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.

Diagnostic value of endometrial thickness determined by transvaginal sonography in infertile women with endometrial polyps

Background Endometrial polyps （EPs） occur in approximately 34.9% of infertile women. Transvaginal sonography （TVS） is a routine, non-invasive component of fertility evaluation. Most ultrasonographic studies of EPs have focused on abnormal uterine bleeding; few have assessed EPs in infertile women. Furthermore, no studies have explored endometrial thickness and its correlation with EPs in infertile women. This study aimed to assess transvaginal sonographic assessment of endometrial thickness and its value in diagnosis and prediction of EPs in infertile women. Methods A retrospective study on 314 infertile women was conducted from June to December 2010. After TVS, endometrial biopsies were obtained by hysteroscopy. Pathologically confirmed EPs were taken as the gold standard. Results Based on recognized criteria, TVS had a sensitivity of 37.04%, specificity of 98.71%, positive predictive value of 90.91%, negative predictive value of 81.85%, and accuracy of 82.80% for diagnosing EPs. Mean endometrial thickness was significantly different in patients with and without EPs （P=0.0001）. In women in the mid and late-proliferative phase, the endometrial thickness was significantly greater in those with EPs than in those without them （P=0.0001 and 0.024）. Receiver operating characteristic analysis showed that endometrial thickness had a sensitivity of 85.2% and specificity of 38% in the diagnosis of EPs, the area under the curve being 0.64. In the mid-proliferative phase, sensitivity was up to 90.9%, the area under the curve being 0.70. Conclusions TVS is poor at detecting EPs in infertile women; however, transvaginal sonographic measurement of endometrial thickness is helpful. It is suggested that the diagnostic value of TVS for EPs in infertile women could be improved by adding the measurement of endometrial thickness to the variables that are routinely assessed.