Preoperative prediction of high-risk endometrial cancer by expert and non-expert transvaginal ultrasonography, magnetic resonance imaging, and endometrial histology

ObjectiveTo identify women with high-risk endometrial cancers using expert and non-expert transvaginal ultrasonography (TVS) MRI.Study designMyometrial involvement was prospectively evaluated in patients atypical hyperplasia or cancer on ultrasound by non-experts at first visit (non-expert-TVS: n = 266) experts (expert-TVS: 188) second visit. MRI (n 175) performed when suspected non-expert-TVS. Preoperatively, defined as myometrial ≥50 %, preoperative unfavorable tumor histology (grade 3 endometrioid, non-endometrioid tumors, cervical biopsies) obtained sampling hysteroscopic biopsies. Preoperative evaluations were compared final histopathology surgery, being FIGO stage ≥1b.ResultsPreoperative seen 64 correctly identified 63 of 128 cancers. diagnosis i.e. judged high-risk, had an area under the curve (AUC), sensitivity, specificity 79.5 93.8 65.2 % non-expert-TVS; 85.5 84.4 86.5 expert-TVS, 85.4 89.6 81.2 MRI. AUC values not significantly different between but lower non-expert-TVS (p < 0.02). However, sensitivity highest non-expert-TVS, where a low cutpoint for used (included potentially deep difficult evaluations) contrast to exact expert-TVS MRI.The AUC, 88.6 determined TVS. Sensitivity reduced 85.9 while increased 91.3 %. Thus, needed risk classification only 104 (39 %) patients.ConclusionDiagnostically, comparable superior classified all unclear thereby misdiagnosed 6.2 cases. Non-expert-TVS combined simple effective method imaging low- select SLND. Addition diagnostic regimen 39 our patients.