OBJECTIVE: To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: This was a prospective multicenter study of 1714 women with biopsy-confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high-end ultrasound equipment. Clinical and sonographic data were entered into a web-based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c-statistic. RESULTS: In total, 1538 women were included in the final analysis. Median age was 65 (range, 27-98) years, median body mass index was 28.4 (range 16-67) kg/m2 , 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High-risk tumors, compared with low-risk tumors, were less likely to have regular endometrial-myometrial junction (difference of -23%; 95% CI, -27 to -18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non-uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). CONCLUSION: Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high- and low-risk endometrial cancer. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Center of Obstetrics and Gynecology Vilnius University Hospital Santariskiu Clinic Vilnius Lithuania

Clinic of Obstetrics and Gynecology University of Milan Bicocca San Gerardo Hospital Monza Italy

Department of Clinical Science and Education Karolinska Institutet and Department of Obstetrics and Gynecology Södersjukhuset Stockholm Sweden

Department of Development and Regeneration KU Leuven Leuven Belgium

Department of Electrical Engineering ESAT SCD STADIUS Center for Dynamical Systems Signal Processing and Data Analysis KU Leuven and imec Leuven Belgium

Department of Gynecological Oncology Catholic University of the Sacred Heart Rome Italy

Department of Gynecological Oncology European Institute of Oncology Milan Italy

Department of Obstetrics and Gynaecology Queen Charlotte's and Chelsea Hospital Imperial College London London UK

Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Obstetrics and Gynecology Clinica Universidad de Navarra Pamplona Spain

Department of Obstetrics and Gynecology Clinical Sciences Institute L Sacco Milan Italy

Department of Obstetrics and Gynecology Karolinska University Hospital Huddinge Stockholm Sweden

Department of Obstetrics and Gynecology National Cancer Institute Milan Italy

Department of Obstetrics and Gynecology Skåne University Hospital Malmö Lund University Sweden

Department of Obstetrics and Gynecology University Hospital Leuven Leuven Belgium

Department of Obstetrics and Gynecology University of Cagliari Policlinico Universitario Duilio Casula Monserrato Cagliari Italy

Department of Obstetrics and Gynecology Ziekenhuis Oost Limburg Genk Belgium

Department of Obstetrics Gynecology and Reproduction Hospital Universitario Dexeus Barcelona Spain

Department of Pathology Karolinska University Hospital Stockholm Sweden

Institute for the Care of Mother and Child Prague and 3rd Faculty of Medicine Charles University Prague Czech Republic

Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK

Ultrasound Obstet Gynecol. 2018 Nov;52(5):684. doi: 10.1002/uog.20133. PubMed

References provided by Crossref.org

Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements

Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort