Advances in ultrasound-based imaging for diagnosis of endometrial cancer

Table 1 QUADAS-2 quality assessment

Ref.	Imaging modality	Patient selection	Index test	Reference standard	Flow and timing	Overall risk of bias
Tameish et al[24], 2023	TVUS vs MRI	Low	Low	Low	Low	Low risk
Jacobs et al[25], 2011	TVUS	Low	Low	Unclear	Low	Some concerns
Bian et al[26], 2023	Elastography	Low	Low	Low	Low	Low risk
Ziogas et al[27], 2022	3D-US	Low	Low	Low	Low	Low risk
Xydias et al[28], 2022	3D-US	Low	Low	Unclear	Low	Some concerns
Stoelinga et al[29], 2021	Contrast-enhanced US	Low	Low	Low	Low	Low risk
Guler et al[30], 2024	Elastography	Unclear	Low	Low	Unclear	Some concerns
Moro et al[38], 2022	AI	Low	Low	Unclear	Low	Some concerns
Jin and Zhou[37], 2025	TVUS vs MRI	Low	Low	Low	Low	Low risk
Tameish et al[24], 2023	Two-dimensional-US	Unclear	Low	Unclear	Unclear	High risk
Jacobs et al[25], 2011	TVUS	Low	Low	Low	Low	Low risk
Wu et al[34], 2020	AI (breast US)	Low	Low	Low	Low	Low risk
Song et al[33], 2022	AI (renal US)	Low	Low	Low	Low	Low risk
Zheng et al[31], 2024	AI (thyroid US)	Low	Low	Unclear	Low	Some concerns
Mohit et al[32], 2023	AI review	N/A	N/A	N/A	N/A	Not applicable
Nathani et al[35], 2024	AI (pulmonology US)	Unclear	Low	Low	Unclear	Some concerns
Bajaj et al[36], 2021	AI (intravascular US)	Low	Low	Low	Low	Low risk

AI: Artificial intelligence; MRI: Magnetic resonance imaging; N/A: Not applicable; TVUS: Transvaginal ultrasound; US: Ultrasound; 3D-US: Three-dimensional ultrasound.

Table 2 Diagnostic performance summary

Modality	Sensitivity	Specificity	Area under the curve	Primary indication	Strengths	Weaknesses
Transvaginal US	76%–96%	61%–86%	0.88	Initial screening; endometrial thickness measurement	Widely available; cost-effective; high sensitivity	Operator-dependent; reduced accuracy in obesity/retroversion
MRI	79%–92%	84%–95%	0.89–0.91	Staging (myometrial/cervical invasion, lymph nodes)	High soft tissue contrast; reliable staging	Expensive; limited availability
Three-dimensional US	75%–88%	75%–91%	0.86–0.90	Volumetric analysis; preoperative planning	Similar accuracy to MRI; enhanced resolution	Requires advanced equipment and training
Contrast-enhanced US	82%–90%	78%–89%	0.85–0.88	Vascular characterization; benign vs malignant differentiation	Real-time microvascular imaging	Contrast contraindications; standardization needed
Elastography	78%–85%	70%–88%	0.83–0.87	Tissue stiffness evaluation; adjunct diagnostic tool	Non-invasive characterization	Limited operator experience; fewer studies
Artificial intelligence (radiomics/machine learning)	80%–90%	78%–92%	0.88–0.91	Risk prediction; segmentation; decision support	High potential for automation; promising accuracy	Data bias; hardware demands; limited external validation

MRI: Magnetic resonance imaging; US: Ultrasound.