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118 Ultrasonography in Gynaecological Cancers

Figure 5. The parameters for individualized surgical treatment (the minimum thickness between tumour and pericervical fascia and
the minimum distance between tumour and internal orificium). The minimum thickness of tumour-free cervical stroma is measured
as the distance between tumour and pericervical fascia in points where parametria (ventral, lateral, dorsal) attach to the cervix. The
measurements are demonstrating on scheme (A) and on transrectal scan of cervical cancer in transverse plane (B). Different radicality
of parametrial resection in relation to the minimum thickness between tumour and PCF (lateral tumour-free margin) is presenting on
scheme as a red dash-line (A) and on intraoperative specimen (C). The cranial tumour-free margin is measured as the distance between
upper tumour edge and internal cervical orificium (scheme (D), intraoperative specimen (E), cranial tumour-free margin assessing using
gray-scale ultrasound [F] and Dopler [G]). Please note isoechogenic structure and abundant vascularization of adenocancer (F, G), the
minimum cranial tumour-free margin should be equal or more than 10 mm. PCF-pericervical fascia.

Preoperative Assessment of Infiltrated results were consistently obtained not only from a single-
(metastatic) Lymph Nodes unit study (30), but also from a European multicenter
study published by Pálsdóttir et al. (31).
The studies demonstrating the performance of
ultrasound in detection of positive lymph nodes in early- Other modern imaging methods have similar
stage cervical cancer showed a low sensitivity (38-43%) limitations in the detection of affected nodes in early
(30, 31). It is important to emphasise that the positive stages of cervical cancer. Magnetic resonance imaging
(infiltrated) lymph nodes in clinically early-stage disease evaluates the affected nodes based on their size (size in
in most cases were of normal size (median maximum size the short axis > 1cm nodes), changes in a shape (rounded
of affected nodes 14.0 mm, the minimum and maximum lymph node), the presence of irregular node edges,
range of 0.7 to 25.0 mm) and the metastases were found necroses and signal intensities within the nodes similar to
mostly only microscopically (median size of intranodal the primary tumour (15). Positron emission tomography
metastasis 3.5 mm, minimum and maximum range from combined with computed tomography (PET/CT) also
0.3 to 20.0 mm) (30). For these reasons, the preoperative has its limitations when displaying lesions smaller than
detection of infiltrated lymph nodes in early-stage 5-10 mm. Therefore, the sensitivity of MRI and PET/
disease using ultrasound is technically difficult or even CT for evaluation of infiltrated nodes was low (58% and
impossible. In these two reported studies the pelvic 30%) (32). Similar results were obtained in a study that
and para-aortic lymph nodes were evaluated using compared the benefits of hybrid MRI/PET and PET/
transabdominal probe, therefore it was possible to assess CT with proven sensitivity of 54.2% for MRI/PET and
an infiltrated lymph node merely by changing its shape 44.1% for PET/CT (33). The specificity of both imaging
and size (30, 31). In the case of using a transvaginally or methods (MRI and PET/CT) was high (92.6%) (32) and
transrectally placed high resolution probe, the change in comparable to ultrasound (96%) (30, 31).
architecture and perfusion within infiltrated nodes can
also be observed, which should improve the sensitivity of Endometrial Cancer
ultrasound detection (Figure 6).
In addition to being the first imaging technique used to
On the other hand, regarding the specificity in the evaluate abnormal uterine bleeding, ultrasonography,
detection of infiltrated lymph nodes, ultrasound achieved preferably specialised ultrasonography, offers the
high specificity (96%) in the assessment (30, 31). These possibility of evaluating the size of malignant tumor,