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464 Comparison of different methods to determine myometrial invasion in endometrial cancer – a nationwide SweGCG study
  1. J Björg1,
  2. M Bjurberg2,
  3. C Borgfeldt3,
  4. P Dahm-Kähler4,
  5. A Flöter-Rådestad5,
  6. K Hellman6,
  7. E Hjerpe7,
  8. E Holmberg8,
  9. P Kjølhede9,
  10. J Marcickiewicz10,
  11. P Rosenberg11,
  12. B Tholander12,
  13. E Åvall-Lundquist13,
  14. K Stålberg1 and
  15. T Högberg14
  1. 1Department of Women’s and Children’s health, Uppsala University, Sweden
  2. 2Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, and Department of Clinical Sciences, Lund University, Sweden
  3. 3Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Sweden
  4. 4Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sweden
  5. 5Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Sweden
  6. 6Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Sweden
  7. 7Department of Obstetrics and Gynecology, Visby Hospital, Sweden
  8. 8Region Västra Götaland, Regional Cancer Centre West, Sweden
  9. 9Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Sweden
  10. 10Department of Obstetrics and Gynecology, Halland Hospital, Sweden
  11. 11Department of Oncology, and Department of Biomedical and Clinical Sciences, Sweden
  12. 12Department of Oncology, Uppsala University Hospital, Sweden
  13. 13Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
  14. 14Department of Cancer Epidemiology, Lund University, Sweden


Background Deep myometrial invasion (MI) (≥50%) is a prognostic factor for lymph node metastases and poorer survival in endometrial cancer. There is no consensus regarding which pre/peroperative diagnostic method should be preferred.

Aim To explore the pattern of different diagnostic methods for MI assessment in Sweden and to evaluate differences between MRI, vaginal ultrasound, frozen section and gross examination in clinical practice.

Methods Women with endometrial cancer registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) between January 2010 and December 2019 were eligible. Inclusion criteria were FIGO stage I-III and available information on histology and on assessment of MI. Data on age, histology, FIGO stage, degree of MI, histology results, method for MI assessment and hospital level were collected from the SQRGC. The final assessment by the pathologist on specimens from hysterectomy was golden standard.

Results The study population included 1,950 women, 33% (n=649) had a MI ≥50%. The methods used for MI assessment were vaginal ultrasound in 54%, MRI in 22%, gross examination in 13% and frozen section in 11% of cases. Age, histology or FIGO stadium did not differ between the methods. The sensitivity, specificity and accuracy of vaginal ultrasound was 61.2%, 83.3% and 0.75% respectively, and for MRI 74.2%, 72.7% and 0.73%. The highest accuracy was for frozen section; 95.0%.

Conclusion The assessment of deep myometrial invasion in endometrial cancer is most often performed with vaginal ultrasound in Sweden. The sensitivity of this method is lower in clinical practice than for MRI and perioperative methods.

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