Role of three-dimensional ultrasound in the diagnosis and staging of gynecological malignancies: Focus on endometrial and cervical cancer

Alcázar J.L.; Espinosa F.; de la Maza F.; Opazo M.P.; Venturo C.; Lozano M.; Vilches J.C.; Orozco R. · Best Practice and Research: Clinical Obstetrics and Gynaecology (2026) · DOI: 10.1016/j.bpobgyn.2026.102758

Resumen

Three-dimensional (3D) ultrasound has emerged as a valuable non-invasive imaging modality in gynecologic oncology, particularly in the evaluation of endometrial and cervical cancers. This technique offers enhanced spatial visualization of pelvic anatomy compared to conventional two-dimensional ultrasound, improving diagnostic accuracy and preoperative staging. In endometrial cancer, 3D ultrasound provides detailed assessment of endometrial thickness, volume, and vascular patterns through power Doppler angiography, aiding in the detection of malignancy. Furthermore, it allows for accurate measurement of myometrial invasion depth, which is a critical factor in staging and treatment planning. In cervical cancer, 3D ultrasound facilitates delineation of tumor margins, stromal infiltration, and parametrial involvement, contributing to more precise local staging. The integration of multiplanar reconstruction and volume contrast imaging improves the sensitivity and specificity of lesion characterization. Several studies have demonstrated that 3D ultrasound approaches the diagnostic performance of magnetic resonance imaging (MRI) for local staging, while being more accessible, cost-effective, and tolerable for patients. Despite these advantages, limitations include operator dependency and reduced image quality in certain patient populations. Nevertheless, ongoing advances in ultrasound technology and standardized protocols are enhancing its clinical utility. In this narrative review we summarize current evidence regarding the role of three-dimensional ultrasound in the diagnosis and staging of endometrial and cervical cancer.