A COMPARATIVE-STUDY OF PREOPERATIVE PROCEDURES TO ASSESS CERVICAL INVASION BY ENDOMETRIAL CARCINOMA

Objective To compare the accuracy of different diagnostic procedures c urrently used to assess cervical involvement in endometrial carcinoma. Design Retrospective observational study. Setting Department of Obste rics and Gynecology, Shinshu University Hospital, Matsumoto, Japan. Pa rticipants Sixty-four patients with endometrial carcinoma were evaluat ed pre-operatively for cervical involvement by six different diagnosti c procedures: cervical cytology, endocervical curettage, transvaginal ultrasonography, hysteroscopy, magnetic resonance imaging, and serum l evels of CA125. The number of positive and negative diagnoses of cervi cal invasion by each of these procedures were correlated with the actu al invasion determined by histological examination. Results Cervical i nvasion was confirmed in 12 (18.8%). Endocervical curettage showed hig h sensitivity (91%), the highest negative predictive value (96%), and the lowest negative likelihood ratio (0.14). Hysteroscopy showed high positive likelihood ratio (8.2) and low negative likelihood ratio (0.2 0). Magnetic resonance imaging showed the highest positive predictive value (75%) and the highest positive likelihood ratio (12.5). Magnetic resonance imaging was excellent for predicting stromal invasion, wher eas hysteroscopy was superior for assessing mucosal involvement to mag netic resonance imaging. Conclusion Endocervical curettage is a good t est for excluding cervical involvement by endometrial carcinoma. Hyste roscopy is a good test in making both positive and negative diagnoses for cervical involvement. Magnetic resonance imaging is an excellent t est for detecting cervical involvement, especially when the stroma is invaded.