Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy

Rasmus W Green, Lil Valentin, Juan Luis Alcazar, Valentina Chiappa, Balazs Erdodi, Dorella Franchi, Filip Frühauf, Robert Fruscio, Stefano Guerriero, Betlem Graupera, Attila Jakab, Alessia di Legge, Manuela Ludovisi, Floriana Mascilini, M Angela Pascual, Thierry van den Bosch, Elisabeth Epstein

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy.

METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ).

RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually.

CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.

Original languageEnglish
Pages (from-to)438-445
Number of pages8
JournalGynecologic Oncology
Volume150
Issue number3
DOIs
Publication statusPublished - Sep 2018

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Neoplasm Staging
Endometrial Neoplasms
Surgical Instruments
Nonparametric Statistics
Hysterectomy
Biopsy

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Contrast Media
  • Endometrial Neoplasms/diagnostic imaging
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Middle Aged
  • Myometrium/diagnostic imaging
  • Neoplasm Invasiveness
  • Neoplasm Staging/methods
  • Observer Variation
  • Reproducibility of Results
  • Retrospective Studies
  • Ultrasonography/methods

Cite this

Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging : Intermethod agreement, interrater reliability and diagnostic accuracy. / Green, Rasmus W; Valentin, Lil; Alcazar, Juan Luis; Chiappa, Valentina; Erdodi, Balazs; Franchi, Dorella; Frühauf, Filip; Fruscio, Robert; Guerriero, Stefano; Graupera, Betlem; Jakab, Attila; di Legge, Alessia; Ludovisi, Manuela; Mascilini, Floriana; Pascual, M Angela; van den Bosch, Thierry; Epstein, Elisabeth.

In: Gynecologic Oncology, Vol. 150, No. 3, 09.2018, p. 438-445.

Research output: Contribution to journalArticle

Green, RW, Valentin, L, Alcazar, JL, Chiappa, V, Erdodi, B, Franchi, D, Frühauf, F, Fruscio, R, Guerriero, S, Graupera, B, Jakab, A, di Legge, A, Ludovisi, M, Mascilini, F, Pascual, MA, van den Bosch, T & Epstein, E 2018, 'Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy', Gynecologic Oncology, vol. 150, no. 3, pp. 438-445. https://doi.org/10.1016/j.ygyno.2018.06.027
Green, Rasmus W ; Valentin, Lil ; Alcazar, Juan Luis ; Chiappa, Valentina ; Erdodi, Balazs ; Franchi, Dorella ; Frühauf, Filip ; Fruscio, Robert ; Guerriero, Stefano ; Graupera, Betlem ; Jakab, Attila ; di Legge, Alessia ; Ludovisi, Manuela ; Mascilini, Floriana ; Pascual, M Angela ; van den Bosch, Thierry ; Epstein, Elisabeth. / Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging : Intermethod agreement, interrater reliability and diagnostic accuracy. In: Gynecologic Oncology. 2018 ; Vol. 150, No. 3. pp. 438-445.
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title = "Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy",
abstract = "OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy.METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50{\%}) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ).RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76{\%} (range 64-93{\%}) and for CSI median 88{\%} (range 79-97{\%}). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76{\%} (range 59-84{\%}) with 2D-TVU and 69{\%} (range 52-83{\%}) for 3D-VCI; the corresponding figures for CSI were 88{\%} (range 81-93{\%}) and 86{\%} (range 72-95{\%}). Accuracy was significantly correlated to how many cases the raters assessed annually.CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.",
keywords = "Adult, Aged, Aged, 80 and over, Contrast Media, Endometrial Neoplasms/diagnostic imaging, Female, Humans, Imaging, Three-Dimensional, Middle Aged, Myometrium/diagnostic imaging, Neoplasm Invasiveness, Neoplasm Staging/methods, Observer Variation, Reproducibility of Results, Retrospective Studies, Ultrasonography/methods",
author = "Green, {Rasmus W} and Lil Valentin and Alcazar, {Juan Luis} and Valentina Chiappa and Balazs Erdodi and Dorella Franchi and Filip Fr{\"u}hauf and Robert Fruscio and Stefano Guerriero and Betlem Graupera and Attila Jakab and {di Legge}, Alessia and Manuela Ludovisi and Floriana Mascilini and Pascual, {M Angela} and {van den Bosch}, Thierry and Elisabeth Epstein",
note = "Copyright {\circledC} 2018 Elsevier Inc. All rights reserved.",
year = "2018",
month = "9",
doi = "10.1016/j.ygyno.2018.06.027",
language = "English",
volume = "150",
pages = "438--445",
journal = "Gynecologic Oncology",
issn = "0090-8258",
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}

TY - JOUR

T1 - Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging

T2 - Intermethod agreement, interrater reliability and diagnostic accuracy

AU - Green, Rasmus W

AU - Valentin, Lil

AU - Alcazar, Juan Luis

AU - Chiappa, Valentina

AU - Erdodi, Balazs

AU - Franchi, Dorella

AU - Frühauf, Filip

AU - Fruscio, Robert

AU - Guerriero, Stefano

AU - Graupera, Betlem

AU - Jakab, Attila

AU - di Legge, Alessia

AU - Ludovisi, Manuela

AU - Mascilini, Floriana

AU - Pascual, M Angela

AU - van den Bosch, Thierry

AU - Epstein, Elisabeth

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2018/9

Y1 - 2018/9

N2 - OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy.METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ).RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually.CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.

AB - OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy.METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ).RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually.CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Contrast Media

KW - Endometrial Neoplasms/diagnostic imaging

KW - Female

KW - Humans

KW - Imaging, Three-Dimensional

KW - Middle Aged

KW - Myometrium/diagnostic imaging

KW - Neoplasm Invasiveness

KW - Neoplasm Staging/methods

KW - Observer Variation

KW - Reproducibility of Results

KW - Retrospective Studies

KW - Ultrasonography/methods

U2 - 10.1016/j.ygyno.2018.06.027

DO - 10.1016/j.ygyno.2018.06.027

M3 - Article

C2 - 30029961

VL - 150

SP - 438

EP - 445

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 3

ER -