Evaluation of pretreatment transvaginal ultrasonography in the management of patients with endometrial carcinoma.

OBJECTIVE: The objective of this study was to evaluate the usefulness of pretreatment assessment with ultrasonography in patients with endometrial carcinoma.

STUDY DESIGN: Fifty patients with endometrial carcinoma diagnosed by endometrial biopsy or curettage were studied before hysterectomy, bilateral salpingo-oophorectomy, and selected lymph node sampling. Ultrasonographic criteria for determination of tumor grade, depth of myometrial invasion, uterine volume, and tumor volume were established. Tumor grade was compared with preoperative and postoperative pathologic diagnoses, depth of invasion was compared with postoperative pathologic evaluation, and uterine volume and tumor volume were compared with postoperative evaluation of tumor grade and depth of invasion. Data were analyzed by chi 2 testing, and, where appropriate, sensitivity, specificity, and accuracy of the ultrasonographic measurements were determined.

RESULTS: The following statistically significant correlations (p less than or equal to 0.05) were found. Ultrasonography predicted tumor grade as accurately as preoperative pathologic evaluation did. Depth of invasion less than or equal to 50% or greater than 50% significantly correlated. Uterine volume less than or equal to 200 ml predicted less than or equal to 50% depth of invasion 28 of 32 times. Uterine volume greater than 500 ml was noted in six cases; five of these had grade 2 or 3 tumor and four had depth of invasion greater than 50%. Tumor volume less than or equal to 20 ml predicted a grade 1 tumor in 25 of 39 cases and depth of invasion less than or equal to 50% in 34 of 39 cases. Tumor volume greater than 20 ml correlated with a grade 2 or 3 tumor in 11 of 11 cases and a depth of invasion greater than 50% in seven of 11 cases. In 25 grade 1 tumors diagnosed postoperatively by pathologic study, none was associated with a tumor volume greater than 20 ml.

CONCLUSION: Pretreatment ultrasonographic measurements should be of value in the management of patients with endometrial carcinoma.