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433 Myometrial infiltration assessment in low-risk endometrial cancer by 3D transvaginal ultrasound and diffusion-weighted magnetic resonance imaging
  1. N Carreras Diéguez1,
  2. M Munmany2,
  3. C De Guirior3,
  4. P Fusté1,
  5. I Matas3,
  6. B Diaz-Feijoo1,
  7. AG Glickman1,
  8. L Buñesch4,
  9. N Agustí1,
  10. C Ros3,
  11. M Sebastià4,
  12. M Del Pino1,
  13. A Saco5,
  14. C Nicolau4,
  15. J Ordi5 and
  16. A Torne1
  1. 1Hospital Clínic de Barcelona, Gynaecologic Oncology Unit, Barcelona, Spain
  2. 2Hospital Clínic de Barcelona, Gynaecology, Obstetrics and Neonatology , Barcelona, Spain
  3. 3Hospital Clínic de Barcelona, Gynaecology, Obstetrics and Neonatology, Barcelona, Spain
  4. 4Hospital Clínic de Barcelona, Radiology, Barcelona, Spain
  5. 5Hospital Clínic de Barcelona, Pathology Department, Barcelona, Spain


Introduction/Background*In patients with early-stage, grade 1-2, endometrioid endometrial cancer, preoperative assessment of myometrial invasion is essential to define the need of pelvic and paraaortic lymph node dissection. Our aim was to evaluate the role of three-dimensional transvaginal ultrasound (3D-TVUS) and diffusion-weighted magnetic resonance imaging (DW-RMI) for the assessment of myometrial infiltration in patients with well-differentiated (G1) or moderately differentiated (G2) endometrioid endometrial carcinoma (EC).

Methodology We performed a retrospective observational study. Myometrial infiltration was assessed by 3D-TVUS and DW-MRI in 152 women with G1 or G2 endometroid EC who underwent surgical treatment in a tertiary referral center between 2012 and 2019. Sensitivity, specificity, predictive values and accuracy for the two techniques and for a combination of both were computed. Definitive histopathological data in the surgical specimen regarding myometrial infiltration was used as ‘Gold Standard’.

Result(s)*One hundred and fifty-two patients were included, 120 (79%) patients presented myometrial infiltration <50% in postoperative analysis of surgical specimen and 32 (21%) patients presented deep myometrial infiltration (>50%). 3D-TVUS and DW-MRI showed an agreement of 78.9% with a kappa index of 0.44 for the detection of deep myometrial infiltration. Sensitivity, specificity and accuracy of 3D-TVUS for the detection of deep myometrial infiltration were 71.0%, 80.5% and 78.5% respectively. Evaluation of myometrial infiltration with DW-MRI had a sensitivity, specificity and accuracy of 76.2%, 84.4% and 82.9% respectively. Association of both techniques increased sensitivity and specificity up to 84.6% and 93.2% and provided a low false negative rate (2.3%).

Conclusion*The combination of 3D-TVUS and DW-RMI offers a high sensitivity and specificity to identify deep myometrial infiltration in patients with endometrioid G1 or G2 EC, thus these patients might benefit from performance of both techniques in preoperative evaluation.

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