Application of transvaginal sonographic elastography to distinguish endometrial cancer from benign masses

Transvaginal sonographic elastography can be used for the differentiation of malignant and benign lesions in different systems. Recent studies on strain elastography showed that different endometrial tissues demonstrated different stiffness characteristics. In this study, we aim to evaluate the diagnostic value of transvaginal sonographic elastography to distinguish endometrial cancer from benign masses. A prospective study was conducted on patients with suspected intracavitary uterine focal lesions, abnormal uterine bleeding for routine ultrasound examination of the pelvis. A total of 217 patients were included and underwent both conventional B-mode sonography and elastography. Endometrial lesions were categorized into 3 types for qualitative analysis and the strain ratio (SR) was measured for quantitative analysis. Pathological examinations were also conducted to establish final diagnosis. There were 104 patients diagnosed with endometrial cancer and 113 with benign lesions. All type 1 endometrial lesions were diagnosed as benign, while 95.8% of type 3 were malignant. For quantitative elastography results, the AUC for SR was 0.904 with 95% CI between 0.866 and 0.942. Using an ROC curve, the best cut-off SR value was found to be 3.02 and it could achieve a sensitivity of 81.7%, a specificity of 85%, a positive predictive value of 83.3% and a negative predictive value of 83.5%. Our results suggested that transvaginal sonographic elastography is a promising diagnostic tool for differentiating endometrial cancer from benign masses, and that SR has excellent diagnostic performance.