Download PDF
Ultraschall Med 2023; 44(03): 280-289
DOI: 10.1055/a-1408-2292
Review

Preoperative Assessment of Cervical Involvement in Endometrial Cancer by Transvaginal Ultrasound and Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

Präoperative Bewertung der Zervixbeteiligung bei Endometriumkarzinom mittels transvaginalen Ultraschalls und Magnetresonanztomografie: Ein systematischer Review und Metaanalyse
Juan Luis Alcazar 
1   Obstetrics and Gynecology, University of Navarra Clinic, Pamplona, Spain
,
Patricia Carazo
2   Obstetrics and Gynecology, University Hospital Complex Badajoz, Spain
,
Leyre Pegenaute
3   Obstetrics and Gynecology, Araba University Hospital Txagorritxu Campus, Vitoria-Gasteiz, Spain
,
Elena Gurrea
4   Obstetrics and Gynecology, Virgen de la Arrixaca University Hospital, El Palmar, Spain
,
Irene Campos
4   Obstetrics and Gynecology, Virgen de la Arrixaca University Hospital, El Palmar, Spain
,
Manuela Neri
5   Obstetrics and Gynecology, Università degli Studi di Cagliari, Italy
,
Maria Angela Pascual 
6   Obstetrics and Gynecology, Institut Universitari Dexeus, Barcelona, Spain
,
Stefano Guerriero 
5   Obstetrics and Gynecology, Università degli Studi di Cagliari, Italy
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for detecting cervical infiltration by endometrial carcinoma using meta-analysis assessment.

Methods An extensive search of papers comparing TVS and MRI for assessing cervical infiltration in endometrial cancer in the same set of patients was performed in Medline (Pubmed), Web of Science, and the Cochrane Database. Quality was assessed using QUADAS-2 tool (Quality Assessment of Diagnostic Accuracy Studies-2). Quantitative meta-analysis was performed.

Results Our extended search identified 12 articles that used both techniques in the same set of patients and were included in the meta-analysis. The risk of bias for most studies was high for patient selection and index tests in QUADAS-2. Overall, the pooled estimated sensitivity and specificity for diagnosing cervical infiltration in women with endometrial cancer were identical for both techniques [69 % (95 % CI, 51 %–82 %) and 93 % (95 % CI, 90 %–95 %) for TVS, and 69 % (95 % CI, 57 %–79 %) and 91 % (95 % CI, 90 %–95 %) for MRI, respectively]. No statistical differences were found when comparing both methods. Heterogeneity was high for sensitivity and moderate for specificity when analyzing TVS and moderate for both sensitivity and specificity in the case of MRI.

Conclusion TVS and MRI showed very similar diagnostic performance for diagnosing cervical involvement in women with endometrial cancer.

Zusammenfassung

Ziel Vergleich der diagnostischen Genauigkeit des transvaginalen Ultraschalls (TVS) und der Magnetresonanztomografie (MRT) zum Nachweis einer Zervixbeteiligung bei Endometriumkarzinom mittels Metaanalyse.

Methoden In Medline (PubMed), Web of Science und der Cochrane-Datenbank wurde eine umfassende Suche nach Artikeln durchgeführt, in denen TVS und MRT hinsichtlich der Bewertung der zervikalen Infiltration in der gleichen Patientengruppe verglichen wurden. Die Qualität wurde mit dem QUADAS-2-Tool (Quality Assessment of Diagnostic Accuracy Studies-2) bewertet. Eine quantitative Metaanalyse wurde durchgeführt.

Ergebnisse Unsere erweiterte Suche identifizierte 12 Artikel, die beide Techniken bei der gleichen Patientengruppe anwendeten und in die Metaanalyse aufgenommen wurden. Das Biasrisiko war in den meisten Studien für die Patientenauswahl und die Index-Tests in QUADAS-2 hoch. Insgesamt waren die gepoolte geschätzte Sensitivität und Spezifität für die Diagnose einer zervikalen Infiltration bei Frauen mit Endometriumkarzinom für beide Techniken identisch (69 % (95 %-KI 51–82 %) und 93 % (95 %-KI 90–95 %) für TVS bzw. 69 % (95 %-KI 57–79 %) und 91 % (95 %-KI 90–95 %) für MRT). Beim Vergleich der beiden Methoden wurden keine statistischen Unterschiede festgestellt. Die Heterogenität war hoch für die Sensitivität und moderat für die Spezifität bei der TVS und moderat sowohl für die Sensitivität als auch für die Spezifität bei der MRT.

Schlussfolgerung TVS und MRT zeigten eine sehr ähnliche diagnostische Leistung für die Diagnose einer Zervixbeteiligung bei Frauen mit Endometriumkarzinom.

Key words

endometrial cancer - ultrasound - MRI - cervical infiltration - gynecology


Publication History

Received: 29 October 2020

Accepted: 09 February 2021

Article published online:
23 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lortet-Tieulent J, Ferlay J, Bray F. et al International patterns and trends in endometrial cancer incidence, 1978–2013. J Natl Cancer Inst 2018; 110: 354-361 . doi:10.1093/jnci/djx214
    CrossrefPubMedGoogle Scholar
  • 2 Amant F, Mirza MR, Koskas M. et al Cancer of the corpus uteri. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 37-50 . doi:10.1002/ijgo.12612
    CrossrefPubMedGoogle Scholar
  • 3 Colombo N, Creutzberg C, Amant F. et al ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 2016; 26: 2-30 . doi:10.1097/IGC.0000000000000609
    CrossrefPubMedGoogle Scholar
  • 4 Luomaranta A, Leminen A, Loukovaara M. Magnetic resonance imaging in the assessment of high-risk features of endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer 2015; 25: 837-842 . doi:10.1097/IGC.0000000000000194
    CrossrefPubMedGoogle Scholar
  • 5 Bi Q, Chen Y, Wu K. et al The Diagnostic Value of MRI for Preoperative Staging in Patients with Endometrial Cancer: A Meta-Analysis. Acad Radiol 2020; 27: 960-968 . doi:10.1016/j.acra.2019.09.018
    CrossrefPubMedGoogle Scholar
  • 6 Alcázar JL, Pérez L, Güell O. et al Diagnostic performance of transvaginal ultrasound for detecting cervical invasion in women with endometrial carcinoma: a systematic review and meta-analysis. J Ultrasound Med 2019; 38: 179-189 . doi:10.1002/jum.14682
    CrossrefPubMedGoogle Scholar
  • 7 Sotiriadis A, Papatheodorou SI, Martins WP. Synthesizing Evidence from Diagnostic Accuracy TEsts: the SEDATE guideline. Ultrasound Obstet Gynecol 2016; 47: 386-395 . doi:10.1002/uog.15762
    CrossrefPubMedGoogle Scholar
  • 8 Moher D, Liberati A, Tetzlaff J. et al Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535 . doi:10.1136/bmj.b2535
    Google Scholar
  • 9 Whiting PF, Rutjes AWS, Westwood ME. et al QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536 . doi:10.7326/0003-4819-155-8-201110180-00009
    CrossrefPubMedGoogle Scholar
  • 10 Higgins JPT, Thompson SG, Deeks JJ. et al Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560 . doi:10.1136/bmj.327.7414.557
    Google Scholar
  • 11 Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005; 58: 882-893 . doi:10.1016/j.jclinepi.2005.01.016
    CrossrefPubMedGoogle Scholar
  • 12 Toki T, Oka K, Nakayama K. et al A comparative study of pre-operative procedures to assess cervical invasion by endometrial carcinoma. Br J Obstet Gynaecol 1998; 105: 512-516 . doi:10.1111/j.1471-0528.1998.tb10151.x
    CrossrefPubMedGoogle Scholar
  • 13 Savelli L, Ceccarini M, Ludovisi M. et al Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol 2008; 31: 560-566 . doi:10.1002/uog.5295
    CrossrefPubMedGoogle Scholar
  • 14 Cicinelli E, Marinaccio M, Barba B. et al Reliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: a comparative study with transvaginal sonography and MRI. Gynecol Oncol 2008; 111: 55-61 . doi:10.1016/j.ygyno.2008.06.022
    CrossrefPubMedGoogle Scholar
  • 15 Celik C, Ozdemir S, Kiresi D. et al Evaluation of cervical involvement in endometrial cancer by transvaginal sonography, magnetic resonance imaging and frozen section. J Obstet Gynaecol 2010; 30: 302-307 . doi:10.3109/01443610903521890
    CrossrefPubMedGoogle Scholar
  • 16 Ørtoft G, Dueholm M, Mathiesen O. et al Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy. Acta Obstet Gynecol Scand 2013; 92: 536-545 . doi:10.1111/aogs.12103
    CrossrefPubMedGoogle Scholar
  • 17 Antonsen SL, Jensen LN, Loft A. et al MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer – a multicenter prospective comparative study. Gynecol Oncol 2013; 128: 300-308 . doi:10.1016/j.ygyno.2012.11.025
    CrossrefPubMedGoogle Scholar
  • 18 Yin XH, Jia HY, Shi M. et al Magnetic resonance imaging for detection of depth of myometrial invasion and cervical invasion in patients with endometrial carcinoma. Int J Clin Exp Med 2015; 8: 19501-19505
    PubMedGoogle Scholar
  • 19 Angioli R, Plotti F, Capriglione S. et al Preoperative local staging of endometrial cancer: the challenge of imaging techniques and serum biomarkers. Arch Gynecol Obstet 2016; 294: 1291-1298 . doi:10.1007/s00404-016-4181-z
    CrossrefPubMedGoogle Scholar
  • 20 Christensen JW, Dueholm M, Hansen ES. et al Assessment of myometrial invasion in endometrial cancer using three-dimensional ultrasound and magnetic resonance imaging. Acta Obstet Gynecol Scand 2016; 95: 55-64 . doi:10.1111/aogs.12806
    CrossrefPubMedGoogle Scholar
  • 21 Rahmani M, Heydari S, Mousavi A. et al Accuracy of Imaging in Preoperative Local Staging of Endometrial Cancer: Could Imaging Predict Low Risk Patients?. Int J Women's Health Reprod Science 2018; 6: 363-368 . doi:10.15296/ijwhr.2018.59
    CrossrefPubMedGoogle Scholar
  • 22 Brocker KA, Radtke JP, Hallscheidt P. et al Comparison of the determination of the local tumor extent of primary endometrial cancer using clinical examination and 3 Tesla magnetic resonance imaging compared to histopathology. Arch Gynecol Obstet 2019; 299: 1391-1398 . doi:10.1007/s00404-019-05072-5
    CrossrefPubMedGoogle Scholar
  • 23 Yang T, Tian S, Li Y. et al Magnetic Resonance Imaging (MRI) and Three-Dimensional Transvaginal Ultrasonography Scanning for Preoperative Assessment of High Risk in Women with Endometrial Cancer. Med Sci Monit 2019; 25: 2024-2031 . doi:10.12659/MSM.915276
    CrossrefPubMedGoogle Scholar