TRANSVAGINAL SONOGRAPHY VS HYSTEROSCOPY IN THE PREOPERATIVE STAGING OF ENDOMETRIAL CARCINOMA

The aim of this study was to evaluate the diagnostic accuracy of trans vaginal sonography vs. hysteroscopy in the preoperative staging of end ometrial carcinoma, in order to establish the most appropriate surgica l therapy. Transvaginal sonography and hysteroscopy were used preopera tively in 67 women with histologically proven endometrial carcinoma. D eep myometrial invasion (> 50%) was present at Post operative patholog y in 26/67 (39%) women and spread to the cervix occurred in 11/67 (16% ) women. Transvaginal sonographic examination was initially directed a t assessing myometrial invasion, which was correctly Predicted in 52/6 7 (78%) women. Transvaginal sonography demonstrated a sensitivity of 8 8% (23/26) and a specificity of 71% (29/41) for deep invasion, with a positive predictive value (PPV) of 66% (23/35) and a negative predicti ve value (NPV) of 91% (29/32). The accuracy of transvaginal sonography in detecting cervical involvement was 82% (55/67), and that of hyster oscopy was 72% (48/67): transvaginal sonography was slightly less sens itive (54% vs. 64%), hut move specific (87% vs. 73%) than hysteroscopy . When cervical invasion was present, the PPVs of transvaginal sonogra phy and hysteroscopy were 46% (6/13) and 32% (7/22), respectively, whi le the NPV was 91% for both techniques (49/54; 41/45). Our data show t hat the accuracy of transvaginal sonography was comparable with that o f hysteroscopy in detecting cervical involvement. Therefore, in the ma jority of cases, when both techniques showed that disease was limited, the appropriately limited type of surgery would be performed. Convers ely, detection of a myometrial invasion of > 50% or an extension to th e cervix would lead to art unnecessarily extensive operation if this w as the sole criterion used for making the decision.