# Diagnostic value of contrast-enhanced ultrasound for the depth of myometrial infiltration in early endometrial cancer: a meta-analysis

## TL;DR

This study shows that contrast-enhanced ultrasound is effective in determining how deep endometrial cancer has spread into the uterus muscle.

## Contribution

The paper provides a meta-analysis confirming the diagnostic accuracy of contrast-enhanced ultrasound for myometrial infiltration in early endometrial cancer.

## Key findings

- CEUS has high sensitivity and specificity for diagnosing deep myometrial infiltration in endometrial cancer.
- The area under the curve for CEUS in diagnosing myometrial infiltration is 0.95, indicating strong diagnostic performance.
- CEUS is also effective for diagnosing superficial myometrial invasion with a sensitivity of 0.91.

## Abstract

Globally, endometrial cancer (EC) is currently one of the most common gynecologic malignancies among females. Preoperative infiltration depth analysis is important for disease progression and prognostic impact. This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in the infiltration depth analysis of EC.

Electronic databases PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched for more extensive literature on CEUS in the diagnosis of myometrial infiltration in EC patients up to March 29, 2024. Cochran Q and I² were used to assess the heterogeneity of eligible studies. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed for each clinical outcome using a bivariate random effects model. Summary receiver operating characteristic (SROC) curves were also generated.

In total, 23 papers with 1247 EC patients were included in the meta-analysis. The SEN, SPE, PLR, NLR, and DOR for the diagnosis of deep myometrial infiltration (DMI) of EC using CEUS were 0.84 [95% confidence interval (CI): 0.79, 0.89], 0.92 (95%CI: 0.90, 0.94), 11.05 (95%CI: 8.00, 15.25), 0.17 (95%CI: 0.12, 0.23), and 64.91 (95%CI: 37.11, 113.52), respectively. The area under the curve (AUC) was 0.95 (95%CI: 0.93, 0.97). For the diagnosis of superficial myometrial invasion (SMI) of EC by CEUS, the SEN, SPEN, PLR, NLR, DOR and AUC were 0.91 (95%CI: 0.85, 0.95), 0.80 (95%CI: 0.64, 0.90), 4.55 (95%CI: 2.34, 8.85), 0.11 (95%CI: 0.06, 0.21), 41.40 (95%CI: 12.14, 141.13), and 0.94 (95%CI: 0.91, 0.95), respectively.

CEUS might be a reliable and practical technique for EC myometrial infiltration diagnosis. More clinical data and studies are still needed to confirm these results in the future.