Ultrasound Scoring to Predict High-Risk Endometrial Cancer

Objectives: To evaluate a scoring system using transvaginal ultrasound (TVS) to predict high-risk endometrial cancer. Methods: Consecutive patients with endometrial cancer/atypical hyperplasia (n = 266) were preoperatively examined by residents using TVS. Clinical parameters, endometrial morphology and Doppler scores were recorded using a gray scale and Doppler TVS and related to final histopathology at hysterectomy. Multivariate logistic regression was used to correlate imaging and clinical parameters to the presence of high-risk endometrial cancer (defined as FIGO stage Ib-IV or high-grade tumors [grade 3/non-endometroid]) to develop the High-Risk Endometrial Cancer (HIREC) score. Results: High-risk endometrial cancer (n = 128) and lympho-vascular space invasion (LVSI) (n = 43) were predicted by increased endometrial thickness (ET), age, and Doppler score. The HIREC scoring system, based on age, Doppler score, and ET performed well with an AUC of 78.5% (CI 95%: 73–84) to predict high-risk cancer. By using a 2-step strategy of (1) Preoperative identification of high-grade tumors by biopsy, (2) Assessing the HIREC score, high-risk endometrial cancer could be predicted at a HIREC score of ≥7 with sensitivity, specificity, and accuracy of 72.7, 88.4, and 80.8%. Low-risk endometrial cancer was predicted at HIREC scores of <5 with sensitivity, specificity, and accuracy values of 91.4, 46.4 and 68.1%, respectively. Conclusions: Low and high HIREC scores effectively predicted low- and high-risk endometrial cancer. The score is a simple point system suitable for the first ultrasound assessment. It may be used in preoperative work-up to select treatment and additional imaging, but it needs to be validated in further studies.