Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study

E. Epstein, D. Fischerova, L. Valentin, A.C. Testa, D. Franchi, P. Sladkevicius, F. Frühauf, P.G. Lindqvist, F. Mascilini, R. Fruscio, L.A. Haak, G. Opolskiene, M.A. Pascual, J.L. Alcazar, V. Chiappa, S. Guerriero, J.W. Carlson, C. Van Holsbeke, F.P. Giuseppe Leone, B. De MoorT. Bourne, B. van Calster, A. Installe, D. Timmerman, J.Y. Verbakel, T. Van den Bosch

Research output: Contribution to journalArticle

Abstract

Objective: To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. Methods: This was a prospective multicenter study of 1714 women with biopsy-confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high-end ultrasound equipment. Clinical and sonographic data were entered into a web-based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c-statistic. Results: In total, 1538 women were included in the final analysis. Median age was 65 (range, 27–98) years, median body mass index was 28.4 (range 16–67) kg/m2, 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High-risk tumors, compared with low-risk tumors, were less likely to have regular endometrial–myometrial junction (difference of −23%; 95% CI, −27 to −18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non-uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). Conclusion: Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high- and low-risk endometrial cancer. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Original languageEnglish
Pages (from-to)818-828
Number of pages11
JournalUltrasound in Obstetrics and Gynecology
Volume51
Issue number6
DOIs
Publication statusPublished - 2018

Keywords

  • diagnostic imaging
  • Doppler
  • endometrial neoplasm
  • neoplasm staging
  • ultrasonography
  • adult
  • aged
  • cancer grading
  • classification
  • clinical trial
  • color Doppler flowmetry
  • consensus development
  • cross-sectional study
  • endometrium tumor
  • evaluation study
  • female
  • human
  • middle aged
  • multicenter study
  • nomenclature
  • pathology
  • prospective study
  • reproducibility
  • standards
  • very elderly
  • Adult
  • Aged
  • Aged, 80 and over
  • Consensus Development Conferences as Topic
  • Cross-Sectional Studies
  • Endometrial Neoplasms
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Grading
  • Prospective Studies
  • Reproducibility of Results
  • Terminology as Topic
  • Ultrasonography, Doppler, Color

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    Epstein, E., Fischerova, D., Valentin, L., Testa, A. C., Franchi, D., Sladkevicius, P., Frühauf, F., Lindqvist, P. G., Mascilini, F., Fruscio, R., Haak, L. A., Opolskiene, G., Pascual, M. A., Alcazar, J. L., Chiappa, V., Guerriero, S., Carlson, J. W., Van Holsbeke, C., Giuseppe Leone, F. P., ... Van den Bosch, T. (2018). Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study. Ultrasound in Obstetrics and Gynecology, 51(6), 818-828. https://doi.org/10.1002/uog.18909