• Klíčová slova
• submukózní myom,
• MeSH
• diagnostické zobrazování metody   MeSH
• hysteroskopie metody   MeSH
• leiomyom diagnóza   etiologie   patologie   terapie   MeSH
• lidé MeSH
• myom * chirurgie   diagnóza   etiologie   klasifikace   terapie   MeSH
• myometrium diagnostické zobrazování   patologie   MeSH
• nádory dělohy diagnóza   etiologie   klasifikace   patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVES: To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer. METHODS/MATERIALS: We included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases. RESULTS: The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion (≥ 50%) (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011). CONCLUSIONS: Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.

• MeSH
• histiocyty patologie   MeSH
• hysterektomie MeSH
• invazivní růst nádoru MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie MeSH
• lymfatické uzliny diagnostické zobrazování   patologie   chirurgie   MeSH
• myometrium diagnostické zobrazování   patologie   chirurgie   MeSH
• nádory endometria diagnostické zobrazování   patologie   chirurgie   MeSH
• následné studie MeSH
• prognóza MeSH
• prospektivní studie MeSH
• senioři MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy. METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ). RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually. CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.

• MeSH
• dospělí MeSH
• invazivní růst nádoru MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium diagnostické zobrazování   patologie   MeSH
• nádory endometria diagnostické zobrazování   patologie   chirurgie   MeSH
• odchylka pozorovatele MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů metody   MeSH
• ultrasonografie metody   MeSH
• zobrazování trojrozměrné * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 and December 2011, were prospectively enrolled. Myometrial invasion was evaluated by subjective assessment using ultrasound (<50% or ≥50%) and calculated as deepest invasion/normal myometrium ratio (Gordon's ratio) and as tumor/uterine anteroposterior diameter ratio (Karlsson's ratio). Histological assessment from hysterectomy was considered the gold standard. Altogether 210 patients were prospectively included. Subjective assessment and two objective ratios were found to be statistically significant predictors of the myometrial invasion (AUC = 0.65, p value < 0.001). Subjective assessment was confirmed as the most reliable method to assess myometrial invasion (79.3% sensitivity, 73.2% specificity, and 75.7% overall accuracy). Deepest invasion/normal myometrium (Gordon's) ratio (cut-off 0.5) reached 69.6% sensitivity, 65.9% specificity, and 67.3% overall accuracy. Tumor/uterine anteroposterior diameter (Karlsson's) ratio with the same cut-off reached 56.3% sensitivity, 76.4% specificity, and 68.1% overall accuracy. The subjective ultrasound evaluation of myometrial invasion performed better than objective methods in nearly all measures but showed statistically significantly better outcomes only in case of sensitivity.

• MeSH
• invazivní růst nádoru diagnóza   diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium diagnostické zobrazování   patologie   chirurgie   MeSH
• nádory endometria diagnóza   diagnostické zobrazování   patologie   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ultrasonografie * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Cíl studie: Analýza úspěšnosti ultrazvukového stagingu časných stadií karcinomu endometria v závislosti na gradingu (histologickém typu), vyhodnocení přesnosti vyšetření s přibývajícími zkušenostmi sonografistů a komparace subjektivního versus objektivního hodnocení hluboké invaze do myometria v souboru pacientek, které byly referované do Onkogynekologického centra Gynekologicko-porodnického oddělení v Českých Budějovicích. Typ studie: Retrospektivní studie. Název a sídlo pracoviště: Gynekologicko-porodnické oddělení, Nemocnice České Budějovice a.s. Metodika a soubor: V tomto článku retrospektivně hodnotíme soubor 136 pacientek s časným stadiem karcinomu endometria, které podstoupily diagnostiku a léčbu na našem pracovišti v období let 2012–2016 a u kterých bylo možno porovnat různé modality hodnocení hluboké invaze tumoru do myometria pomocí ultrazvukového vyšetření. Výsledky: Při srovnání jednotlivých použitých metod hodnocení hluboké myometriální invaze pomocí ultrazvukového vyšetření u pacientek s časným stadiem karcinomu endometria je patrné, že nejvyšší míry přesnosti dosahuje subjektivní hodnocení expertem, kdy po prvním roce hodnocení senzitivita dosahovala 80 %, specificita 79 %, u postižení stromatu hrdla 70 % a 99 %. V případě rozdělení do podskupin podle gradingu je patrný se zvyšujícím se gradingem nárůst senzitivity z 64 % na 100 %, při poklesu specificity ze 75 % na 56 %. Při vyhodnocování způsobů objektivního hodnocení při zvolených cut off nejvyšší senzitivitu, 81 %, vykazovalo měření vzdálenosti tumor/seróza (specificita 67 %). Naopak nejlepších hodnot specificity 90 % dosahovalo hodnocení poměru AP (anterioposteriorní) rozměr tumoru/AP rozměr dělohy (senzitivita 54 %). Závěr: Všeobecně je v onkologické léčbě kladen důraz na co nejpřesnější staging nádorových onemocnění. V rámci onkogynekologie se čím dál tím více prosazuje v tomto ohledu ultrazvukové vyšetření. Náš soubor prokázal význam ultrazvuku v diagnostice a stagingu karcinomu endometria a míru jeho přesnosti u časných stadií v závislosti na zkušenostech sonografisty, které po roce již dosahují celosvětově prezentovaných výsledků, ať pomocí ultrazvukového vyšetření, MRI či při využití frozen section.

Objective: The aim of the presented study was to evaluate the accuracy of ultrasound staging of early stage endometrial cancer depending on grading, evaluation of ultrasound examination accuracy growing overtime with gained experience of examiners and comparison of subjective versus objective modalities of deep myometrial invasion assessment in the file of patients who were referred in The Oncogyneacologic Center, Department of Gyneacology and Obstetrics in České Budějovice. Design: Retrospective study. Settings: Department of Gyneacology and Obstetrics, Hospital České Budějovice a.s. Methods and the file: In this arcticle we retrospectively evaluate the file of 136 patients with early stage endometrial cancer. The patients underwent diagnostic and therapeutic procedures during the years 2012-2016 in our department. All these patients were able to be compared in different aproaches to deep myometrial invasion assessment using ultrasound examination. Results: Comparing the used methods of deep myometrial invasion assessment with ultrasound examination of early stage endometrial cancer patients the examiner's subjective evaluation seems to be the best approach. After the first year of doing these assessments sensitivity performed 80%, specificity 79% and infiltration of cervix sensitivity 70% and specificity 99%. In case the patients were divided into groups according to the grading, low grade assessed worst sensitivity 64% (high grade l00%), but the best specificity 75% (high grade 56%). The evaluation of objective approaches of ultrasound assement with used cut offs performed the best sensitivity 81% tumour free minimal margin (specificity 67%). On the contrary the best specificity 90% performed the ratio AP (anteroposterior) diameter tumour/AP diameter uterine (senzitivity 54%). Conclusion: Generally in oncological therapy the most important things to put stress on the very accurate staging of oncological disease. In oncogyneacology ultrasound becomes more and more required examination. In our file we proved the significance of ultrasound examination in diagnostics and staging of endometrial cancer and we also proved that the accuracy level in early stage depends on the examiner´s experience. After one year practice our results reach the level of the results presented globally, no matter which of the methods – ultrasound MRI or frozen section – was used.

• MeSH
• endometrium anatomie a histologie   MeSH
• incidence MeSH
• interpretace statistických dat MeSH
• lidé MeSH
• myometrium diagnostické zobrazování   MeSH
• nádory endometria * diagnostické zobrazování   diagnóza   MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: To develop and validate strategies, using new ultrasound-based mathematical models, for the prediction of high-risk endometrial cancer and compare them with strategies using previously developed models or the use of preoperative grading only. METHODS: Women with endometrial cancer were prospectively examined using two-dimensional (2D) and three-dimensional (3D) gray-scale and color Doppler ultrasound imaging. More than 25 ultrasound, demographic and histological variables were analyzed. Two logistic regression models were developed: one 'objective' model using mainly objective variables; and one 'subjective' model including subjective variables (i.e. subjective impression of myometrial and cervical invasion, preoperative grade and demographic variables). The following strategies were validated: a one-step strategy using only preoperative grading and two-step strategies using preoperative grading as the first step and one of the new models, subjective assessment or previously developed models as a second step. RESULTS: One-hundred and twenty-five patients were included in the development set and 211 were included in the validation set. The 'objective' model retained preoperative grade and minimal tumor-free myometrium as variables. The 'subjective' model retained preoperative grade and subjective assessment of myometrial invasion. On external validation, the performance of the new models was similar to that on the development set. Sensitivity for the two-step strategy with the 'objective' model was 78% (95% CI, 69-84%) at a cut-off of 0.50, 82% (95% CI, 74-88%) for the strategy with the 'subjective' model and 83% (95% CI, 75-88%) for that with subjective assessment. Specificity was 68% (95% CI, 58-77%), 72% (95% CI, 62-80%) and 71% (95% CI, 61-79%) respectively. The two-step strategies detected up to twice as many high-risk cases as preoperative grading only. The new models had a significantly higher sensitivity than did previously developed models, at the same specificity. CONCLUSION: Two-step strategies with 'new' ultrasound-based models predict high-risk endometrial cancers with good accuracy and do this better than do previously developed models.Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

• MeSH
• časná detekce nádoru MeSH
• cervix uteri * diagnostické zobrazování   patologie   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• invazivní růst nádoru MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium * diagnostické zobrazování   patologie   MeSH
• nádory endometria * diagnostické zobrazování   patologie   MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• staging nádorů MeSH
• teoretické modely MeSH
• ultrasonografie dopplerovská barevná * MeSH
• ultrazvuk * trendy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH