OP14.10: Assessment of myometrial and cervical invasion in endometrial cancer by magnetic resonance imaging and 2D, 3D and HDlive ultrasonography

To compare the diagnostic performance of two-dimensional transvaginal ultrasonography (2D-TVS), three-dimensional transvaginal ultrasonography (3D-TVS), high definition real-time transvaginal ultrasonography (HDLive-TVS), and magnetic resonance imaging (MRI) for the assessment of deep myometrial invasion and cervical involvement in endometrial cancer (EC). This prospective study included 53 patients with histologically proven EC. Patients underwent TVS and MRI within 4 weeks prior to treatment. 3D-TVS and HDlive-TVS were performed at the time of 2D-TVS and they were evaluated by an ultrasonographer blinded to the findings of 2D-TVS. Myometrial involvement (categorised as ≥ or < 50%) and cervical involvement were assessed. The median age of the study population was 69 years (range, 52–96 years). 47.2% of the patients had FIGO stage IA EC, 15.1% stage IB, 7.5% stage II and 30.2% stage III. 81.1% of the patients had endometrioid EC, 13.2% serous EC, 3.8% clear cell EC and 1.9% mucinous EC. The histological grade of EC was grade 1 in 26.4% of the patients, grade 2 in 45.3% and grade 3 in 28.3%. There was no significant difference in the accuracy of 2D-TVS and MRI in predicting myometrial invasion (p = 0.125); 3D-TVS and HDlive-TVS did not increase the accuracy of 2D-TVS in predicting myometrial invasion. Uterine fibroids, adenomyosis and body mass index > 30 kg/m2 were associated with a lower accuracy of 2D-TVS in diagnosing myometrial invasion. There was no significant difference in the accuracy of MRI, 2D-TVS, 3D-TVS and HDLive-TVS in diagnosing cervical involvement. 2D-TVS and MRI are comparable in predicting myometrial and cervical invasion in EC. 3D-TVS and HDlive-TVS do not increase the accuracy of 2D-TVS in predicting myometrial and cervical invasion. MRI may be used when low quality scans are obtained because of obesity, uterine fibroids and adenomyosis.