Can Elastographic Evaluation Be a New Approach in Prediction of Endometrial Cancer Prognostic Markers?

Endometrial cancer is the most common gynecologic cancer, particularly in developed countries of the World. Today, it ranks as the 4th most common cancer among the women after breast, colorectal and lung malignencies. Although 4% of patients are premenopausal, most common symptom of disease is postmenopausal bleeding. Obtaining pathological sample as an endometrial Pipelle Biopsy, dilatation-curettage or hysterescopic excision are main diagnostic methods in endometrial cancer. Prognosis of disease depends on age, grade, myometrial invasion-histologic type of tumor, lymph node and distant metastasis.

In addition to pathologic reports; transvaginal ultrasound is most commonly used preoperative non invasive, no radiation-related and low cost imaging method to assess the endometrial cavity, endo-myometrial invasion, tumor diameter, cervical and adnexal involvement. Some of these risk factors can be easily detected with transvaginal ultrasound as well as intraoperative frozen-section examination.

Sonoelastography is a novel technique, which evaluate tissue stiffness both qualitatively and quantitatively and can distinguish different lesions in various organs as liver, breast and thyroid. Strain and shear-wave imagings are two main elastographic technics that commonly used with ultrasound technology. In the first method, the operator exerts manual compression on the tissue with the ultrasound transducer. Strain elastography evaluates the tissue elasticity by measuring the degree of distorsion by the compression and decompression of soft tissues and strain ratio (SR) is obtained by proportioning the tissue elasticity of the suspicious pathologic area with a reference point. Manual compression works fairly well for superficial organs such as the breast, superficial lymph nodes and thyroid but is challenging for assessing elasticity in deeper located organs such as the liver. Strain elastography is a semi-quantitative method due to the variations in compression and decompression pressures and selected ROI areas between practitioners. The use of SR makes this relative subjective technic more objective. In shear wave elastography, the ultrasound transducer is held steady, and tissue displacement is generated by internal physiologic motion (e.g. cardiovascular, respiratory). Since this method is not dependent on superficially applied compression, variations between practitioners are negligible and it may be used to assess deeper located organs.

In gynecology clinical practice, sono elastography has been used in recent years in different subjects as ovarian and endometrial benign lesions. In diagnostic process, elastography is not been well established in endometrial cancer.

In this study, we aimed to determine whether sonoelastography could be a new prognostic predictor in endometrial cancer. Accordingly, we examined the relationship between the elastographic features of the lesions and known pathologic prognostic factors in endometrial cancer cases.