BACKGROUND Endometrial cancer(EC)is the most common gynecological malignancy in high-income countries,with incidence rates rising globally.Early and accurate diag-nosis is essential for improving outcomes.Transvaginal...BACKGROUND Endometrial cancer(EC)is the most common gynecological malignancy in high-income countries,with incidence rates rising globally.Early and accurate diag-nosis is essential for improving outcomes.Transvaginal ultrasound(TVUS)remains a cost-effective first-line tool,and emerging techniques such as three-dimensional(3D)ultrasound(US),contrast-enhanced US(CEUS),elastography,and artificial intelligence(AI)-enhanced imaging may further improve diagnostic performance.AIM To systematically review recent advances in US-based imaging techniques for the diagnosis and staging of EC,and to compare their performance with magnetic resonance imaging(MRI).METHODS A systematic search of PubMed,Scopus,Web of Science,and Google Scholar was performed to identify studies published between January 2010 and March 2025.Eligible studies evaluated TVUS,3D-US,CEUS,elastography,or AI-enhanced US in EC diagnosis and staging.Methodological quality was assessed using the QUADAS-2 tool.Sensitivity,specificity,and area under the curve(AUC)were extracted where available,with narrative synthesis due to heterogeneity.RESULTS Forty-one studies met the inclusion criteria.TVUS demonstrated high sensitivity(76%–96%)but moderate specificity(61%–86%),while MRI achieved higher spe-cificity(84%–95%)and superior staging accuracy.3D-US yielded accuracy com-parable to MRI in selected early-stage cases.CEUS and elastography enhanced tissue characterization,and AI-enhanced US achieved pooled AUCs up to 0.91 for risk prediction and lesion segmentation.Variability in per-formance was noted across modalities due to patient demographics,equipment differences,and operator experi-ence.CONCLUSION TVUS remains a highly sensitive initial screening tool,with MRI preferred for definitive staging.3D-US,CEUS,elastography,and AI-enhanced techniques show promise as complementary or alternative approaches,particularly in low-resource settings.Standardization,multicenter validation,and integration of multi-modal imaging are needed to optimize diagnostic pathways for EC.展开更多
文摘BACKGROUND Endometrial cancer(EC)is the most common gynecological malignancy in high-income countries,with incidence rates rising globally.Early and accurate diag-nosis is essential for improving outcomes.Transvaginal ultrasound(TVUS)remains a cost-effective first-line tool,and emerging techniques such as three-dimensional(3D)ultrasound(US),contrast-enhanced US(CEUS),elastography,and artificial intelligence(AI)-enhanced imaging may further improve diagnostic performance.AIM To systematically review recent advances in US-based imaging techniques for the diagnosis and staging of EC,and to compare their performance with magnetic resonance imaging(MRI).METHODS A systematic search of PubMed,Scopus,Web of Science,and Google Scholar was performed to identify studies published between January 2010 and March 2025.Eligible studies evaluated TVUS,3D-US,CEUS,elastography,or AI-enhanced US in EC diagnosis and staging.Methodological quality was assessed using the QUADAS-2 tool.Sensitivity,specificity,and area under the curve(AUC)were extracted where available,with narrative synthesis due to heterogeneity.RESULTS Forty-one studies met the inclusion criteria.TVUS demonstrated high sensitivity(76%–96%)but moderate specificity(61%–86%),while MRI achieved higher spe-cificity(84%–95%)and superior staging accuracy.3D-US yielded accuracy com-parable to MRI in selected early-stage cases.CEUS and elastography enhanced tissue characterization,and AI-enhanced US achieved pooled AUCs up to 0.91 for risk prediction and lesion segmentation.Variability in per-formance was noted across modalities due to patient demographics,equipment differences,and operator experi-ence.CONCLUSION TVUS remains a highly sensitive initial screening tool,with MRI preferred for definitive staging.3D-US,CEUS,elastography,and AI-enhanced techniques show promise as complementary or alternative approaches,particularly in low-resource settings.Standardization,multicenter validation,and integration of multi-modal imaging are needed to optimize diagnostic pathways for EC.
