In endometrial cancer (EC), deep myometrial invasion (DMI) is a prognostic factor that can be evaluated by various imaging methods; however, the best method of choice is uncertain. We aimed to compare the diagnostic performance of two-dimensional transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the preoperative detection of DMI in patients with EC. Pubmed, Embase and Cochrane Library were systematically searched in May 2023. We included original articles that compared TVS to MRI on the same cohort of patients, with final histopathological confirmation of DMI as reference standard. Several subgroup analyses were performed. Eighteen studies comprising 1548 patients were included. Pooled sensitivity and specificity were 76.6% (95% confidence interval (CI), 70.9–81.4%) and 87.4% (95% CI, 80.6–92%) for TVS. The corresponding values for MRI were 81.1% (95% CI, 74.9–85.9%) and 83.8% (95% CI, 79.2–87.5%). No significant difference was observed (sensitivity:p= 0.116, specificity:p= 0.707). A non-significant difference between TVS and MRI was observed when no-myometrium infiltration vs. myometrium infiltration was considered. However, when only low-grade EC patients were evaluated, the specificity of MRI was significantly better (p= 0.044). Both TVS and MRI demonstrated comparable sensitivity and specificity. Further studies are needed to assess the presence of myometrium infiltration in patients with fertility-sparing wishes.
在子宫内膜癌中，深肌层浸润是可通过多种影像学方法评估的预后因素，但最佳选择方案尚未明确。本研究旨在比较二维经阴道超声与磁共振成像对子宫内膜癌患者术前深肌层浸润检测的诊断效能。我们于2023年5月系统检索了Pubmed、Embase和Cochrane图书馆数据库，纳入以最终组织病理学确认为金标准、在同一患者队列中比较经阴道超声与磁共振诊断性能的原始研究，并进行多项亚组分析。共纳入18项研究，涵盖1548例患者。经阴道超声的汇总敏感性与特异性分别为76.6%（95%置信区间70.9-81.4%）和87.4%（95%置信区间80.6-92%），磁共振成像对应值分别为81.1%（95%置信区间74.9-85.9%）和83.8%（95%置信区间79.2-87.5%），两者无显著差异（敏感性p=0.116，特异性p=0.707）。在评估无肌层浸润与肌层浸润时，经阴道超声与磁共振成像未见显著差异。但在仅评估低级别子宫内膜癌患者时，磁共振成像的特异性显著更优（p=0.044）。经阴道超声与磁共振成像在诊断性能上具有可比性，未来需进一步研究以评估有生育意愿患者的肌层浸润情况。
肿瘤(癌症)患者之家