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.