PDF(Pubmed)
Abstract：
UNASSIGNED: Preoperative staging of uterine cancer has recently been implied as an important contribution to an accurate selection of low-risk cases, ultimately avoiding unnecessary lymph node debulking. The aim of this study was to evaluate the validity of transvaginal ultrasonography (TVS) in preoperative staging of uterine cancer in comparison to pelvic magnetic resonance imaging (MRI) and permanent section.
UNASSIGNED: We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI).
UNASSIGNED: Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI.
UNASSIGNED: TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.
UNASSIGNED: We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI).
UNASSIGNED: Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI.
UNASSIGNED: TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.
摘要：
■子宫癌的术前分期最近被暗示为准确选择低风险病例的重要贡献。最终避免不必要的淋巴结缩小。这项研究的目的是与盆腔磁共振成像（MRI）和永久性切开术相比，评估经阴道超声检查（TVS）在子宫癌术前分期中的有效性。
■我们在2017年至2018年之间进行了一项前瞻性纵向多中心试验。纳入标准包括经组织学证实的子宫内膜瘤形成或强烈影像学怀疑的病例。择期手术作为主要治疗的候选人。协议比例(PA)，卡帕统计量(K)，灵敏度,用95%置信区间(95CI)计算特异性和准确性.
■82名患者符合研究条件，平均年龄为68岁(标准差11)。在关于子宫肌层浸润的TVS评估中，戈登和卡尔松的主观和客观方法的灵敏度为79%，79%和67%[95CI63-91；63-91；50-81]，65%的特异性，58%和79%[95CI49-79；42-73；64-89]，总体准确率为72%，68%和73%[95CI61-81；57-78；63-82]。MRI分别表现出敏感性，特异性和总体准确率为92%，70%和82%[95CI77-98；52-85；71-90]。关于宫颈受累，灵敏度分别为31%，对于主观方法，50%和67%[95CI9-61；21-79；35-90]，目的TVS和MRI,特异性为98%，90%和100%[95CI92-100；77-97；94；100]。TVS和MRI在评估宫颈侵犯方面的一致性更好，PA范围为0.82至0.93，K范围为0.45至0.58，而PA范围为0.68至0.73，K范围为0.31至0.50。考虑到宫颈受累的评估，由于MRI显示特异性为100%,因此不可能增加特异性.然而,有可能增加灵敏度，考虑TVS与客观方法和MRI的结合。
■TVS作为子宫内膜癌术前分期的工具可能具有很好的作用，表现出接近MRI的表现，在评估宫颈侵犯方面具有较高的一致性。
■我们在2017年至2018年之间进行了一项前瞻性纵向多中心试验。纳入标准包括经组织学证实的子宫内膜瘤形成或强烈影像学怀疑的病例。择期手术作为主要治疗的候选人。协议比例(PA)，卡帕统计量(K)，灵敏度,用95%置信区间(95CI)计算特异性和准确性.
■82名患者符合研究条件，平均年龄为68岁(标准差11)。在关于子宫肌层浸润的TVS评估中，戈登和卡尔松的主观和客观方法的灵敏度为79%，79%和67%[95CI63-91；63-91；50-81]，65%的特异性，58%和79%[95CI49-79；42-73；64-89]，总体准确率为72%，68%和73%[95CI61-81；57-78；63-82]。MRI分别表现出敏感性，特异性和总体准确率为92%，70%和82%[95CI77-98；52-85；71-90]。关于宫颈受累，灵敏度分别为31%，对于主观方法，50%和67%[95CI9-61；21-79；35-90]，目的TVS和MRI,特异性为98%，90%和100%[95CI92-100；77-97；94；100]。TVS和MRI在评估宫颈侵犯方面的一致性更好，PA范围为0.82至0.93，K范围为0.45至0.58，而PA范围为0.68至0.73，K范围为0.31至0.50。考虑到宫颈受累的评估，由于MRI显示特异性为100%,因此不可能增加特异性.然而,有可能增加灵敏度，考虑TVS与客观方法和MRI的结合。
■TVS作为子宫内膜癌术前分期的工具可能具有很好的作用，表现出接近MRI的表现，在评估宫颈侵犯方面具有较高的一致性。
