Ultrasonic shear-wave elastography: a novel method for assessing the tumor grade in endometrial cancer: a prospective study
Abstract
Aims: To evaluate the diagnostic performance of the real time shear-wave elastography in patients with endometrial cancer in terms of tumor grade and myometrial invasion depth preoperatively.
Methods: In this prospective observational study, forty-eight women who were diagnosed with endometrioid type endometrium cancer in our gynecologic oncology clinic of a tertiary hospital between September 2020-January 2021 in Turkey. All patients underwent an ultrasonographic shear-wave measurements. Mean shear-wave values were measured from the tumor itself. Mean elasticity values were assessed in terms of tumor grade and myometrial invasion depth.
Results: The median [%25-%75] shearwave value of the participants was 29.45kPa (5.02-167.21). Shear-wave value for grade 3 endometrial cancer showed a statistically significant difference compared to grade 1 and 2 shear-wave values (p<0.001). To determine the myometrial invasion depth, lymph node involvement, lympho-vascular stromal invasion and cervical stromal invasion statues, shear-wave measurements did not show a significant result (p>0.05). ROC curve analysis showed significant results to determine the myometrial invasion depth and grade 3 endometrial cancer with the mean shear-wave cut-off values of 28.29 kPa and 57 kPa respectively (p<0.001).
Conclusion: Real-time shear-wave elastography is a promising tool to predict the grade 3 tumors and deep myometrial invasion in endometrial cancer patients.
Keywords
Endometrial cancer Shear-wave elastography shear-wave tumor grade grade 3 endometrial cancer
References
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- Sorosky JI. Endometrial cancer. Obstet Gynecol. 2012;120(2 Pt 1):383-397. doi:10.1097/AOG.0b013e3182605bf1
- Krouskop TA, Dougherty DR, Vinson FS. A pulsed Doppler ultrasonic system for making noninvasive measurements of the mechanical properties of soft tissue. J Rehabil Res Dev. 1987;24(2):1-8.
- Lerner RM, Huang SR, Parker KJ. "Sonoelasticity" images derived from ultrasound signals in mechanically vibrated tissues. Ultrasound Med Biol. 1990;16(3):231-239. doi:10.1016/0301-5629(90)90002-t
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- Ariji Y, Nakayama M, Nishiyama W, Nozawa M, Ariji E. Shear-wave sonoelastography for assessing masseter muscle hardness in comparison with strain sonoelastography: study with phantoms and healthy volunteers. Dentomaxillofac Radiol. 2016;45(2):20150251. doi:10.1259/dmfr.20150251
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- Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12-39. doi:10.1136/ijgc-2020-002230
- Fujimoto T, Nanjyo H, Fukuda J, et al. Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence. Gynecol Oncol. 2009;112(2):342-347. doi:10.1016/j.ygyno.2008.10.019
- Grigsby PW, Perez CA, Kuten A, et al. Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system. Int J Radiat Oncol Biol Phys. 1992;22(5):905-911. doi:10.1016/0360-3016(92)90786-h
- Creutzberg CL, van Putten WL, Warlam-Rodenhuis CC, et al. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the postoperative radiation therapy in endometrial carcinoma Trial. J Clin Oncol. Apr 1 2004;22(7):1234-1241. doi:10.1200/JCO.2004.08.159
- Abu-Rustum NR, Yashar CM, Bradley K, et al. NCCN Guidelines (R) Insights: uterine neoplasms, version 3.2021. J Natl Compr Canc Netw. 2021;19(8):888-895. doi:10.6004/jnccn.2021.0038
- Gungorduk K, Muallem J, Asicioglu O, et al. Survival outcomes of women with grade 3 endometrioid endometrial cancer: the impact of adjuvant treatment strategies. Arch Gynecol Obstet. 2022;305(3):671-681. doi:10.1007/s00404-021-06187-4
- Baek MH, Park YR, Suh DS, et al. Reliability of tumour grade 1 and endometrioid cell type on preoperative endometrial biopsy. J Obstet Gynaecol. 2015;35(1):79-81. doi:10.3109/01443615.2014.935723
- Visser NCM, Reijnen C, Massuger L, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Obstet Gynecol. 2017;130(4):803-813. doi:10.1097/AOG.0000000000002261
- Alcazar JL, Gaston B, Navarro B, Salas R, Aranda J, Guerriero S. Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis. J Gynecol Oncol. 2017;28(6):e86. doi:10.3802/jgo.2017.28.e86
- Shao J, Shen Y, Lu J, Wang J. Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules. Clin Endocrinol (Oxf). 2015;83(2):254-260. doi:10.1111/cen.12589
- Du YY, Yan XJ, Guo YJ, et al. Transvaginal real-time shear wave elastography in the diagnosis of endometrial lesions. Int J Gen Med. 2021;14:2849-2856. doi:10.2147/IJGM.S312292
- Hohn AK, Brambs CE, Hiller GGR, May D, Schmoeckel E, Horn LC. 2020 WHO classification of female genital tumors. Geburtshilfe Frauenheilkd. 2021;81(10):1145-1153. doi:10.1055/a-1545-4279
Abstract
References
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. doi:10.3322/caac.21551
- Vitale SG, Capriglione S, Zito G, et al. Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition. Arch Gynecol Obstet. 2019;299(2):299-315. doi:10.1007/s00404-018-5006-z
- Health UNIo. National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Surveillance, Epidemiology, and End Results (SEER). Program Research Data (1973-2008). 2015.
- Sorosky JI. Endometrial cancer. Obstet Gynecol. 2012;120(2 Pt 1):383-397. doi:10.1097/AOG.0b013e3182605bf1
- Krouskop TA, Dougherty DR, Vinson FS. A pulsed Doppler ultrasonic system for making noninvasive measurements of the mechanical properties of soft tissue. J Rehabil Res Dev. 1987;24(2):1-8.
- Lerner RM, Huang SR, Parker KJ. "Sonoelasticity" images derived from ultrasound signals in mechanically vibrated tissues. Ultrasound Med Biol. 1990;16(3):231-239. doi:10.1016/0301-5629(90)90002-t
- Emelianov SY, Lubinski MA, Weitzel WF, Wiggins RC, Skovoroda AR, O'Donnell M. Elasticity imaging for early detection of renal pathology. Ultrasound Med Biol. 1995;21(7):871-883. doi:10.1016/0301-5629(94)00146-5
- Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X.eElastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13(2):111-134. doi:10.1177/ 016173469101300201
- Shiina T, Nightingale KR, Palmeri ML, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41(5):1126-1147. doi:10.1016/j.ultrasmedbio.2015.03.009
- Liu Z, Jing H, Han X, et al. Shear wave elastography combined with the thyroid imaging reporting and data system for malignancy risk stratification in thyroid nodules. Oncotarget. 2017;8(26):43406-43416. doi:10.18632/oncotarget.15018
- Lee HY, Lee JH, Shin JH, et al. Shear wave elastography using ultrasound: effects of anisotropy and stretch stress on a tissue phantom and in vivo reactive lymph nodes in the neck. Ultrasonography. 2017;36(1):25-32. doi:10.14366/usg.16003
- Ariji Y, Nakayama M, Nishiyama W, Nozawa M, Ariji E. Shear-wave sonoelastography for assessing masseter muscle hardness in comparison with strain sonoelastography: study with phantoms and healthy volunteers. Dentomaxillofac Radiol. 2016;45(2):20150251. doi:10.1259/dmfr.20150251
- Chang JM, Won JK, Lee KB, Park IA, Yi A, Moon WK. Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol. 2013;201(2):347-356. doi:10.2214/AJR.12.10416
- Cong Y, Fan Z, Dai Y, Zhang Z, Yan K. Application value of shear wave elastography in the evaluation of tumor downstaging for locally advanced rectal cancer after neoadjuvant chemoradiotherapy. J Ultrasound Med. 2021;40(1):81-89. doi:10.1002/jum.15378
- Zhao HX, Du YY, Guo YJ, et al. Application value of real-time shear wave elastography in diagnosing the depth of infiltrating muscular layer of endometrial cancer. J Ultrasound Med. 2021;40(9):1851-1861. doi:10.1002/jum.15568
- Liu C, Li TT, Hu Z, et al. Transvaginal real-time shear wave elastography in the diagnosis of cervical disease. J Ultrasound Med. 2019;38(12):3173-3181. doi:10.1002/jum.15018
- Barr RG, Ferraioli G, Palmeri ML, et al. Elastography assessment of liver fibrosis: society of radiologists in ultrasound consensus conference statement. Radiology. 2015;276(3):845-861. doi:10.1148/radiol.2015150619
- Bojunga J, Herrmann E, Meyer G, Weber S, Zeuzem S, Friedrich-Rust M. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid. 2010;20(10):1145-1150. doi:10.1089/thy.2010.0079
- Bakay OA, Golovko TS. Use of elastography for cervical cancer diagnostics. Exp Oncol. 2015;37(2):139-145.
- Bian J, Li J, Liu Y. Diagnostic accuracy of shear wave elastography for endometrial cancer: A meta-analysis. Medicine (Baltimore). 2023;102(4):e32700. doi:10.1097/MD.0000000000032700
- Murali R, Davidson B, Fadare O, et al. High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations. Int J Gynecol Pathol. 2019;38 Suppl 1(Iss 1 Suppl 1):S40-S63. doi:10.1097/PGP.0000000000000491
- Koyama T, Tamai K, Togashi K. Staging of carcinoma of the uterine cervix and endometrium. Eur Radiol. 2007;17(8):2009-2019. doi:10.1007/s00330-006-0555-0
- Fukuhara T, Matsuda E, Endo Y, et al. Correlation between quantitative shear wave elastography and pathologic structures of thyroid lesions. Ultrasound Med Biol. 2015;41(9):2326-2332. doi:10.1016/j.ultrasmedbio.2015.05.001
- Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12-39. doi:10.1136/ijgc-2020-002230
- Fujimoto T, Nanjyo H, Fukuda J, et al. Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence. Gynecol Oncol. 2009;112(2):342-347. doi:10.1016/j.ygyno.2008.10.019
- Grigsby PW, Perez CA, Kuten A, et al. Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system. Int J Radiat Oncol Biol Phys. 1992;22(5):905-911. doi:10.1016/0360-3016(92)90786-h
- Creutzberg CL, van Putten WL, Warlam-Rodenhuis CC, et al. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the postoperative radiation therapy in endometrial carcinoma Trial. J Clin Oncol. Apr 1 2004;22(7):1234-1241. doi:10.1200/JCO.2004.08.159
- Abu-Rustum NR, Yashar CM, Bradley K, et al. NCCN Guidelines (R) Insights: uterine neoplasms, version 3.2021. J Natl Compr Canc Netw. 2021;19(8):888-895. doi:10.6004/jnccn.2021.0038
- Gungorduk K, Muallem J, Asicioglu O, et al. Survival outcomes of women with grade 3 endometrioid endometrial cancer: the impact of adjuvant treatment strategies. Arch Gynecol Obstet. 2022;305(3):671-681. doi:10.1007/s00404-021-06187-4
- Baek MH, Park YR, Suh DS, et al. Reliability of tumour grade 1 and endometrioid cell type on preoperative endometrial biopsy. J Obstet Gynaecol. 2015;35(1):79-81. doi:10.3109/01443615.2014.935723
- Visser NCM, Reijnen C, Massuger L, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Obstet Gynecol. 2017;130(4):803-813. doi:10.1097/AOG.0000000000002261
- Alcazar JL, Gaston B, Navarro B, Salas R, Aranda J, Guerriero S. Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis. J Gynecol Oncol. 2017;28(6):e86. doi:10.3802/jgo.2017.28.e86
- Shao J, Shen Y, Lu J, Wang J. Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules. Clin Endocrinol (Oxf). 2015;83(2):254-260. doi:10.1111/cen.12589
- Du YY, Yan XJ, Guo YJ, et al. Transvaginal real-time shear wave elastography in the diagnosis of endometrial lesions. Int J Gen Med. 2021;14:2849-2856. doi:10.2147/IJGM.S312292
- Hohn AK, Brambs CE, Hiller GGR, May D, Schmoeckel E, Horn LC. 2020 WHO classification of female genital tumors. Geburtshilfe Frauenheilkd. 2021;81(10):1145-1153. doi:10.1055/a-1545-4279
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| Primary Language | English |
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| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Original Article |
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| Early Pub Date | September 26, 2023 |
| Publication Date | September 28, 2023 |
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