and Cytology and Institution for Oncology-Pathology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
  4. 4 Gynecological Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
  5. 5 Department of Pathology, First Faculty of Medicine, Charles University, Prague, Czech Republic
  6. 6 Pathology Unit, San Gerardo Hospital, Monza, Italy
  7. 7 Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
  8. 8 Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
  9. 9 Division of Pathology, European Institute of Oncology, Milan, Italy
  10. 10 Institute for the Care of Mother and Child, Prague, Czech Republic
  11. 11 Third Faculty of Medicine, Charles University, Prague, Czech Republic
  12. 12 Institute for the Care of Mother and Child, Praque, Czech Republic
  13. 13 National Centre of Pathology, Vilnius, Lithuania
  14. 14 Center of Obstetrics and Gynecology, Vilnius University Hospital, Santariskiu Clinic, Vilnius, Lithuania
  15. 15 Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
  16. 16 Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
  17. 17 Department of Pathology and Cytology, Hospital Universitario Dexeus, Barcelona, Spain
  18. 18 Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
  19. 19 Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
  1. Correspondence to Linda S E Eriksson, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm 171 76, Sweden; linda.eriksson{at}sll.se

Abstract

Objectives To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer.

Methods/materials We included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases.

Results The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion ≥ 50% (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011).

Conclusions Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.

  • ultrasonography
  • diagnostic imaging
  • endometrial neoplasms
  • neoplasm staging
  • MELF
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Footnotes

  • Correction notice There have been some layout and grammar changes to this article since it was first published. No data or text has been changed.

  • Funding This study was supported by grants from the Swedish government; Avtal om Läkarutbildning och Forskning (ALF), ALF-Stockholm County (Grant no 550411); and cancer research funding from Radiumhemmet Stockholm Sweden (Grant no 154112).

  • Provenance and peer review Not commissioned, externally peer reviewed.

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