{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:16:04Z","timestamp":1789578964560,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T00:00:00Z","timestamp":1576195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare the performance of ultrasound measurements and subjective ultrasound assessment (SA) in detecting deep myometrial invasion (MI) and cervical stromal invasion (CSI) in women with endometrial cancer, overall  and according to whether they had low\u2010 or high\u2010grade disease separately, and to validate published measurement cut\u2010offs and prediction models to identify MI, CSI and  high\u2010risk disease (Grade\u20103 endometrioid or non\u2010endometrioid cancer and\/or deep MI and\/or CSI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study comprised 1538 patients with endometrial cancer from the International Endometrial Tumor Analysis (IETA)\u20104 prospective multicenter study, who underwent standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the tumor\/uterine  anteroposterior (AP) diameter ratio for detecting deep MI and that of the distance from the lower margin of the tumor to the outer cervical os (Dist\u2010OCO) for detecting CSI. We also validated two two\u2010step strategies for the prediction of high\u2010risk cancer; in the first step, biopsy\u2010confirmed Grade\u20103 endometrioid or mucinous or non\u2010endometrioid cancers were classified as high\u2010risk cancer, while the  second step encompassed the application of a  mathematical model to classify the remaining tumors. The \u2018subjective prediction model\u2019 included biopsy grade (Grade 1 <jats:italic>vs<\/jats:italic> Grade 2) and subjective assessment of deep MI or CSI (presence or absence) as variables, while the \u2018objective prediction model\u2019 included biopsy grade (Grade 1 <jats:italic>vs<\/jats:italic> Grade 2) and minimal tumor\u2010free margin. The predictive performance of the two two\u2010step strategies was compared with that of simply classifying patients as high risk if either deep MI or CSI was suspected based on SA or if biopsy showed Grade\u20103 endometrioid or mucinous or non\u2010endometrioid histotype (i.e. combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 1275 patients with measurable lesions, the sensitivity and specificity of SA for detecting deep MI was 70% and 80%, respectively, in patients with a Grade\u20101 or \u20102 endometrioid or mucinous tumor <jats:italic>vs<\/jats:italic> 76% and 64% in patients with a Grade\u20103 endometrioid or mucinous or a non\u2010endometrioid tumor. The corresponding values for the detection of CSI were 51% and 94% <jats:italic>vs<\/jats:italic> 50% and 91%. Tumor AP diameter and tumor\/uterine AP diameter ratio showed the best performance for predicting deep MI (area under the receiver\u2013operating characteristics curve (AUC) of 0.76 and 0.77, respectively), and Dist\u2010OCO had the best performance for predicting CSI (AUC, 0.72). The proportion of patients classified correctly as having high\u2010risk cancer was 80% when simply combining SA with biopsy grade <jats:italic>vs<\/jats:italic> 80% and 74% when using the subjective and objective two\u2010step strategies, respectively. The subjective and objective models had an AUC of 0.76 and 0.75, respectively, when applied to Grade\u20101 and \u20102 endometrioid tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the hands of experienced ultrasound examiners, SA was superior to ultrasound measurements for the prediction of deep MI and CSI of endometrial cancer, especially in patients with a Grade\u20101 or \u20102 tumor. The mathematical models for the prediction of high\u2010risk cancer performed as expected. The best strategies for predicting high\u2010risk endometrial cancer were combining SA with biopsy grade and the subjective two\u2010step strategy, both having an accuracy of 80%. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20374","type":"journal-article","created":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T09:19:08Z","timestamp":1561108748000},"page":"115-124","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Validation of ultrasound strategies to assess tumor extension and to predict high\u2010risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)\u20104 cohort"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7166-7211","authenticated-orcid":false,"given":"J. Y.","family":"Verbakel","sequence":"first","affiliation":[{"name":"Department of Public Health and Primary Care KU Leuven  Leuven Belgium"},{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Mascilini","sequence":"additional","affiliation":[{"name":"Department of Woman and Child Health and Public Health Fondazione Policlinico Universitario Agostino Gemelli\u2010IRCSS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Wynants","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Epidemiology CAPHRI Care and Public Health Research Institute, Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7224-3218","authenticated-orcid":false,"given":"D.","family":"Fischerova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, First Faculty of Medicine Charles University and General University Hospital in Prague  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. C.","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of Woman and Child Health Universit\u00e0 Cattolica del Sacro Cuore, Division of Gynecologic Oncology  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Franchi","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Fr\u00fchauf","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, First Faculty of Medicine Charles University and General University Hospital in Prague  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Cibula","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, First Faculty of Medicine Charles University and General University Hospital in Prague  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1652-8235","authenticated-orcid":false,"given":"P. G.","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology, S\u00f6dersjukhuset, Stockholm  Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Fruscio","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. A.","family":"Haak","sequence":"additional","affiliation":[{"name":"Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Opolskiene","sequence":"additional","affiliation":[{"name":"Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius University  Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"J. L.","family":"Alcazar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Clinica Universidad de Navarra  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Mais","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Cagliari, Policlinico Universitario Duilio Casula  Monserrato, Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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