| Summary: | To describe and analyze the diagnostic performance of uterine virtual
navigation with three-dimensional (3D) ultrasonography (US) for the assessment of
the depth of myometrial infiltration by endometrial cancer. MATERIALS AND
METHODS: Institutional review board approval was obtained; patients gave oral
informed consent. Women with endometrial cancer were evaluated by using 3D US
prior to surgical staging. A 3D volume of the whole uterus was obtained and
analyzed by using software. Virtual navigation through three orthogonal planes
was performed to identify the shortest myometrial tumor-free distance to serosa
(TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the
myometrium. Myometrial infiltration was also assessed by subjective impression of
an examiner. Histologic findings of myometrial infiltration and TDS measured by a
pathologist were used as the reference standard. A receiver operating
characteristic curve was plotted to identify the best cutoff for TDS for
identifying myometrial infiltration of 50% or more. RESULTS: Ninety-six women
(mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included
in the study. At histologic analysis, myometrial invasion was found to be less
than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with
US was positively correlated with histologically measured TDS (r = 0.649; 95%
confidence interval: 0.52, 0.76). The best cutoff for US-measured TDS was 9.0 mm
(sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive
predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a
specificity of 82.3%, a negative predictive value of 96.6%, and a positive
predictive value of 67.7%. CONCLUSION: Uterine virtual navigation with 3D US is a
reliable method for the assessment of myometrial infiltration in patients with
endometrial cancer.
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