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Ultrasound Measurement of Tumor-Free Distance from the Serosal Surface as the Alternative to Measuring the Depth of Myometrial Invasion in Predicting Lymph Node Metastases in Endometrial Cancer

1
Department of Obstetrics and Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
2
Department of Statistics, Faculty of Management, Gdańsk University, 81-824 Sopot, Poland
3
Department of Pathology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
4
Department of Gynecologic Oncology, PCK Marine Hospital in Gdynia, 81-519 Gdynia, Poland
*
Author to whom correspondence should be addressed.
Academic Editor: Hiroshi Fujiwara
Diagnostics 2021, 11(8), 1472; https://doi.org/10.3390/diagnostics11081472
Received: 19 July 2021 / Revised: 8 August 2021 / Accepted: 11 August 2021 / Published: 14 August 2021
(This article belongs to the Special Issue Diagnosis and Management of Gynecological Cancers)
Background: Ultrasonography’s usefulness in endometrial cancer (EC) diagnosis consists in its roles in staging and prediction of metastasis. Ultrasound-measured tumor-free distance from the tumor to the uterine serosa (uTFD) is a promising marker for these diagnostic and prognostic variables. The aim of the study was to determine the usefulness of this biomarker in locoregional staging, and thus in the prediction of lymph node metastasis (LNM). Methods: We conducted a single-institutional, prospective study on 116 consecutive patients with EC who underwent 2D transvaginal ultrasound examination. The uTFD marker was compared with the depth of ultrasound-measured myometrial invasion (uMI). Univariable and multivariable logit models were evaluated to assess the predictive power of the uTFD and uMI in regard to LNM. The reference standard was a final histopathology result. Survival was assessed by the Kaplan–Meier method. Results: LNM was found in 17% of the patients (20/116). In the univariable analysis, uMI and uTFD were significant predictors of LNM. The accuracy was 70.7%, and the NPV was 92.68% (OR 4.746, 95% CI 1.710–13.174) for uMI (p = 0.002), and they were 63.8% and 89.02% (OR 0.842, 95% CI 0.736–0.963), respectively, for uTFD (p = 0.01). The cutoff value for uTFD in the prediction of LNM was 5.2 mm. The association between absence of LNM and biomarker values of uMI < 1/2 and uTFD ≥ 5.2 mm was greater than that between the presence of metastases and uMI > 1/2 and uTFD values <5.2 mm. In the multivariable analysis, the accuracy of the uMI–uTFD model was 74%, and its NPV was 90.24% (p = non-significant). Neither uMI nor uTFD were surrogates for overall and recurrence-free survivals in endometrial cancer. Conclusions: Both uMI and uTFD, either alone or in combination, were valuable tools for gaining additional preoperative information on expected lymph node status. Negative lymph nodes status was better described by ultrasound biomarkers than a positive status. It was easier to use the uTFD rather than the uMI measurement as a biomarker of EC invasion, and the former still maintained a similar predictive value for lymph node metastases to the latter at diagnosis. View Full-Text
Keywords: ultrasound; endometrial cancer; lymph nodes metastasis; myometrial invasion; tumor-free distance ultrasound; endometrial cancer; lymph nodes metastasis; myometrial invasion; tumor-free distance
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MDPI and ACS Style

Liro, M.; Śniadecki, M.; Wycinka, E.; Wojtylak, S.; Brzeziński, M.; Stańczak, A.; Wydra, D. Ultrasound Measurement of Tumor-Free Distance from the Serosal Surface as the Alternative to Measuring the Depth of Myometrial Invasion in Predicting Lymph Node Metastases in Endometrial Cancer. Diagnostics 2021, 11, 1472. https://doi.org/10.3390/diagnostics11081472

AMA Style

Liro M, Śniadecki M, Wycinka E, Wojtylak S, Brzeziński M, Stańczak A, Wydra D. Ultrasound Measurement of Tumor-Free Distance from the Serosal Surface as the Alternative to Measuring the Depth of Myometrial Invasion in Predicting Lymph Node Metastases in Endometrial Cancer. Diagnostics. 2021; 11(8):1472. https://doi.org/10.3390/diagnostics11081472

Chicago/Turabian Style

Liro, Marcin, Marcin Śniadecki, Ewa Wycinka, Szymon Wojtylak, Michał Brzeziński, Agata Stańczak, and Dariusz Wydra. 2021. "Ultrasound Measurement of Tumor-Free Distance from the Serosal Surface as the Alternative to Measuring the Depth of Myometrial Invasion in Predicting Lymph Node Metastases in Endometrial Cancer" Diagnostics 11, no. 8: 1472. https://doi.org/10.3390/diagnostics11081472

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