Diagnostik und präoperatives Staging des Endometriumkarzinoms mittels transvaginaler Sonographie - eine Übersicht

Zusammenfassung

Das Endometriumkarzinom ist derzeit der häufigste maligne Tumor des weiblichen Genitale. Bei der Diagnosestellung spielt die transvaginale Sonographie des Endometriums im Rahmen der nichtinvasiven Diagnostik eine wichtige Rolle. Das Hauptkriterium stellt die (doppelte) Endometriumdicke dar. Die Festlegung auf einen cut-off-Wert bei Patientinnen mit postmenopausaler Blutung ist noch umstritten. Allerdings kann unterhalb (≤) von 4 bzw. 5 mm ein Endometriumkarzinom mit großer Wahrscheinlichkeit ausgeschlossen werden. Beträgt die doppelte Breite über 4 bzw. 5 mm oder persistiert eine postmenopausale Blutung, sollte eine histologische Abklärung mittels Hysteroskopie und fraktionierter Abrasio erfolgen. Andere sonographische Parameter wie Struktur und Abgrenzbarkeit des Endometriums erhöhen allenfalls in Kombination mit der Dicke die Spezifität der Diagnostik, sind aber nicht als alleiniges Kriterium anzuwenden. Intrakavitäre Flüssigkeitsansammlung ist eher ungeeignet bei der Dignitätsbeurteilung. Das präoperative Staging ist für die Radikalität des operativen Vorgehens bei den zumeist älteren multimorbiden Patientinnen von großer Wichtigkeit. Als Methode zur präoperativen Abschätzung der myometranen Invasionstiefe und des zervikalen Befalls hat sich die transvaginale Sonographie noch nicht etabliert. Trotz einiger viel versprechender Arbeiten sind noch zusätzliche Untersuchungen notwendig, um die Rolle des transvaginalen Ultraschalls neben anderen Methoden (CT, MRT) festzulegen. Diese Übersicht soll die aktuelle Studienlage zur transvaginalsonographischen Dignitätsbeurteilung des Endometriumkarzinoms wiedergeben.

Abstract

Endometrial carcinoma is the most common malignant tumor of the female genital tract. The major non-invasive diagnostic method is ultrasound. Endometrial thickness (double layer) is measured by transvaginal sonography. The cut-off value in patients with postmenopausal bleeding is still controversial, although in patients with endometrial thickness below 4 mm (or 5 mm respectively), malignancy can be excluded with high probability. If the endometrium measures more than 4 mm (or more than 5 mm respectively) or the patient presents with continuous bleeding, hysteroscopy and curettage should be performed in order to obtain histologic diagnosis. Sonographic findings like structure and demarcation of the endometrium increase diagnostic specificity only when combined with the measurement of endometrial thickness. Measuring the fluid within the uterine cavity does not seem to be useful in differentiating malignant from benign disorders. The extent of surgery depends on the preoperative estimation of the tumor stage which is particularly important for elder patients with increased morbidity. Transvaginal sonography has not been widely accepted to predict the depth of myometrial invasion or cervical infiltration. Although promising studies exist, additional examinations have to be done in order to determine the role of transvaginal sonography beside other methods (CT, MRT). This article on transvaginal ultrasound reviews current data on the method's capacity to identify endometrial cancer and to diagnose the depth of invasion.

Schlüsselwörter

Endometriumkarzinom - Ultraschall - transvaginale Sonographie - Endometriumdicke - Myometriuminvasion

Key words

endometrial cancer - ultrasound - transvaginal sonography - endometrial thickness - myometrial invasion

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