Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis

Abstract

Objective: To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for detecting myometrial infiltration (MI) in endometrial carcinoma.

Methods: An extensive search of papers comparing TVS and MRI in assessing MI in endometrial cancer was performed in MEDLINE (PubMed), Web of Science, and Cochrane Database from January 1989 to January 2017. Quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

Results: Our extended search identified 747 citations but after exclusions we finally included in the meta-analysis 8 articles. The risk of bias for most studies was low for most 4 domains assessed in QUADAS-2. Overall, pooled estimated sensitivity and specificity for diagnosing deep MI were 75% (95% confidence interval [CI]=67%-82%) and 82% (95% CI=75%-93%) for TVS, and 83% (95% CI=76%-89%) and 82% (95% CI=72%-89%) for MRI, respectively. No statistical differences were found when comparing both methods (p=0.314). Heterogeneity was low for sensitivity and high for specificity for TVS and MRI.

Conclusion: MRI showed a better sensitivity than TVS for detecting deep MI in women with endometrial cancer. However, the difference observed was not statistically significant.

Keywords: Endometrial Neoplasms; Infiltration; Magnetic Resonance Imaging; Myometrium; Transvaginal; Ultrasound.

Fig. 1

Flow chart showing studies selection process.

Fig. 2

Histogram plot showing quality assessment (risk of bias and concerns about applicability) for all studies included in the meta-analysis. MRI, magnetic resonance imaging; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2; TVS, transvaginal ultrasound.

Fig. 3

Forest plot for sensitivity and specificity for each study and pooled sensitivity and specificity for TVS (A) and MRI (B). CI, confidence interval; MRI, magnetic resonance imaging; TVS, transvaginal ultrasound.

Fig. 4

sROC curve for TVS (A) and MRI (B). AUC, area under the curve; MRI, magnetic resonance imaging; SENS, sensitivity; SPEC, specificity; sROC, summary receiver-operating characteristics; TVS, transvaginal ultrasound.

Fig. 5

Fagan nomograms showing how pre-test probability change after the test is performed (post-test probability) depending on a positive or negative result for TVS (A) and MRI (B). LR, likelihood ratio; LR+, positive likelihood ratio; LR−, negative likelihood ratio; MRI, magnetic resonance imaging; TVS, transvaginal ultrasound.