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Non-Invasive Ultrasound Assessment of Endometrial Cancer Progression in Pax8-Directed Deletion of the Tumor Suppressors Arid1a and Pten in Mice
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Correlation between ultrasonographic findings and histopathological and molecular characteristics in endometrial

Irene Colombi1, Giuseppe Vizzielli2, Eugenia Costantini3

  • 1Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, Prato, Italy.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|December 20, 2025
PubMed
Summary

Detailed ultrasound features can predict endometrial cancer aggressiveness. Vascularity, junctional zone, and thickness correlate with tumor stage, grade, and molecular profile, aiding personalized treatment strategies.

Keywords:
Endometrial cancerMolecular patternUltrasound

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Area of Science:

  • Gynecologic Oncology
  • Medical Imaging
  • Molecular Pathology

Background:

  • Accurate preoperative assessment of endometrial cancer is vital for effective surgical and therapeutic planning.
  • Correlating ultrasonographic findings with histopathological and molecular data can enhance presurgical staging accuracy.

Purpose of the Study:

  • To investigate the association between ultrasound characteristics and the histopathological/molecular profiles of endometrial cancer.
  • To improve preoperative assessment and risk stratification for endometrial cancer.

Main Methods:

  • A multicenter retrospective study involving 156 women undergoing standardized ultrasound (transvaginal/transrectal) based on IETA criteria.
  • Analysis of ultrasonographic parameters (endometrial thickness, echogenicity, junctional zone, vascularity) and correlation with postoperative histopathology and molecular classification (p53, MMR, POLE, NSMP).

Main Results:

  • Ultrasound staging accuracy was 65.5%, with specific errors in p53-abnormal and MMRd tumor staging.
  • Increased endometrial thickness, irregular junctional zone, and complex vascular patterns were significantly associated with higher tumor stage, grade, and molecular aggressiveness (e.g., p53 mutations, MMR deficiency).
  • Scattered vascular patterns indicated a higher risk of lymphovascular space invasion.

Conclusions:

  • Specific ultrasound features, especially vascularity, junctional zone integrity, and endometrial thickness, are strong indicators of endometrial cancer stage, grade, and molecular subtype.
  • Integrating detailed ultrasound assessments into preoperative evaluations can identify high-risk cancers and personalize treatment.
  • Further prospective studies are recommended to validate these findings.