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Transvaginal Ultrasonography With and Without Saline Infusion in Assessment of Myometrial Invasion of Endometrial Cancer

Iztok Taka, MD, PhD

Gynecology and Perinatology Service, Maribor Teaching Hospital, Maribor, Slovenia.

Address correspondence to Iztok Taka, MD, PhD, Gynecology and Perinatology Service, Maribor Teaching Hospital, Ljubljanska 5, 2000 Maribor, Slovenia. E-mail: iztok.takac{at}sb-mb.si

Objective. The purpose of this study was to determine the diagnostic accuracy of saline infusion ultrasonography (SIUS) compared with transvaginal ultrasonography (TVUS) in the assessment of myometrial invasion of endometrial cancer. Methods. A total of 53 patients with endometrial cancer were examined preoperatively with TVUS and SIUS with respect to myometrial invasion. All patients were postmenopausal. Ultrasonographic findings were compared with histopathologic findings of the surgical specimens. Results. The median age of the patients ± SD was 64 ± 7 years (range, 51–77 years). In all patients, the procedure was well tolerated. The median thickness of malignant endometria was 17 ± 9 mm (range, 2–51 mm). The specimens consisted of 40 endometrioid adenocarcinomas, 2 serous papillary carcinomas, 5 clear cell adenocarcinomas, 2 adenosquamous carcinomas, 3 mixed types, and 1 undifferentiated carcinoma. There were 18 grade G1, 24 G2, and 11 G3 cases. On histopathologic examination, superficial myometrial invasion (50% of the myometrium) was present in 25 specimens (47.2%), and deep myometrial invasion (>50% of the myometrium) was present in 28 (52.8%). For superficial myometrial invasion, evaluation by TVUS was accurate in 19 (76.0%) of 25 cases, and evaluation by SIUS was accurate in 18 (72.0%) of 25. For deep myometrial invasion, evaluation by TVUS was accurate in 24 (85.7%) of 28 cases, and evaluation by SIUS was accurate in 27 (96.4%) of 28. Conclusions. Transvaginal ultrasonography is a reliable method for assessing myometrial invasion of endometrial cancer. Saline infusion ultrasonography showed slightly better accuracy in the assessment of myometrial invasion than TVUS, but the differences were not statistically significant.

Key Words: cancer • endometrium • invasion • myometrium • sonohysterography • transvaginal ultrasonography

Abbreviations: FIGO, International Federation of Gynecology and Obstetrics • SIUS, saline infusion ultrasonography • TVUS, transvaginal ultrasonography