Comparison of 3D ultrasound, 2D ultrasound and 3D Doppler in the diagnosis of endometrial carcinoma in patients with uterine bleeding: A systematic review and meta-analysis

• Published in: European journal of obstetrics & gynecology and reproductive biology 2022-10, Vol.277, p.42-52
• Main Authors: Xydias, Emmanouil M., Kalantzi, Sofia, Tsakos, Elias, Ntanika, Anna, Beis, Nikolaos, Prior, Matthew, Daponte, Alexandros, Ziogas, Apostolos C.
• Format: Article
• Language: English
• Subjects: 2D ultrasound; 3D Doppler angiography; 3D ultrasound; Endometrial cancer; Uterine bleeding
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2022.08.005

•3D ultrasound modalities could facilitate endometrial cancer diagnosis.•Endometrial volume was more specific than endometrial thickness.•3D Doppler indices were more sensitive than endometrial volume.•3D modalities additionally offer other technical and practical benefits.•More research is required to further investigate 3D diagnostic efficacy. Endometrial cancer is a common malignancy affecting women worldwide. Usually, it clinically manifests with uterine bleeding, although identical clinical manifestations occur in benign conditions as well, with several endometrial biopsies being conducted unnecessarily. Therefore, an accurate, non-invasive diagnostic test is needed for first-line assessment, so as unnecessary biopsies are limited as much as possible. This systematic review aims to assess the diagnostic accuracy of three-dimensional ultrasound, a relatively novel method in gynecologic assessment, compared to two-dimensional ultrasound and three-dimensional Doppler in the prediction of uterine malignancy in women with abnormal uterine bleeding. The accuracy of endometrial volume, as a diagnostic parameter assessed by three-dimensional ultrasound is compared to diagnostic parameters from the other two methods, namely endometrial thickness and 3D Doppler indices (vascularization index, flow index and vascularization flow index). Articles relevant to our research question were systematically sought in the Web of Science, Scopus and MEDLINE/PubMed databases and underwent rigorous evaluation for inclusion according to the PRISMA 2020 guidelines. Eligible studies were thoroughly assessed for risk of bias and relevant data was extracted and analyzed. Studies were heterogenous and extracted data varied from study to study. Data on endometrial volume was compared to other diagnostic parameters. Forest plots with pooled percentages and hierarchical summary receiver operating characteristic curves were constructed for each comparison. Relative sensitivity and specificity ratios were calculated for each comparison to test for statistical significance. Endometrial volume and thickness comparison showed sensitivity 83% for both parameters and specificity 75% and 69% respectively, with volume being more specific than thickness (p