Abstract

Background: Transvaginal sonographic elastography is a useful technique for the differentiation of benign and malignant lesions in different part of body. In recent researches on strain elastography it has been concluded that different endometrial parts showed different stiffness features. Our goal in this study is to assess the diagnostic utility of transvaginal sonographic elastography in differentiating benign masses from endometrial cancer. Method: Patients undergoing routine pelvic ultrasonography examinations and suspected intracavitary uterine focal lesions with abnormal uterine bleeding were the subjects of this prospective study. Two types of sonography were performed on the 200 patients: elastography and traditional B-mode sonography. For qualitative analysis, endometrial lesions were divided into three categories, and for quantitative analysis, the strain ratio (SR) was calculated. Additional pathological exams were carried out in order to get a final diagnosis. Result: There were 103 patients diagnosed with benign lesions and 103 patients with endometrial cancer. While 94.6% of type 3 endometrial lesions were found to be malignant, all type 1 lesions were found to be benign. The AUC for SR was 0.903 with 95% CI between 0.867 and 0.943 for quantitative elastography results. The optimal cut-off SR value, as determined by ROC curve analysis, was 3.03, achieving 82.5% sensitivity, 84.6% specificity, 82.8% positive predictive value, 84.3% negative predictive value and accuracy 83.6%. These findings suggested that SR has good diagnostic performance and that transvaginal sonographic elastography is a useful diagnostic tool for separating benign masses from endometrial cancer. Conclusion: We have concluded that transvaginal sonographic elastography is a potentially useful method for identifying benign and malignant endometrial lesions in addition to standard sonography.

Description

Endometrial cancer is one of the most frequent gynecologic malignancies and is becoming more and more dangerous for postmenopausal women in developed nations and the primary symptom is bleeding. [1] The patient's age, the type of histology, the degree of invasion, and the existence of metastases all have a significant role in prognosis of the disease. [2] If a patient is diagnosed with endometrial cancer at stage I, the overall 5-year survival rate ranges from 85% to 90%, which is a favorable result. Patients who have cervical stroma invasion or myometrial invasion typically have a worse prognosis. [3] This means that lowering the locoregional recurrence rate for endometrial cancer requires precise diagnosis, staging of the illness, and appropriate adjuvant therapy selection.[4]. Noninvasive preoperative diagnostic procedures are preferable to other intra-operative exams among all the methods used in clinical practice for the diagnosis of endometrial diseases because they allow healthcare resources to be optimized and operation to be customized to prevent unwanted morbidity. [5] Tumor staging, therapy planning, evaluating treatment response, and identifying recurring illness have all always benefited greatly from radio-imaging.The most popular imaging technique for screening women for endometrial cancer is transvaginal ultrasonography because of its accessibility, affordability, and lack of radiation. [6] The abilities and clinical background of the examiner, however, play a major role in the lesions' detection. Accordingly, interobserver variance is most likely to occur with traditional transvaginal ultrasonography. [7] Therefore, the use of a unique technique that could assess the tissue properties both qualitatively and quantitatively could improve the disease's diagnosis accuracy. Since its introduction in the 1990s, elastography—an ultrasonic technology—has been used to accurately and non-invasively measure the mechanical characteristics and stiffness of tissues. [8] Two techniques are available to assess the stiffness of the tissue: imaging the shear and mechanical waves, or measuring the strain in the tissue under stress. [9] A compression is delivered to the tissue using the quasi-static method of elastography in order to visualize the stiffness of the areas under examination and to produce a color-coded strain map. Differentiating solid tumors from normal tissues is made possible by elastography, which uses the altered elasticity of soft tissues to identify specific disease processes. The guidelines released by the European Federation for Ultrasound in Medicine and Biology suggest potential therapeutic applications, such as determining the degree of liver fibrosis and distinguishing between breast lesions, thyroid nodules, and prostate abnormalities. [10,11] In clinical practices of obstetrics and gynecology, possible application of elastography includes successful labor induction and prediction of preterm delivery. [12, 13] A real-time study on elastographical revealed high degree of agreement with diagnosis compared to magnetic resonance imaging (MRI) for adenomyosis and fibroids. [14] The purpose of this study is to assess the diagnostic performance of elastography in differentiating between endometrial malignancies and benign tumors, taking into account the possibility that endometrial cancer may cause changes in tissue elasticity. The gold standard in this analysis will be the pathological results, when they are available.