Prediction of Myometrial Invasion Depth and Staging in Endometrial Cancer Patients with Three-Dimensional Ultrasonography Using VOCAL Technique: A Prospective Study

Year 2025, Volume: 7 Issue: 1, 88 - 94, 25.02.2025

Gizem Işık , Bengü Mutlu Sütcüoğlu , Yağmur Soykan , Ferah Kazancı , Özlem Erdem , M.anıl Onan

https://doi.org/10.52827/hititmedj.1388759

Abstract

Objective: In this study, the aim was to compare preoperative endometrial volume measurements using three-dimensional transvaginal ultrasonography in cases of endometrioid type endometrial cancer with both intraoperative frozen results and final pathology results.
Material and Method: Ultrasonography was performed using a GE Voluson E6 ultrasound device with a threedimensional transvaginal probe immediately before surgery for all endometrial cancer patients who had endometrial biopsy results of the endometrioid type. Endometrial volume measurement was calculated in cm3 using the VOCAL method for uterine total volume measurement, and drawings were made for endometrial thickness and disease-free myometrial volumes. Volume measurements were prospectively recorded along with frozen and final pathology results.
Results: A total of 50 patients were included in the study. There was no statistically significant difference between three-dimensional transvaginal ultrasonography measurements of endometrium, myometrium, and uterine volumes when myometrial invasion was less than or greater than 50% (p=0.3, p=0.3, p=0.6, respectively). Similarly, no statistically significant difference was found in the ratio of endometrial volume to uterine volume when evaluating myometrial invasion below and above 50% (p=0.21).
Conclusion: While three-dimensional transvaginal ultrasonography offers the possibility of three-dimensional
volume measurement of the uterus and holds promise for predicting myometrial infiltration, our study has shown that it is still a technique that requires further investigation. More research is needed to assess its usability in the context of endometrial cancer invasion.

Keywords

endometrial cancer, predictiveness, prognosis, three-dimensional ultrasonography, ultrasonography

Ethical Statement

Ethics committee approval was obtained before starting the study.

Supporting Institution

none

Thanks

none

Endometrium Kanseri Hastalarında 3D Ultrasonografi VOCAL Teknikle Myometriyal İnvazyon Derinliği ve Evre Prediksiyonu: Prospektif Çalışma

Abstract

Amaç: Bu çalışmada, endometrioid tip endometrium kanserli vakaların üç boyutlu – transvajinal ultrasonografi ile preoperatif endometrial volüm ölçümlerinin hem intraoperatif frozen sonuçları hem de nihai patoloji sonuçları ile karşılaştırılması hedeflenmiştir.
Gereç ve Yöntem: ÇEndometrial biyopsi sonuçları endometrioid tip gelen, operasyon için hospitalize edilen tüm endometrium kanseri hastalarına operasyondan hemen önce GE Voluson E6 ultrasonografi cihazı ile üç boyutlu transvajinal probu kullanılarak ultrasonografi yapıldı. Endometrial volüm ölçümü, uterin total volüm ölçümü VOCAL yöntemi kullanılarak; endometrium kalınlığı ve hastalıksız myometrium volümleri çizim yapılarak cm3 olarak hesaplandı. Volüm ölçümleri, frozen ve nihai patoloji sonuçları prospektif olarak kaydedildi.
Bulgular: Çalışmaya toplam 50 hasta dâhil edildi. Myometerium invazyonunun %50’den az ya da çok olması ile, üç boyutlu – transvajinal ultrasonografi ile yapılan endometrium, myometrium ve uterus volüm ölçümleri arasında istatistiksel anlamlı fark saptanmamıştır (sırasıyla p=0,3, p=0,3, p=0,6). Endometrium volümünün uterus volümüne oranı değerlendirildiğinde yine myometrial invazyon %50 altında ve üzerinde olan gruplarda istatistiksel anlamlı fark saptanmamıştır (p=0,21).
Sonuç: Üç boyutlu – transvajinal ultrasonografi uterusun üç boyutlu volüm ölçümüne olanak sağladığından, myometrial infiltrasyon prediksiyonunda umut vaadedici olsa da, alışmamızın sonucu da göstermiştir ki halen araştırılması gereken bir tekniktir. Endometrial kanser invazyonu açısından kullanılabilirliğini ölçebilmek adına daha çok çalışmaya ihtiyaç vardır.

Keywords

endometerium kanseri, prognoz, prediktivite, ultasonografi, Üç boyutlu ultrasonografi

Ethical Statement

Çalışmaya başlanmadan önce etik kurul onayı alınmıştır.

Supporting Institution

-

Thanks

-

References

• Deo S, Sharma J, Kumar S. GLOBOCAN 2020 report on global cancer burden: challenges and opportunities for surgical oncologists. Annals of Surgical Oncology 2022;29(11):6497-6500.
• May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database of Systematic Reviews 2010 Jan 20:(1):CD007585.
• Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK. Prognostic significance of gross myometrial invasion with endometrial cancer. Obstetrics & Gynecology 1996;88(3):394-398.
• Cacciatore B, Lehtovirta P, Wahlström T, Ylänen K, Ylöstalo P. Contribution of vaginal scanning to sonographic evaluation of endometrial cancer invasion. Acta Oncologica 1989;28(4):585-588.
• Ergenoglu M, Akman L, Terek M, et al. The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital. Medical Ultrasonography 2016;18(2):201-206.
• Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in earlystage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008;100(23):1707-1716.
• AlHilli MM, Podratz KC, Dowdy SC, et al. Risk-scoring system for the individualized prediction of lymphatic dissemination in patients with endometrioid endometrial cancer. Gynecol Oncol 2013;131(1):103-108.
• Yildirim N, Saatli B, Kose S, et al. Predictability of myometrial, lower uterine segment and cervical invasion with 3D transvaginal ultrasonography and magnetic resonance imaging in endometrial cancer patients: a prospective cohort study. Med Ultrason 2018;20(3):348-354.
• Torricelli P, Ferraresi S, Fiocchi F, et al. 3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer. American Journal of Roentgenology 2008;190(2):489-495.
• Alcazar JL, Gaston B, Navarro B, Salas R, Aranda J, Guerriero S. ransvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis. J Gynecol Oncol 2017;28(6):e86.
• Akbayir O, Corbacioglu A, Numanoglu C, et al. Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma by transvaginal ultrasound. Gynecol Oncol 2011;122(3):600-603.
• Haldorsen IS, Salvesen HB. What Is the Best Preoperative Imaging for Endometrial Cancer? Curr Oncol Rep 2016;18(4):25.
• Christensen JW, Dueholm M, Hansen ES, Marinovskij E, Lundorf E, Ortoft G. Assessment of myometrial invasion in endometrial cancer using three-dimensional ultrasound and magnetic resonance imaging. Acta Obstet Gynecol Scand 2016;95(1):55-64.
• Saarelainen SK, Koobi L, Jarvenpaa R, Laurila M, Maenpaa JU. The preoperative assessment of deep myometrial invasion by three-dimensional ultrasound versus MRI in endometrial carcinoma. Acta Obstet Gynecol Scand 2012;91(8):983-990.
• Stachowiak G, Zajac A, Pertynska-Marczewska M, Stetkiewicz T. 2D/3D ultrasonography for endometrial evaluation in a cohort of 118 postmenopausal women with abnormal uterine bleedings. Ginekol Pol 2016;87(12):787-792.
• Spagnol G, Noventa M, Bonaldo G, et al. Three-dimensional transvaginal ultrasound vs magnetic resonance imaging for preoperative staging of deep myometrial and cervical invasion in patients with endometrial cancer: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2022;60(5):604-611.
• Ergenoglu M, Akman L, Terek MC, et al. The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital. Med Ultrason 2016;18(2):201-206.
• 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.