Background: endometrial carcinoma is the most common gynaecological cancer in Europe; and it is the sixth most frequent tumor in women worldwide. Currently, its staging system is a surgical staging system based on anatomical-pathological evaluations made on a tumor sample, collected by a standard surgical procedure: total hysterectomy, bilateral salpingo-oophorectomy and sentinel lymph node dissection or systematic lymphadenectomy of pelvic/ para-aortic lymph nodes. Preliminary investigations to assess the surgical approach consist in pre-surgical performing of Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) that allow the evaluation of the most important prognostic factors: myometrial infiltration grade, cervical extension of the disease and presence of metastases in the lymph nodes. Three-dimensional transvaginal ultrasound (3D-TVS) is a modern imaging technique that can be used to assess the above prognostic factors. Aim: the aim of our study was to assess the appropriateness of the use of three-dimensional transvaginal ultrasound for the pre-surgical staging of endometrial cancer, as an alternative of Magnetic Resonance Imaging, in support of the classic imaging modalities provided by international Guidelines. Materials and methods: the study conducted is a prospective observational study. Patients with histological diagnosis of endometrial carcinoma by performing an endometrial biopsy through hysteroscopic were included. For all patients, clinical data (BMI, parity and age at surgery), histological data on the diagnostic biopsy and on the biopsy of the operative piece (histotype and grade), radiological data through three-dimensional transvaginal ultrasound, magnetic resonance imaging, computed tomography (infiltration of the myometrium, infiltration of the cervix, infiltration of the vagina, infiltration of the vescico-uterine septum, infiltration of the recto-vaginal septum and the presence of pathological lymph nodes) and operative data were collected. The performance of the three imaging modalities and, particularly, the performance of the three-dimensional transvaginal ultrasound in the assessment of the myometrial and cervical invasion by endometrial cancer was studied, by comparing pre-surgical radiological data and histological data obtained from the operative piece. Results: the study included 22 patients. Three-dimensional transvaginal ultrasound has a diagnostic accuracy same as that of magnetic resonance imaging in evaluating the myometrial and cervical infiltration by endometrial cancer (equal to 77%, in both cases). In defining the myometrial infiltration three-dimensional transvaginal ultrasound is more sensitive but less specific than magnetic resonance imaging. Conclusions: considering the easy accessibility and the non-invasiveness of the three-dimensional transvaginal ultrasound, in addition to all the other advantages that it has compared to the other classic imaging modalities, this exam is a valid choice for the pre-surgical staging of endometrial carcinoma.
Presupposti dello studio: il carcinoma dell’endometrio è il più comune tumore ginecologico maligno in Europa; e rappresenta il sesto tumore più frequente nelle donne a livello mondiale. Attualmente, la sua stadiazione è chirurgica e si basa su valutazioni anatomo-patologiche condotte su un campione di neoplasia, raccolto per mezzo di un intervento standard: isterectomia totale, annessiectomia bilaterale e dissezione del linfonodo sentinella o linfoadenectomia sistematica dei linfonodi pelvici/ para-aortici. Le indagini preliminari per la valutazione dell’approccio chirurgico consistono nell’esecuzione preoperatoria di Tomografia Computerizzata (TC) e/o Risonanza Magnetica (RM), che permettono la valutazione dei più importanti fattori prognostici, quali: il grado di infiltrazione miometriale, l’estensione cervicale della malattia e la presenza di metastasi linfonodali. L’ecografia trans-vaginale tridimensionale (ECO-3D) è una moderna tecnica di imaging che può essere utilizzata per la valutazione dei suddetti fattori prognostici. Scopo dello studio: l’obiettivo del nostro studio è stato valutare l’appropriatezza di utilizzo dell’ecografia trans-vaginale tridimensionale per la stadiazione pre-operatoria del carcinoma endometriale, in alternativa alla risonanza magnetica, a supporto delle classiche metodiche di imaging previste dalle Linee guida internazionali. Materiali e metodi: lo studio condotto è uno studio osservazionale prospettico. Sono state incluse pazienti con diagnosi istologica di carcinoma dell’endometrio, posta mediante l’esecuzione di una biopsia isteroscopica. Per tutte le pazienti sono stati raccolti dati clinici (BMI, parità e età all’intervento), dati istologici sulla biopsia diagnostica e sul pezzo operatorio (istotipo e grado), dati radiologici mediante ecografia trans-vaginale tridimensionale, risonanza magnetica, tomografia computerizzata (infiltrazione del miometrio, infiltrazione della cervice, infiltrazione della vagina, infiltrazione del setto vescico-uterino, infiltrazione del setto retto-vaginale, linfonodi patologici) e dati operatori. È stata quindi valutata la performance delle tre metodiche di imaging e, in particolare, dell’ecografia trans-vaginale tridimensionale nel valutare il grado di infiltrazione del miometrio e della cervice da parte del carcinoma endometriale, confrontando i dati radiologici ricavati in fase pre-operatoria con quelli istologici ricavati dal pezzo operatorio. Risultati: lo studio ha incluso 22 pazienti. L’ecografia trans-vaginale tridimensionale ha un’accuratezza diagnostica uguale a quella della risonanza magnetica nel valutare il grado di invasione del miometrio e della cervice uterina da parte del carcinoma endometriale (pari al 77% in entrambi i casi). Nel definire l’entità dell’infiltrazione miometriale l’ecografia trans-vaginale tridimensionale è più sensibile ma meno specifica della risonanza magnetica. Conclusioni: considerando la facile accessibilità e la non invasività dell’ecografia trans-vaginale tridimensionale, in aggiunta a tutti gli altri vantaggi che essa presenta rispetto alle classiche modalità di imaging, tale esame è una valida scelta per la stadiazione pre-chirurgica del carcinoma dell’endometrio.
Ecografia trans-vaginale tridimensionale: nuova risorsa nella stadiazione pre-chirurgica del carcinoma dell'endometrio
GRASSANO, FRANCESCA
2022/2023
Abstract
Background: endometrial carcinoma is the most common gynaecological cancer in Europe; and it is the sixth most frequent tumor in women worldwide. Currently, its staging system is a surgical staging system based on anatomical-pathological evaluations made on a tumor sample, collected by a standard surgical procedure: total hysterectomy, bilateral salpingo-oophorectomy and sentinel lymph node dissection or systematic lymphadenectomy of pelvic/ para-aortic lymph nodes. Preliminary investigations to assess the surgical approach consist in pre-surgical performing of Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) that allow the evaluation of the most important prognostic factors: myometrial infiltration grade, cervical extension of the disease and presence of metastases in the lymph nodes. Three-dimensional transvaginal ultrasound (3D-TVS) is a modern imaging technique that can be used to assess the above prognostic factors. Aim: the aim of our study was to assess the appropriateness of the use of three-dimensional transvaginal ultrasound for the pre-surgical staging of endometrial cancer, as an alternative of Magnetic Resonance Imaging, in support of the classic imaging modalities provided by international Guidelines. Materials and methods: the study conducted is a prospective observational study. Patients with histological diagnosis of endometrial carcinoma by performing an endometrial biopsy through hysteroscopic were included. For all patients, clinical data (BMI, parity and age at surgery), histological data on the diagnostic biopsy and on the biopsy of the operative piece (histotype and grade), radiological data through three-dimensional transvaginal ultrasound, magnetic resonance imaging, computed tomography (infiltration of the myometrium, infiltration of the cervix, infiltration of the vagina, infiltration of the vescico-uterine septum, infiltration of the recto-vaginal septum and the presence of pathological lymph nodes) and operative data were collected. The performance of the three imaging modalities and, particularly, the performance of the three-dimensional transvaginal ultrasound in the assessment of the myometrial and cervical invasion by endometrial cancer was studied, by comparing pre-surgical radiological data and histological data obtained from the operative piece. Results: the study included 22 patients. Three-dimensional transvaginal ultrasound has a diagnostic accuracy same as that of magnetic resonance imaging in evaluating the myometrial and cervical infiltration by endometrial cancer (equal to 77%, in both cases). In defining the myometrial infiltration three-dimensional transvaginal ultrasound is more sensitive but less specific than magnetic resonance imaging. Conclusions: considering the easy accessibility and the non-invasiveness of the three-dimensional transvaginal ultrasound, in addition to all the other advantages that it has compared to the other classic imaging modalities, this exam is a valid choice for the pre-surgical staging of endometrial carcinoma.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/47989