Table 2.

Key points related to the role of transvaginal ultrasound (TVUS) in evaluating endometrial cancer and its prognostic factors.

Aspect	Summary
Role of Transvaginal Ultrasound (TVUS)	TVUS is fundamental in evaluating endometrial pathology, serving as a preliminary prognostic factor later confirmed by histological examination.
Prognostic Factors in Endometrial Cancer	Myometrial infiltration depth is a primary prognostic factor; deep infiltration (stage IB) is associated with a higher risk of metastasis. Histological differentiation (grading) is also a prognostic factor.
Sonomorphologic and Doppler Features	Low-risk endometrial cancers exhibit homogeneous echogenicity with minimal vasculature, while high-grade tumors show differentiated echogenicity and abundant perfusion. These parameters can predict lymph node metastasis and recurrence.
Ultrasound Parameters for Prediction	Preoperative grading, myometrial infiltration depth (uMI), and serum CA 125 levels can predict lymph node metastasis. Tumor size > 2.5 cm, uMI > 50%, RI < 0.4, and uTFD correlate with metastasis and unfavorable outcomes.
Two-Step Strategy	Combining preoperative histopathologic evaluation with ultrasound assessment of myometrial and cervical stroma invasion aids in identifying high and low-risk cases of lymph node metastasis.
Tumor-Free Distance (uTFD)	uTFD measurement is valuable for assessing locoregional cancer invasion and may be recommended alongside uMI, especially when myomas or adenomyosis coexist.
Ultrasound for Risk Identification	Tumor size and p53 status assessment on ultrasound help identify women at risk of recurrence or progression, aiding in treatment decisions and prognosis in endometrial cancer.
Combined Demographic and Ultrasound Factors	Combining demographic factors, ultrasound findings, and ProMisE subtype improves preoperative risk stratification, outperforming traditional risk classifications in endometrial cancer.