LOCAL STAGING OF ENDOMETRIAL CARCINOMA - COMPARISON OF TRANSVAGINAL AND INTRAOPERATIVE SONOGRAPHY AND GROSS VISUAL INSPECTION

OBJECTIVE. The purposes of this study were to compare transvaginal son ography (NS), intraoperative sonography (IOS), and gross visual inspec tion of the uterus with the histopathologic findings in patients with endometrioid adenocarcinoma, and to compare the accuracies of TVS, IOS , and gross visual inspection in staging of the tumor. SUBJECTS AND ME THODS. Sixteen patients with endometrioid carcinoma were prospectively evaluated with TVS and IOS. Intraoperative gross visual inspection wa s also performed. Gray-scale, duplex, and color Doppler findings were used to stage patients. The location and depth of myometrial invasion and the presence of cervical involvement were recorded. At gross visua l inspection, only the absence or presence and the depth of myometrial invasion (less than or equal to 50% or >50%) were recorded. The data were analyzed three ways. First, in uterine specimens with myometrial invasion, a site-by-site comparison was made among the TVS and IOS fin dings and the final histologic results regarding location and depth of tumor invasion. Next, to determine tumor stage, myometrial invasion w as defined in two ways: (1) absent, 50% or less, or greater than 50%; and (2) 50% or less or greater than 50%. Then imaging findings, gross visual inspection, and the final histologic results were compared. RES ULTS. Of the 16 uterine specimens, eight had myometrial invasion, with 13 separate sites of tumor invasion. IOS correctly identified the loc ation and depth (+/-10% of the histologic depth) of tumor invasion at four (31%) sites, and TVS at one (8%) site. TVS and IOS overestimated myometrial invasion due to adenomyosis, bulky intraluminal tumor, and lymphovascular invasion. When myometrial invasion was defined as absen t, 50% or less, or greater than 50%. TVS was correct in 60% of cases, IOS in 56%, and gross visual inspection in 53%. When myometrial invasi on was defined as 50% or less or greater than 50%, TVS was correct in 93% of cases, IOS in 81%, and gross visual inspection in 80%. CONCLUSI ON. TVS and IOS are inaccurate in predicting the precise location and depth of myometrial tumor invasion. However, when a less rigorous defi nition of invasion is used, the accuracies of TVS and IOS are comparab le to gross visual inspection in staging of the tumor.