Ultrasound proves as good as MRI for presurgical staging of endometrial cancer

Transvaginal ultrasound exams conducted by expert practitioners can replace MR imaging for preoperative staging of endometrial cancer. Researchers conclude that expensive MRIs should be reserved for patients whose ultrasound exams are unclear.

Dr. Luca Savelli from the department of obstetrics and gynecology at the University of Bologna and colleagues at hospitals around Italy published their research in Ultrasound in Obstetrics and Gynecology, which made it available online April 9. They studied 74 consecutive patients diagnosed with endometrial carcinoma.

Physicians trained in gynecological ultrasound conducted transvaginal ultrasound exams, and radiologists with an interest in gynecology conducted MRI exams. Both groups looked for neoplastic invasion of the outer half of the myometrium and cervical involvement. The results of these exams were later compared with postsurgical pathological staging of the uterus, adnexa, and pelvic lymph nodes.

The researchers found that in evaluation of myometrial infiltration, transvaginal ultrasound and MRI both had a sensitivity of 84%. Transvaginal ultrasound beat MRI, however, with a specificity of 83% versus 81%, positive predictive value of 79% versus 77%, negative predictive value of 88% versus 87%, and overall diagnostic accuracy of 84% versus 82%.

Transvaginal ultrasound performed even better in the detection of cervical involvement, with a sensitivity of 93% versus MRI's 79%, specificity of 92% versus 87%, positive predictive value of 72% versus 58%, negative predictive value of 98% versus 95%, and overall diagnostic accuracy of 92% versus 85%.

The researchers concluded that expert practitioners could use the cheaper transvaginal ultrasound to provide accurate presurgical staging of endometrial cancer and reserve MRI for those patients who have poor quality ultrasound results.