Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists

Ultrasound Obstet Gynecol. 2015 Apr;45(4):476-82. doi: 10.1002/uog.14645.

Abstract

Objectives: To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer.

Methods: Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard.

Results: Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P < 0.01; 83% (95% CI, 78-86%) vs 87% (95% CI, 83-90%), P = 0.02; and kappa, 0.45 (95% CI, 0.40-0.49) vs 0.58 (95% CI, 0.53-0.62), P < 0.001, respectively) but not of deep myometrial invasion (73% (95% CI, 66-79%) vs 73% (95% CI, 66-79%), P = 1.0; 70% (95% CI, 65-75%) vs 69% (95% CI, 63-74%), P = 0.68; and kappa, 0.48 (95% CI, 0.44-0.53) vs 0.52 (95% CI, 0.48-0.57), P = 0.11, respectively). Though interobserver reproducibility (in the context of test proportions 'good' and 'very good', according to kappa) regarding deep myometrial invasion did not differ between the groups (experts, 34% vs gynecologists, 22%, P = 0.13), ultrasound experts assessed cervical stromal invasion with significantly greater interobserver reproducibility than did gynecologists (53% vs 14%, P < 0.001).

Conclusion: Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion.

Keywords: diagnostic imaging; endometrial neoplasms; neoplasm staging; reproducibility of results; ultrasonography; uterine neoplasms.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Cervix Uteri / diagnostic imaging*
  • Cervix Uteri / pathology
  • Endometrial Neoplasms / diagnostic imaging*
  • Endometrial Neoplasms / pathology*
  • Female
  • Humans
  • Middle Aged
  • Myometrium / diagnostic imaging*
  • Myometrium / pathology
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Observer Variation
  • Preoperative Care / methods
  • Preoperative Care / standards
  • Reproducibility of Results
  • Ultrasonography / methods
  • Ultrasonography / standards
  • Vagina