Is transvaginal elastography useful in pre-operative diagnosis of cervical cancer?

Objective: To evaluate the clinical value of transvaginal elastography (TVES) in diagnosing cervical malignancies by detecting changes of tissue stiffness.

Methods: One hundred and ten consecutive patients with cervical lesions were enrolled. Pathological results were used as the gold standards. TVES was employed to detect the stiffness changes of the cervix. Strain ratio was calculated and compared between the benign and malignant lesions. Depth of invasion into stromas of 56 cases of cervical cancers measured by TVES were recorded and compared with the pathological results. Interclass correlation coefficient (ICC) was used to analyze the reproducibility.

Results: Strain ratio of malignant lesions were much higher than that of the benign lesions (8.19±5.66 vs. 2.81±2.24, P<0.01). Area under the curve (AUC) was 0.905 with a 95% CI (0.835-0.976). The best cut-off point of strain ratio value was 4.53. Specificity and sensitivity for the best cut-off point were 0.788 and 0.897, respectively. Mean depth of the 56 malignant lesions was 17.8±7.4mm measured by TVES (range 5.4-43.1mm) and 11.5±8.8mm measured by pathological samples (range 3.7-38.4mm). ICC of the 2 methods were 0.87 (95% CI 0.863-0.947) and 0.931 (95% CI 0.902-0.952) for the 2 observers.

Conclusions: TVES was a useful technique in confirming the diagnoses of cervical cancer and in estimating the infiltrating region. When the strain ratio of a cervical lesion was higher than 4.53, it is confidential to be diagnosed as malignant.