[Preoperative and intraoperative evaluation of myometrial invasion in endometrial cancer by progesterone-challenge test, CT scan, magnetic resonance imaging, PET scan and intraoperative visual evaluation and Frozen section]

Abstract

Aim: Our aim was to compare the diagnostic value and accuracy of progesterone-challenge test combined with TVS, CT scan, MRI, Pet scan and Visual and histologic evaluation (Frozen section) for assessment of Myometrial invasion of the endometrial cancer.

Methods: Our research work includes 300 patients with endometrial cancer for the period of 1999-2009. All of them were found by Progesterone challenge test combined with TVS, Collor-doppler sonography, who additionally were examined by CT MRI and Pet scan. In the time of surgery was evaluated visually and histologically the Myometrial invasion of the tumor: a) As superficial cancer b) Infiltration up to 50% c) Infiltration more than 50% of the myometrium. Frozen section was also performed, which gave the final diagnosis of the infiltration in the myometrium.

Results: The Progesteron-challenge test combined with TVC, CT scan, MRI, Visual assessment and Frozen section did not give significant differences in assessment of the depth of myometral invasion. A small advantage we detect in the frozen section evaluation without strong statistical significance. The positive value of the intratumor blood flow was higher in deep myometrial invasion without any statistical significance. The median level of RI index was lower in patients with deep myometrial invasion.

Conclusions: The Progesterone-challenge test combined with TVS is a cheap, easily performed and repeated technique for evaluation of deep myometral invasion in endometrial cancer patients. The CT scan, MRI and PET scan we offer in patients with bad quality of TVS. The Visual evaluation and Frozen section help additionally the diagnosis of myometrial infiltration in endometrial cancer patients.