Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: Interobserver reproducibility among ultrasound experts and gynecologists

L. S E Eriksson, P. G. Lindqvist, A. Flöter Rådestad, M. Dueholm, D. Fischerova, D. Franchi, L. Jokubkiene, F. P. Leone, L. Savelli, P. Sladkevicius, A. C. Testa, T. Van Den Bosch, L. Ameye, E. Epstein

Research output: Contribution to journalArticle

Abstract

Objectives: To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer. Methods: Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard. Results: Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P <0.01; 83% (95% CI, 78-86%) vs 87% (95% CI, 83-90%), P = 0.02; and kappa, 0.45 (95% CI, 0.40-0.49) vs 0.58 (95% CI, 0.53-0.62), P <0.001, respectively) but not of deep myometrial invasion (73% (95% CI, 66-79%) vs 73% (95% CI, 66-79%), P = 1.0; 70% (95% CI, 65-75%) vs 69% (95% CI, 63-74%), P = 0.68; and kappa, 0.48 (95% CI, 0.44-0.53) vs 0.52 (95% CI, 0.48-0.57), P = 0.11, respectively). Though interobserver reproducibility (in the context of test proportions 'good' and 'very good', according to kappa) regarding deep myometrial invasion did not differ between the groups (experts, 34% vs gynecologists, 22%, P = 0.13), ultrasound experts assessed cervical stromal invasion with significantly greater interobserver reproducibility than did gynecologists (53% vs 14%, P <0.001). Conclusion: Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion.

Original languageEnglish
Pages (from-to)476-482
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume45
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

Keywords

  • Diagnostic imaging
  • Endometrial neoplasms
  • Neoplasm staging
  • Reproducibility of results
  • Ultrasonography
  • Uterine neoplasms

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

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    Eriksson, L. S. E., Lindqvist, P. G., Flöter Rådestad, A., Dueholm, M., Fischerova, D., Franchi, D., Jokubkiene, L., Leone, F. P., Savelli, L., Sladkevicius, P., Testa, A. C., Van Den Bosch, T., Ameye, L., & Epstein, E. (2015). Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: Interobserver reproducibility among ultrasound experts and gynecologists. Ultrasound in Obstetrics and Gynecology, 45(4), 476-482. https://doi.org/10.1002/uog.14645