Abstract
This study was undertaken to prospectively determine the diagnostic capabilities of magnetic resonance (MR) imaging in detecting myometrial and cervical invasion and lymph node involvement in endometrial carcinoma and to identify the causes of errors in staging endometrial carcinoma.
Materials and methods
Twenty consecutive patients with a histological diagnosis of endometrial carcinoma underwent preoperative MR imaging. MR findings were compared with surgical staging, considered as the standard of reference.
Results
In assessing myometrial invasion, MR imaging showed 70% accuracy, 80% sensitivity, 40% specificity, 80% positive predictive value (PPV), and 40% negative predictive value (NPV). In detecting cervical invasion, MR imaging had 95% accuracy, 100% sensitivity, 94.4% specificity, 66.7% PPV, and 100% NPV. In evaluating lymph node involvement, MR imaging showed 100% accuracy, sensitivity, specificity, PPV and NPV. Errors in evaluating myometrial invasion were caused by polypoid tumour, adenomyosis and leiomyomas, whereas those in evaluating cervical invasion were caused by dilatation and curettage.
Conclusions
MR imaging is a reliable technique for preoperative evaluation of endometrial carcinoma. Its main limitation is differentiating between stage IA and IB carcinomas, which is not highly important for surgical planning. Cooperation between the gynaecologist and radiologist is mandatory to avoid staging errors.
Riassunto
Obiettivo
Scopo del presente lavoro è stato determinare prospettivamente le capacità diagnostiche della risonanza magnetica (RM) nel valutare l’invasione del miometrio, della cervice ed il coinvolgimento linfonodale nel carcinoma dell’endometrio ed identificare le cause di errore nella stadiazione RM.
Materiali e metodi
Venti pazienti consecutive con diagnosi istologica di carcinoma dell’endometrio sono state sottoposte ad esame RM preoperatorio. I reperti RM sono stati confrontati con la stadiazione chirurgica considerata come standard di riferimento.
Risultati
Nel valutare l’invasione del miometrio la RM ha mostrato accuratezza del 70%, sensibilità dell’80%, specificità del 40%, valore predittivo positivo (VPP) dell’80%, valore predittivo negativo (VPN) del 40%. Nell’identificare l’infiltrazione della cervice la RM ha mostrato accuratezza del 95%, sensibilità del 100%, specificità del 94,4%, VPP del 66,7%, VPN del 100%. Nel valutare il coinvolgimento linfonodale la RM ha mostrato accuratezza, sensibilità, specificità, VPP e VPN del 100%. Le cause di errore nella valutazione del miometrio sono state: tumore polipoide, adenomiosi, leiomiomi; nella valutazione della cervice: raschiamento.
Conclusioni
La RM è una tecnica affidabile nella valutazione preoperatoria del carcinoma dell’endometrio; il suo limite principale è rappresentato dalla distinzione fra stadio IA e IB, poco influente sulla strategia chirurgica. La collaborazione fra clinico e radiologo è fondamentale per evitare errori di stadiazione.
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Foti, P.V., Farina, R., Coronella, M. et al. Endometrial carcinoma: MR staging and causes of error. Radiol med 118, 487–503 (2013). https://doi.org/10.1007/s11547-012-0861-3
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DOI: https://doi.org/10.1007/s11547-012-0861-3