Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy

Gitte Ørtoft, Margit Dueholm, Ole Mathiesen, Estrid S Hansen, Erik Lundorf, Charlotte Møller, Edvard Marinovskij, Lone K Petersen

Research output: Contribution to journalJournal articleResearchpeer-review


Objectives To evaluate the accuracy of different preoperative modalities for staging of endometrial cancer to restrict extensive surgery to patients at high risk of metastatic disease. Setting Aarhus University Hospital. Population 156 women referred in 2006-2011 because of atypical endometrial hyperplasia (G0) or endometrial cancer. Methods Patients were offered preoperative transvaginal ultrasonography (TVS), magnetic resonance imaging (MRI), and hysteroscopic-directed biopsies from the uterine tumor and cervix. Final pathology of the removed uterus was the reference standard. Patients were divided into low risk (<50% myometrial invasion, and grades 0, 1, 2, and no cervical invasion) or high risk (all others). Main outcome measures Accuracy, sensitivity, specificity, positive/negative predictive value. Results Patients were aged 32-88 years, with a mean body mass index of 29. At final pathology 81% had cancer and 19% G0 or no residual tumor; 54% were high risk. Hysteroscopy-directed biopsies had a higher accuracy (92%) than endometrial biopsy (58%) for differentiating G0 from cancer (p < 0.001); grade 3 tumor identification had similar accuracy (93 vs. 92%). Deep myometrial invasion was estimated with higher accuracy by MRI (82%) than TVS (74%) (p < 0.02). For cervical involvement, hysteroscopy-directed biopsies had higher accuracy (94%) than MRI (84%,) and TVS (80%) (p < 0.02). Accuracy for identifying high-risk women was highest (83%) using a combination of MRI and hysteroscopic-directed biopsies, compared with TVS and endometrial biopsy (72%) (p < 0.05). Conclusion Preoperative staging with MRI and hysteroscopy-directed biopsy can identify eight of 10 women with high risk of lymph node metastases and spare eight of 10 low-risk women extended surgery.

Original languageEnglish
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number5
Pages (from-to)536-545
Publication statusPublished - May 2013
Externally publishedYes


  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Cervix Uteri/pathology
  • Endometrial Neoplasms/diagnostic imaging
  • Female
  • Humans
  • Hysteroscopy
  • Lymphatic Metastasis
  • Magnetic Resonance Imaging
  • Middle Aged
  • Myometrium/pathology
  • Neoplasm Grading/methods
  • Preoperative Period
  • Reproducibility of Results
  • Risk Assessment
  • Sensitivity and Specificity
  • Ultrasonography
  • myometrial invasion
  • magnetic resonance imaging
  • preoperative staging
  • Endometrial biopsy
  • hysteroscopy
  • endometrial cancer
  • tumor grade TVS


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