Correlation between Depth of Myometrial Invasion and Degree of Lymph Node Affection in Cases of Endometrial Cancer

Introduction: Endometrial cancer is the fourth most frequent cancer in females. Many factors can affect prognosis of this type of cancer, these mainly are the degree of myometrial invasion by the tumour, pelvic and paraaortic lymph node spread as well as the tumour histological type (endometrioid vs non-endometrioid type). transvaginal ultrasound (TVS) is a highly accurate and easy method for preoperative evaluation of myometrial invasion. Aim of the Work: The aim of this work is to assess if there is relation between the depth of myometrial invasion by the tumor and the rate of lymph node involvement in cases of endometrial cancer. Results: It was found that there was a significant relation between lymph node affection and the depth of myometrial invasion, all the positive lymph node affections cases had myomterial invasion > 50.0%. Conclusion: The incidence of pelvic lymph node affection is very high in cases where the myometrium is deeply infiltrated with the tumor. Assessment of myometrial invasion preoperatively by TVU and microscopically by pathological examination of the myometrium after hysterectomy provides an accurate estimation of the rate of pelvic lymph node affection and hence necessitates lymphadenectomy procedures in cases where myometrium is deeply infiltrated by the tumor and omitted in cases where it is tumor free.

A Comparative Study of Transvaginal Sonography and Pelvic MRI in Patients with Endometrial Cancer

Background:The most prevalent type of gynecological cancer is endometrial cancer.Accurate surgical staging is the most important aspect in the management of endometrial cancer.Preoperative evaluation of myometrial invasion and appropriate management could be achieved by transvaginal sonography and pelvic MRI.Methods:A total of 53 patients with endometrial cancer,who were referred to a gynecology oncology department of an academic hospital in Mashhad University of Medical Sciences from 2018 to 2020,were evaluated in this study.Data were collected using a questionnaire on endometrial cancer.All the patients underwent preoperative transvaginal sonography and pelvic MRI to evaluate myometrial invasion.The involvement of myometrium thickness and histological findings were compared between two imaging modalities,and SPSS 23.0 was used to analyze the data.Results:Junctional irregularity was the most prevalent finding on transvaginal sonography.Based on transvaginal sonography,myometrial invasion of less than 50%was found in 73%of patients,while invasion of more than 50%was observed in 26.31%.In 57.44%of MRIs,there was less than 50%myometrial invasion,while in 42.55%of MRIs,there was more than 50%myometrial invasion.In both modalities,the most common finding was myometrial invasion of less than 50%.The accuracy,sensitivity,and specificity of transvaginal sonography were 0.47,0.27,and 0.75,respectively,whereas the accuracy,sensitivity,and specificity of MRI were 0.54,0.45,and 0.61,respectively.Conclusion:MRI can be the modality of choice for evaluating myometrial invasion and optimizing endometrial cancer treatment planning,as well as reducing the complications of non-indicated lymphadenectomy.

Use of contrast-enhanced ultrasound during preoperative evaluation of endometrial carcinoma

Objective:To explore the clinical role of contrast-enhanced ultrasound(CEUS)in a preoperative evaluation of early endometrial carcinoma.Methods:This study included 14 patients who underwent preoperative CEUS and contrast-enhanced magnetic resonance imaging(CEMRI)and were ultimately diagnosed with stage I endometrial carcinoma from December 2019 to December 2020.The parameters of the time-intensity curve(TIC)were compared with the endometrial carcinoma group,the invaded myometrium group,and the normal myometrium group.Results:TIC parameters between the endometrial carcinoma group and the invaded myometrium group were similar.Compared with the normal myometrium group,the time to peak(TTP)was significantly shorter and the ascending slope(AS)was significantly higher in the endometrial carcinoma group.The TTP of the invaded myometrium group was shorter than that of the normal myometrium group and the peak intensity(PI)was higher than that of the normal myometrium group.We then compared the TIC parameters between the endometrial carcinoma group and the invaded myometrium group after adjusting for the normal myometrium group,and the results still did not show any difference.Of the 14 cases of endometrial carcinoma,9 cases were diagnosed by CEMRI and were consistent with the pathology results,1 case was underestimated,and 4 cases were overestimated;while 11 cases diagnosed were diagnosed by CEUS and were consistent with the pathology results,1 case was underestimated,and 2 cases were overestimated.Conclusions:The contrast pulse sequencing technique used in the CEUS examinations performed well in evaluating the extent of the endometrial carcinoma.Future studies with larger sample sizes are needed to determine the applicability and value of this new procedure during preoperative assessments of early endometrial carcinoma.