Usefulness of Sonohysterography in the Assessment of Myometrial Invasion in Endometrial Carcinoma

Abstract

PURPOSE: To determine the usefulness of sonohysterography (SH) in assessing the presence and depth of myometrial invasion in endometrial carcinoma. MATERIALS AND METHODS: 35 patients with histologically confirmed endometrial cancer were prospectively evaluat-ed with both TVS and SH for the last six years. The presence of myometrial invasion was determined by the disruption of subendometrial halo. The depth of myometrial invasion was estimated by measuring the distance from the tumor myometrial junction to the uterine serosa (thickness of the remaining intact myometrium) and was classified into stage IA (tumor limited to the endometrium), IB (invasion of less than half of the myometrium), and IC (invasion of more than half the myometrium). These findings were correlated with pathologic findings, and both techniques were also compared for the assessment of the diagnostic accuracy in determining myometrial invasion. RESULTS: TVS findings were accurate in 26 of 35 patients with a sensitivity of 66.7%, a specificity of 85.7%, and an accuracy of 74.3%. The results of SH were accurate in 31 of 35 patients and showed a sensitivity of 86.4%, a specificity of 92.3%, and an accuracy of 88.6%. The accuracy of SH in the assessment of myomtetial invasion was significantly higher than those of TVS (p < 0.05). The depth of myometrial invasion was underestimated in seven patients(20%) and overestimated in two patients (5.7%) on TVS, but underestimated in three pa-tients(8.6%) and overestimated in one patient (2.9%) with SH. CONCLUSION: SH was accurate in determining the presence, location, and depth of myometrial invasion in endometrial carcinoma, because the tumor and residual myometrium were clearly delineated. SH could be useful in the diagnosis and the assessment of myometrial invasion in endometrial carcinoma.