Ultrasound staging of endometrial cancer – recommended methodology of examination

Authors: F. Frühauf 1;  M. Dvořák 2;  L. Haaková 3;  L. Hašlík 3;  P. Herboltová 4;  B. Chaloupková 5;  J. Kožnarová 6;  B. Kubešová 7;  I. Lukáčová 8;  R. Marek 9;  H. Neumannová 2;  R. Peschout 4;  V. Přibyl 8;  I. Sedláková 10;  M. Smažinka 11 ;  P. Svobodová 7;  M. Vančo 12;  P. Vlasák 11;  V. Weinberger 13 ;  M. Zikán 1 ;  D. Fischerová 1
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. 1;  Onkogynekologické centrum, Gynekologicko-porodnická klinika 1. LF UK a Nemocnice Na Bulovce, Praha, přednosta prof. MUDr. M. Halaška, DrSc. 2;  Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc. 3;  Onkogynekologické centrum, Gynekologicko-porodnické oddělení Nemocnice, Jihlava primář prof. MUDr. A. Roztočil, CSc. 4;  Onkogynekologické centrum, Porodnicko-gynekologické oddělení, Krajská nemocnice T. Bati, a. s., Zlín, primář MUDr. Z. Adamík, Ph. D. 5;  Onkogynekologické centrum, Gynekologicko-porodnické odd. Nemocnice, České Budějovice primář MUDr. P. Sák, Ph. D. 6;  Gynekologicko-porodnická klinika 3. LF UK a FNKV, Praha, přednosta doc. MUDr. E. Kučera, CSc. 7;  Onkogynekologické centrum, Porodnicko-gynekologická klinika FN, Ostrava přednosta doc. MUDr. V. Unzeitig, CSc. 8;  Onkogynekologické centrum, Porodnicko-gynekologická klinika LF UP a FN, Olomouc přednosta prof. MUDr. R. Pilka, Ph. D. 9;  Porodnická a gynekologická klinika LF HK a FN, Hradec Králové přednosta doc. MUDr. J. Špaček, PhD., IFEPAG. 10;  Onkogynekologické centrum, Gynekologicko-porodnická klinika LF UK a FN, Plzeň přednosta doc. MUDr. Z. Novotný, CSc. 11;  Onkogynekologické centrum, Gynekologicko-porodnické odd., Masarykova nemocnice, Ústí nad Labem, přednosta doc. MUDr. T. Binder, CSc. 12;  Onkogynekologické centrum, Gynekologicko-porodnická klinika LF MU a FN, Brno přednosta prof. MUDr. P. Ventruba, DrSc., MBA 13
Published in: Ceska Gynekol 2014; 79(6): 466-476


The extent of the staging surgery in cases of histologically proven endometrial cancer depends on whether the tumor is of high risk or low risk for extrauterine spread and recurrence. There are several significant prognostic factors – histological subtype and grade of dediferentiation from preoperative biopsy and local stage of uterine involvement based on imaging methods. The depth of myometrial invasion and presence of cervical stromal infiltration (local staging) can be assessed by ultrasound with the overall accuracy comparable to that of magnetic resonance. Transvaginal ultrasound enables to vizualize detailed pelvic anatomy and that is why it is considered to be a suitable tool for assessment of local stage of endometrial cancer.

It is advisable to use the standardized terminology defined by International Endometrial Tumor Analysis group (IETA) to describe ultrasound findings. The standardized methodology of ultrasound preoperative staging examination based on prearranged protocols is recommended.

ultrasound, endometrial cancer, staging


1. Akbayir, O., Corbacioglu, A., Numanoglu, C., et al. Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma by transvaginal ultrasound. Gynecol Oncol. 2011, 122, p. 600–603.

2. Alcazar, JL., Galvan, R., Albela, S., et al. Assessing myometrial infiltration by endometrial cancer: uterine virtual navigation with threedimensional US. Radiology, 2009, 250,p. 776–783.

3. Antonsen, SL., Jensen, LN., Loft, A., et al. MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer — A multicenter prospective comparative study. Gynecol Oncol, 2013, 128, p. 300–308.

4. Bese, T., Demirkiran, F., Guralp, O., et al. Transtubal transport of carcinoma cells into the peritoneal cavity after saline infusion via transcervical route in patients with endometrial carcinoma. Int J Gynecol Cancer, 2009, 19, p. 682–685.

5. Calda, P., Břešťák, M., Fischerová, D., et al. Ultrazvuková diagnostika v těhotenství a gynekologii. Praha: Aprofema, 2010, s. 380–392.

6. Colombo, N., Preti, E., Landoni, F., et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24, p. 33–38.

7. Creasman, WT., Odicino, F., Maisonneuve, P., et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 2006, 95 (Suppl. 1), p. 105–143.

8. Epstein, E., Van Holsbeke, C., Mascillini, F., et al. Gray-scale and color Doppler ultrasound characteristics of endometrial cancer in relation to stage, grade and tumor size. Ultrasound Obstet Gynecol, 2011, 38, p. 586–593.

9. Eriksson, LS., Lindqvist, PG., Flöter Rådestad, A., et al. Transvaginal ultrasound assessment of myometrial and cervical stroma invasion in women with endometrial cancer – interobserver reproducibility among ultrasound experts and gynaecologists. Ultrasound Obstet Gynecol. 2014 Aug 4. doi: 10.1002/uog.14645. [Epub ahead of print]

10. Fischerova, D. Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review. Ultrasound Obstet Gynecol, 2011, 38, p. 246–266.

11. Haldorsen, IS., Berg, A., Werner, HM., et al. Magnetic resonance imaging performs better than endocervical curettage for preoperative prediction of cervical stromal invasion in endometrial carcinomas. Gynecol Oncol, 2012, 126, p. 413–418.

12. Karlsson, B., Norstrom, A., Granberg, S., Wikland, M. The use of endovaginal ultrasound to diagnose invasion of endometrial carcinoma. Ultrasound Obstet Gynecol, 1992, 2, p. 35–39.

13. Leone, FPG., Timmerman, D., Bourne, T., et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol, 2010, 35, p. 103–112.

14. Lindaue, J., Fowler, JM., Manolitsas, TP., et al. Is there a prognostic difference between depth of myometrial invasion and the tumor-free distance from the uterine serosa in endometrial cancer? Gynecol Oncol, 2003, 91, p. 547–551.

15. Mascillini, F., Testa, AC., Van Holsbeke, C., et al. Assessing endometrial and cervical invasion in women with endometrial cancer – comparing subjective evaluation to objective measurement techniques. Ultrasound Obstet Gynecol, 2013, 42, p. 353–358.

16. May, K., Bryant, A., Dickinson, HO., et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev, 2010, 1, CD007585.

17. Ortoft, G., Dueholm, M., Mathiesen, O., et al. Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy. Acta Obstet Gynecol Scand, 2013, 92, 5, p. 536–545.

18. Pecorelli, S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet, 2009, 105, p. 103–104.

19. Savelli, L., Ceccarini, M., Ludovisi, M., et al. Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol, 2008, 31, p. 560–566.

20. Savelli, L., Testa, AC., Mabrouk, M., et al. A prospective blinded comparison of the accuracy of transvaginal sonography and frozen section in the assessment of myometrial invasion in endometrial cancer. Gynecol Oncol, 2012, 124, p. 549–552.

21. Sawicki, W., Spiewankiewicz, B., Stelmachow, J., Cendrowski, K. The value of ultrasonography in preoperative assessment of selected prognostic factors in endometrial cancer. Eur J Gynaecol Oncol, 2003, 24, p. 293–298.

22. Sobin, LH., Gospodarowicz, MK., Wittekind, C. International Union Against Cancer. TNM Classifications of Malignant Tumors, 7th ed. New York: Willey-Blackwell, 2009, p. 212–216.

23. Schwab, KV., O‘Malley, DM., Fowler, JM., et al. Prospective evaluation of prognostic significance of the tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma. Gynecol Oncol, 2009, 112, p. 146–149.

24. Takac, I. Transvaginal ultrasonography with and without saline infusion in assessment of myometrial invasion of endometrial cancer. J Ultrasound Med, 2007, 26, p. 949–955.

25. Timmerman, A., Opmeer, BC., Khan, KS., et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol, 2010, 11, p. 160–167.

26. Van Holsbeke, C., Ameye, L., Testa, AC., et al. Development and external validation of (new) ultrasound based mathematical models for preoperative prediction of high-risk endometrial cancer. Ultrasound Obstet Gynecol, 2014, 43, p. 586–595.

27. Weber, G., Merz, E., Bahlmann, F., et al. Assessment of myometrial infiltration and preoperative staging by transvaginal ultrasound in patients with endometrial carcinoma. Ultrasound Obstet Gynecol, 1995, 6, p. 362–367.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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