Background: Myometrial invasion is one of the most important prognostic factors in the preoperative evaluation of patients with endometrial cancer. Several techniques have been used for the preoperative evaluation such as transvaginal ultrasound (TVS), magnetic resonance imaging (MRI) and computed tomography (CT). Transvaginal ultrasound has been shown to have comparable accuracy with MRI, cost effective and is widely available. Main Objective: To determine the diagnostic accuracy of 2D transvaginal ultrasound in assessing myometrial infiltration by measuring the tumor free distance (TFD) and depth of invasion (DOI) among patients with endometrial cancer admitted for elective gynecologic surgery at Philippine General Hospital Department of Obstetrics and Gynecology. Methods: This prospective validation study involved 49 patients with endometrial cancer admitted for elective surgery at the Department of Obstetrics and Gynecology of the Philippine General Hospital from October 1, 2016 to February 28, 2017. All patients had 2D transvaginal ultrasound at least within 1 week prior to schedule of surgery. The tumor free distance (TFD) and the depth of invasion (DOI) were prospectively measured and compared with the histopathologic result. Diagnostic accuracy in assessing myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound were computed and test of association was done using 2x2 Fischer Exact test at 0.05? while AUC-ROC was plotted. Results: The association between transvaginal ultrasound and final histopathology in assessing the myometrial infiltration was statistically significant (p=0.004). Moreover, the transvaginal ultrasound for assessing myometrial infiltration demonstrated 94.4% sensitivity and 43.8% specificity in detecting >50% infiltration wherein a likelihood would likely to occur by 1.68 times higher than those with <50% based on the final histopathology. Moreover, the accuracy values of TVS reflected in the AUC index were as follows, a TFD cut off value of ?0.82cm showed a higher sensitivity (46.88%) and specificity (100%) in predicting >50% myometrial infiltration while a DOI ratio of 0.50 is the cut off value which initiated a sensitivity (16.7%) and a higher specificity (75%) in predicting >50% infiltration. Finally, TFD (AUC = 0.749) yielded a higher accuracy as compared with DOI (AUC = 0.388) in predicting myometrial infiltration. Conclusion Assessment of myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound among patients with endometrial cancer demonstrated clinically acceptable accuracy with higher sensitivity in detecting >50% myometrial infiltration. TFD (cut off value of ?0.82cm) has a higher accuracy compared with DOI in predicting >50% myometrial infiltration.
Endometrial Neoplasms