COMPARISON OF DIAGNOSTIC ACCURACY OF PREOPERATIVE TRANSABDOMINAL AND TRANSVAGINAL ULTRASONOGRAPHY FOR STAGING OF GYNECOLOGICAL TUMORS TAKING HISTOPATHOLOGY AS GOLD STANDARD

Abstract

Background: Accurate preoperative staging of gynecological malignancies is fundamental for determining optimal treatment and predicting prognosis. Ultrasonography, particularly transabdominal (TAUS) and transvaginal (TVUS) methods, provides a non-invasive and cost-effective diagnostic approach. However, comparative data on their diagnostic performance against histopathology remain limited, especially in resource-limited clinical settings where imaging accuracy directly influences surgical planning and patient outcomes.

Objective: To compare the diagnostic accuracy of TAUS and TVUS in the preoperative staging of gynecological malignancies, using histopathology as the gold standard.

Methods: This prospective cohort study included 70 women aged ≥18 years presenting with suspected gynecological tumors at a tertiary care cancer hospital. All participants underwent both TAUS and TVUS prior to surgical management. Standardized imaging protocols were applied, and staging was determined according to FIGO criteria. Histopathological examination of surgical specimens served as the reference standard. Data were analyzed using SPSS version 25.0. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Binary logistic regression was performed to identify independent imaging predictors of malignancy.

Results: The mean age of participants was 44.7 ± 11.3 years; 58.6% were postmenopausal, and 37.1% were multiparous. Histopathology confirmed malignancy in 45 cases (64.3%). TAUS demonstrated a sensitivity of 84.4%, specificity of 80.0%, PPV of 88.4%, NPV of 74.1%, and accuracy of 82.9%. TVUS showed higher diagnostic metrics—sensitivity 93.3%, specificity 88.0%, PPV 93.3%, NPV 88.0%, and accuracy 91.4%. TVUS also had fewer staging misclassifications across FIGO stages, particularly in Stage II and III diseases. Regression analysis identified TVUS as a stronger independent predictor of malignancy (OR = 8.17, p = 0.001) than TAUS (OR = 3.85, p = 0.020).

Conclusion: TVUS demonstrated superior diagnostic accuracy and staging precision compared to TAUS across all tumor types and disease stages. Its incorporation into preoperative evaluation protocols could enhance diagnostic reliability, reduce misclassification, and improve individualized surgical planning in gynecological oncology.