TY - JOUR
T1 - Multivariate assessment of cervical invasion of endometrial carcinoma
T2 - Comparison of transvaginal ultrasonography, hysteroscopy, and magnetic resonance imaging
AU - Miyagi, Yasunari
AU - Yamada, Shinako
AU - Miyagi, Yuji
AU - Yamamoto, Junko
AU - Kawanishi, Kunihiro
AU - Ikuhashi, Hiromi
AU - Kodama, Junichi
AU - Yoshinouchi, Mitsuo
AU - Kudo, Takafumi
AU - Joja, Ikuo
PY - 1997/1/1
Y1 - 1997/1/1
N2 - Background: Preoperative assessment of cervical invasion of endometrial cancer is important in terms of surgical planning. It is of value to compare the usefulness of transvaginal ultrasonography, hysteroscopy, and magnetic resonance imaging (MRI) for evaluating the extent of the invasion. This study evaluated these 3 examinations by univariate and multivariate analysis, retrospectively, and investigated the factors responsible for misdiagnosis. Methods: From 1991 to 1995, 71 patients with endometrial cancer at Okayama University Medical School underwent transvaginal ultrasonography with a 6.5-MHz transducer, MRI at 1.5 T, and hysteroscopy using a rigid hysteroscope. The findings of these examinations were compared against pathologic results. Results: The sensitivity/specificity/accuracy were 0.73/0.89/0.86 for transvaginal ultrasonography, 0.73/0.88/0.85 for MRI, and 0.73/0.80/0.79 for hysteroscopy. The coefficient values for transvaginal ultrasonography/MRI/hysteroscopy were 0.69/0.62/-0.21 and 1.99/1.89/0.79 in quantification theory second family analysis and logistic regression, respectively. Misdiagnosed cases had the following factors: (1) large tumor volume; (2) tumor near the internal os; (3) tumor descending from the uterine cavity; (4) polypoid tumor in the endocervix; (5) artifacts due to the use of a cervix dilator made from stems of the seaweed Laminaria japonica;(6) endocervical glandular involvement only; and (7) atypical signals on MRI. Conclusion: For the preoperative assessment of cervical invasion, transvaginal ultrasonography and MRI were the most reliable. Hysteroscopy was least reliable, because of a large number of false-positive results. The use of these examinations in combination, especially transvaginal ultrasonography and MRI, would be of great value in surgical planning for endometrial cancer, considering the factors responsible for misdiagnosis.
AB - Background: Preoperative assessment of cervical invasion of endometrial cancer is important in terms of surgical planning. It is of value to compare the usefulness of transvaginal ultrasonography, hysteroscopy, and magnetic resonance imaging (MRI) for evaluating the extent of the invasion. This study evaluated these 3 examinations by univariate and multivariate analysis, retrospectively, and investigated the factors responsible for misdiagnosis. Methods: From 1991 to 1995, 71 patients with endometrial cancer at Okayama University Medical School underwent transvaginal ultrasonography with a 6.5-MHz transducer, MRI at 1.5 T, and hysteroscopy using a rigid hysteroscope. The findings of these examinations were compared against pathologic results. Results: The sensitivity/specificity/accuracy were 0.73/0.89/0.86 for transvaginal ultrasonography, 0.73/0.88/0.85 for MRI, and 0.73/0.80/0.79 for hysteroscopy. The coefficient values for transvaginal ultrasonography/MRI/hysteroscopy were 0.69/0.62/-0.21 and 1.99/1.89/0.79 in quantification theory second family analysis and logistic regression, respectively. Misdiagnosed cases had the following factors: (1) large tumor volume; (2) tumor near the internal os; (3) tumor descending from the uterine cavity; (4) polypoid tumor in the endocervix; (5) artifacts due to the use of a cervix dilator made from stems of the seaweed Laminaria japonica;(6) endocervical glandular involvement only; and (7) atypical signals on MRI. Conclusion: For the preoperative assessment of cervical invasion, transvaginal ultrasonography and MRI were the most reliable. Hysteroscopy was least reliable, because of a large number of false-positive results. The use of these examinations in combination, especially transvaginal ultrasonography and MRI, would be of great value in surgical planning for endometrial cancer, considering the factors responsible for misdiagnosis.
KW - Endometrial cancer
KW - Gynecology
KW - Hysteroscopy
KW - Magnetic resonance imaging
KW - Multivariate analysis
KW - Ultrasound
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U2 - 10.1007/BF02488880
DO - 10.1007/BF02488880
M3 - Article
AN - SCOPUS:0344053423
VL - 2
SP - 97
EP - 102
JO - International Journal of Clinical Oncology
JF - International Journal of Clinical Oncology
SN - 1341-9625
IS - 2
ER -
