{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:37:32Z","timestamp":1791412652289,"version":"4.3.3"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T00:00:00Z","timestamp":1593561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002002","name":"Cancer Research Foundation","doi-asserted-by":"publisher","award":["154112"],"award-info":[{"award-number":["154112"]}],"id":[{"id":"10.13039\/100002002","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":[[2020,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the sensitivity and specificity of conventional two\u2010dimensional transvaginal ultrasound\/power Doppler (2D\u2010TVU\/PD) alone and 2D\u2010TVU\/PD combined with dynamic contrast\u2010enhanced ultrasound (DCE\u2010US) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) in women with endometrial cancer (EC), and to assess the association of DCE\u2010US semiquantitative and qualitative variables with International Federation of Gynecology and Obstetrics (FIGO) Stage \u2265\u2009IB and \u2018high\u2010risk\u2019 cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective study of 101 consecutive women with biopsy\u2010confirmed EC, undergoing expert ultrasound examination at Karolinska University Hospital, a tertiary referral center. All consenting women underwent DCE\u2010US using a 1.5\u20132.5\u2010mL intravenous bolus of SonoVue contrast agent, as well as conventional 2D\u2010TVU\/PD examination. DCE\u2010US videoclips were analyzed with regard to filling (global or focal), wash\u2010in (prior, simultaneous or after) and wash\u2010out (global or focal) patterns of the contrast agent in the tumor compared with the surrounding tissue, as well as semiquantitative DCE\u2010US parameters (wash\u2010in slope, time\u2010to\u2010peak, peak intensity and area under the time\u2013intensity curve (TIC)) obtained from a TIC. The study cohort was compared with a control cohort of women with EC examined at our center according to the International Endometrial Tumor Analysis protocol using 2D\u2010TVU\/PD only, matched at a ratio of 3:1 for FIGO stage and grade. The sensitivity and specificity of 2D\u2010TVU\/PD alone in the control cohort and in combination with DCE\u2010US in the study cohort in the diagnosis of deep MI, CSI and high\u2010risk cancer (defined as FIGO Stage \u2265\u2009IB and\/or Grade 3 endometrioid and\/or non\u2010endometrioid histology) were compared, using pathological evaluation after hysterectomy as the \u2018gold standard\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After exclusions, 93 women were included in the study cohort and were matched to 279 women in the control cohort. The prevalence of FIGO Stage IA, Grade 1\u20132 EC was 52% in both cohorts. The sensitivity of 2D\u2010TVU\/PD with DCE\u2010US in the study cohort was higher than that of 2D\u2010TVU\/PD alone in the control cohort in diagnosing both deep MI (0.74\n                      <jats:italic>vs<\/jats:italic>\n                      0.62;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.036) and CSI (0.75\n                      <jats:italic>vs<\/jats:italic>\n                      0.51;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas the specificity was not significantly different (0.87\n                      <jats:italic>vs<\/jats:italic>\n                      0.85 and 0.96\n                      <jats:italic>vs<\/jats:italic>\n                      0.95, respectively). Compared with 2D\u2010TVU\/PD alone, the specificity of 2D\u2010TVU\/PD with DCE\u2010US was higher in detecting high\u2010risk cancer (0.94\n                      <jats:italic>vs<\/jats:italic>\n                      0.85;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.024) but the sensitivity did not differ (0.73\n                      <jats:italic>vs<\/jats:italic>\n                      0.71). High\u2010risk cancer and FIGO Stage \u2265\u2009IB were characterized by a \u2018focal\u2019 filling pattern, with a \u2018prior\u2019 wash\u2010in pattern and a \u2018focal\u2019 wash\u2010out pattern on subjective assessment of DCE\u2010US videoclips. All semiquantitative DCE\u2010US parameters were significantly predictive of FIGO Stage \u2265\u2009IB but not of high\u2010risk cancer, despite a clear trend.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with 2D\u2010TVU\/PD alone, combining 2D\u2010TVU\/PD with DCE\u2010US can significantly improve the detection of deep MI and CSI in women with EC, without increasing the false\u2010positive rate. It can also improve the correct classification of high\u2010risk disease, mainly by increasing specificity, thereby possibly reducing the number of unnecessarily extensive surgeries by almost 10%. Semiquantitative DCE\u2010US parameters, as well as a \u2018focal\u2019 filling pattern, endometrial wash\u2010in prior to the myometrium and a \u2018focal\u2019 wash\u2010out pattern, are all associated with more advanced disease. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.21885","type":"journal-article","created":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T13:15:58Z","timestamp":1571922958000},"page":"96-105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Dynamic contrast\u2010enhanced ultrasound improves diagnostic performance in endometrial cancer staging"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6575-2447","authenticated-orcid":false,"given":"R. 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