Preoperative evaluation of endometrial carcinoma by contrast-enhanced ultrasonography

To investigate the potential usefulness of contrast-enhanced ultrasonography in the preoperative evaluation of endometrial carcinoma and observe its enhancement pattern and time-intensity curve.

A prospective study.

Gynaecological department of a college hospital.

A total of 35 women diagnosed with endometrial carcinoma.

The patients were evaluated with real-time grey-scale contrast-enhanced ultrasonography. In 21 women, the parameters of time-intensity curve were compared between the endometrial lesion and normal myometrium. Findings about the depth of myometrial invasion on sonograms were compared with histological findings.

Enhancement pattern, parameters of time-intensity curve, depth of myometrial invasion detected on sonograms.

In visual evaluation, the brightness of the power Doppler signal and the amount of recognisable vascular areas increased in each tumour after contrast agent administration. Feeding vessels of the tumour were shown in 77.1% (27/35) of women. The other 22.9% (8/35) of women revealed that the signals were first visualised in the central portion of the tumour. The arrival time and peak time of endometrial lesion tended to be shorter than normal myometrium. The tumours started to enhance earlier than or at the same time as myometrium in 90.5% (19/21) of women. The peak intensity, enhancement intensity, and rising rate were higher in endometrial lesion than normal myometrium. There was no myometrial invasion in eight women, inner half myometrial invasion in 19 women and the outer half myometrial invasion in eight women. The corresponding values for ultrasound were 9, 17, and 9. The sensitivity of contrast-enhanced ultrasonography in detecting deep invasion was 75.0%, while the specificity was 88.9%, and the accuracy was 85.7%. The overall accuracy of assessment of myometrial invasion was 68.6%.

There is some benefit in contrast-enhanced ultrasonography of endometrial carcinoma. It may provide better information in tumour imaging. Large studies are needed to determine the appropriate use and benefit of this new procedure.