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MRI of Endometrial Carcinoma

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MRI of the Female and Male Pelvis

Abstract

Endometrial carcinoma (EC) represents the most common gynecological malignancy in developed countries and usually manifests with abnormal vaginal bleedings in perimenopausal women. The diagnosis of EC is performed by means of transvaginal sonography and endometrial biopsy, and the treatment of choice is surgery. MRI is the imaging modality of choice for preoperative staging of EC and is extremely accurate in evaluating the depth of myometrial invasion and the presence of cervical stromal infiltration; on the other hand, MRI sensitivity in recognizing nodal metastases remains quite limited. The knowledge of MRI stage of EC in association with the knowledge of its histological type and grade enables to tailor the best surgical approach for each patient.

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References

  1. Pathiraja P, Dhar S, Haldar K (2013) Serous endometrial intraepithelial carcinoma: a case series and literature review. Cancer Manag Res 5:117–122

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Hamm B, Forstner R, Beinder E (2007) MRI and CT of the female pelvis. Springer, Berlin Heidelberg New York

    Google Scholar 

  3. Brinton LA, Felix AS (2014) Menopausal hormone therapy and risk of endometrial cancer. J Steroid Biochem Mol Biol 142:83–89

    Article  CAS  PubMed  Google Scholar 

  4. Rizner TL (2013) Estrogen biosynthesis, phase I and phase II metabolism, and action in endometrial cancer. Mol Cell Endocrinol 381(1–2):124–139

    Article  CAS  PubMed  Google Scholar 

  5. Hill HA, Eley JW, Harlan LC, Greenberg RS, Barrett RJ 2nd, Chen VW (1996) Racial differences in endometrial cancer survival: the black/white cancer survival study. Obstet Gynecol 88(6):919–926

    Article  CAS  PubMed  Google Scholar 

  6. Cheung MR (2013) African American race and low income neighborhoods decrease cause specific survival of endometrial cancer: a SEER analysis. Asian Pac J Cancer Prev 14(4):2567–2570

    Article  PubMed  Google Scholar 

  7. Foti PV, Farina R, Coronella M, Ruggeri C, Palmucci S, Montana A, Milone P, Zarbo G, Caltabiano R, Lanzafame S et al (2013) Endometrial carcinoma: MR staging and causes of error. Radiol Med 118(3):487–503

    Article  CAS  PubMed  Google Scholar 

  8. Hulse PA, Carrington BM, Carrington BM (2004) MRI manual of pelvic cancer. Taylor & Francis Independence (KY)

    Google Scholar 

  9. Epplein M, Reed SD, Voigt LF, Newton KM, Holt VL, Weiss NS (2008) Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history. Am J Epidemiol 168(6):563–570; discussion 71–6

    Article  PubMed Central  PubMed  Google Scholar 

  10. Akhmedkhanov A, Zeleniuch-Jacquotte A, Toniolo P (2001) Role of exogenous and endogenous hormones in endometrial cancer: review of the evidence and research perspectives. Ann N Y Acad Sci 943:296–315

    Article  CAS  PubMed  Google Scholar 

  11. Blouin K, Nadeau M, Mailloux J, Daris M, Lebel S, Luu-The V, Tchernof A (2009) Pathways of adipose tissue androgen metabolism in women: depot differences and modulation by adipogenesis. Am J Physiol Endocrinol Metab 296(2):E244–E255

    Article  CAS  PubMed  Google Scholar 

  12. Sonoda Y, Barakat RR (2006) Screening and the prevention of gynecologic cancer: endometrial cancer. Best Pract Res Clin Obstet Gynaecol 20(2):363–377

    Article  PubMed  Google Scholar 

  13. Myriokefalitaki E, D’Costa D, Smith M, Ahmed AS (2013) Primary bone metastasis as initial presentation of endometrial cancer (stage IVb). Arch Gynecol Obstet 288(4):739–746

    Article  CAS  PubMed  Google Scholar 

  14. Saibene A, Robbins e Cotran VK (2010) Le basi patologiche delle malattie. Patologia generale. Elsevier. Milano

    Google Scholar 

  15. Amant F, Cadron I, Fuso L, Berteloot P, de Jonge E, Jacomen G, Van Robaeys J, Neven P, Moerman P, Vergote I (2005) Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol 98(2):274–280

    Article  PubMed  Google Scholar 

  16. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60(8 Suppl):2035–2041

    Article  CAS  PubMed  Google Scholar 

  17. Willis G, Misas JE, Byrne W, Podczaski E (2011) Nodal metastasis in endometrial cancer. Eur J Gynaecol Oncol 32(3):259–263

    CAS  PubMed  Google Scholar 

  18. Han SS, Lee SH, Kim DH, Kim JW, Park NH, Kang SB, Song YS (2010) Evaluation of preoperative criteria used to predict lymph node metastasis in endometrial cancer. Acta Obstet Gynecol Scand 89(2):168–174

    Article  CAS  PubMed  Google Scholar 

  19. Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK (1996) Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol 88(3):394–398

    Article  CAS  PubMed  Google Scholar 

  20. Stewart CJ, Doherty DA, Havlat M, Koay MH, Leung YC, Naran A, O’Brien D, Ruba S, Salfinger S, Tan J (2013) Transtubal spread of endometrial carcinoma: correlation of intra-luminal tumour cells with tumour grade, peritoneal fluid cytology, and extra-uterine metastasis. Pathology 45(4):382–387

    Article  CAS  PubMed  Google Scholar 

  21. Renaud MC, Le T, Le T, Bentley J, Farrell S, Fortier MP, Giede C, Kupets R, Plante M, Power P et al (2013) Epidemiology and investigations for suspected endometrial cancer. J Obst Gynaecol Can 35(4):380–383

    Google Scholar 

  22. Zamani F, Goodarzi S, Hallaji F, Zamiri A, Deilami T, Malek M, Modarress Gilani M (2012) Diagnostic value of pelvic MRI for assessment of the depth of myometrial invasion and cervical involvement in endometrial cancer: comparison of new versus old FIGO staging. Iran J Radiol 9(4):202–208

    Article  PubMed Central  PubMed  Google Scholar 

  23. Frei Bonel KA, Kinkel K (eds) (2007) MRI and CT of the female pelvis

    Google Scholar 

  24. Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, Sessa C (2013) Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24 Suppl 6:vi33–vi38

    CAS  PubMed  Google Scholar 

  25. Panici PB, Basile S, Salerno MG, Di Donato V, Marchetti C, Perniola G, Palagiano A, Perutelli A, Maneschi F, Lissoni AA et al (2014) Secondary analyses from a randomized clinical trial: age as the key prognostic factor in endometrial carcinoma. Am J Obstet Gynecol 210(4):363.e1–363.e10

    Article  Google Scholar 

  26. ASTEC Study Group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125–136

    Article  CAS  PubMed  Google Scholar 

  27. May K, Bryant A, Dickinson HO, Kehoe S, Morrison J (2010) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev (1):CD007585

    Google Scholar 

  28. Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, and Lopes AD (2012) Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev (9):CD006655.

    Google Scholar 

  29. Bats AS, Bensaid C, Huchon C, Scarabin C, Nos C, Lecuru F (2010) Current indications of lymphadenectomy in endometrial cancer. Gynecol Obstet Fertil 38(12):754–759

    Article  PubMed  Google Scholar 

  30. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375(9721):1165–1172

    Article  PubMed  Google Scholar 

  31. Kang WD, Kim CH, Cho MK, Kim JW, Kim YH, Choi HS, Kim SM (2009) Lymphadenectomy for low-risk endometrial cancer based on preoperative and intraoperative assessments. Int J Gynecol Cancer 19(4):657–661

    Article  PubMed  Google Scholar 

  32. Antonsen SL, Jensen LN, Loft A, Berthelsen AK, Costa J, Tabor A, Qvist I, Hansen MR, Fisker R, Andersen ES et al (2013) MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer – a multicenter prospective comparative study. Gynecol Oncol 128(2):300–308

    Article  CAS  PubMed  Google Scholar 

  33. Brocker KA, Alt CD, Eichbaum M, Sohn C, Kauczor HU, Hallscheidt P (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 1. Strahlenther Onkol 187(10):611–618

    Article  PubMed  Google Scholar 

  34. Zerbe MJ, Bristow R, Grumbine FC, Montz FJ (2000) Inability of preoperative computed tomography scans to accurately predict the extent of myometrial invasion and extracorporeal spread in endometrial cancer. Gynecol Oncol 78(1):67–70

    Article  CAS  PubMed  Google Scholar 

  35. Rubtsova NA, Novicova EG, Sinitsyn VE, Vostrov AN, Stepanov SO (2012) Endometrial cancer: preoperative staging. The informative value of ultrasound study versus magnetic resonance imaging. Vestn Rentgenol Radiol 2012 Jul–Aug; (4):33–41

    Google Scholar 

  36. Ortoft G, Dueholm M, Mathiesen O, Hansen ES, Lundorf E, Moller C, Marinovskij E, Petersen LK (2013) Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy. Acta Obstet Gynecol Scand 92(5):536–545

    Article  PubMed  Google Scholar 

  37. Bharwani N, Miquel ME, Sahdev A, Narayanan P, Malietzis G, Reznek RH, Rockall AG (2011) Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer. Br J Radiol 84(1007):997–1004

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Takeuchi M, Matsuzaki K, Nishitani H (2009) Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion. Acta Radiol 50(8):947–953

    Article  CAS  PubMed  Google Scholar 

  39. Abu Freij M, Saleh H, Rawlins H, Duncan T, Nieto J (2011) The use of MRI for selecting patients with endometrial cancer and significant co-morbidities for vaginal hysterectomy. Arch Gynecol Obstet 283(5):1097–1101

    Article  PubMed  Google Scholar 

  40. Kang S, Kang WD, Chung HH, Jeong DH, Seo SS, Lee JM, Lee JK, Kim JW, Kim SM, Park SY et al (2012) Preoperative identification of a low-risk group for lymph node metastasis in endometrial cancer: a Korean gynecologic oncology group study. J Clin Oncol 30(12):1329–1334

    Article  PubMed  Google Scholar 

  41. Loubeyre P, Undurraga M, Bodmer A, Petignat P (2011) Non-invasive modalities for predicting lymph node spread in early stage endometrial cancer? Surg Oncol 20(2):e102–e108

    Article  PubMed  Google Scholar 

  42. Manfredi R, Mirk P, Maresca G, Margariti PA, Testa A, Zannoni GF, Giordano D, Scambia G, Marano P (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231(2):372–378

    Article  PubMed  Google Scholar 

  43. Patel S, Liyanage SH, Sahdev A, Rockall AG, Reznek RH (2010) Imaging of endometrial and cervical cancer. Insights Imaging 1(5–6):309–328

    Article  PubMed Central  PubMed  Google Scholar 

  44. Shin KE, Park BK, Kim CK, Bae DS, Song SY, Kim B (2011) MR staging accuracy for endometrial cancer based on the new FIGO stage. Acta Radiol 52(7):818–824

    Article  PubMed  Google Scholar 

  45. Celik C, Ozdemir S, Kiresi D, Emlik D, Tazegul A, Esen H (2010) Evaluation of cervical involvement in endometrial cancer by transvaginal sonography, magnetic resonance imaging and frozen section. J Obstet Gynaecol 30(3):302–307

    Article  CAS  PubMed  Google Scholar 

  46. Connor JP, Andrews JI, Anderson B, Buller RE (2000) Computed tomography in endometrial carcinoma. Obstet Gynecol 95(5):692–696

    Article  CAS  PubMed  Google Scholar 

  47. Weber G, Merz E, Bahlmann F, Mitze M, Weikel W, Knapstein PG (1995) Assessment of myometrial infiltration and preoperative staging by transvaginal ultrasound in patients with endometrial carcinoma. Ultrasound Obstet Gynecol 6(5):362–367

    Article  CAS  PubMed  Google Scholar 

  48. Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13(6):850–855

    Article  CAS  PubMed  Google Scholar 

  49. Furukawa N, Takekuma M, Takahashi N, Hirashima Y (2010) Intraoperative evaluation of myometrial invasion and histological type and grade in endometrial cancer: diagnostic value of frozen section. Arch Gynecol Obstet 281(5):913–917

    Article  PubMed  Google Scholar 

  50. Kisu I, Banno K, Lin LY, Ueno A, Abe T, Kouyama K, Okuda S, Masugi Y, Umene K, Nogami Y et al (2013) Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer: comparison of magnetic resonance imaging and frozen sections. Acta Obstet Gynecol Scand 92(5):525–535

    Article  PubMed  Google Scholar 

  51. Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Takahashi S, Ebina Y, Miyahara Y, Yamada H, Sugimura K (2013) Value of fusion of PET and MRI for staging of endometrial cancer: comparison with F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI. Eur J Radiol 2013;82(10):1672–1676. doi: 10.1016/j.ejrad.2013.05.005. Epub 2013 May 30

  52. Ren C, Xue HD, Li S, Zhang J, Pan WD, Sun ZY, Fang HY, Sun HY, Jin ZY (2012) Clinical application of magnetic resonance imaging in preoperative evaluation of endometrial cancer. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 34(5):455–460

    PubMed  Google Scholar 

  53. Dogan D, Inan N, Sarisoy HT, Gumustas S, Akansel G, Muezzinoglu B, Yucesoy I, Demirci A (2013) Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI. Abdom Imaging 38(2):388–396

    Article  PubMed  Google Scholar 

  54. Hori M, Kim T, Murakami T, Imaoka I, Onishi H, Nakamoto A, Nakaya Y, Tomoda K, Tsutsui T, Enomoto T et al (2009) MR imaging of endometrial carcinoma for preoperative staging at 3.0T: comparison with imaging at 1.5T. J Magn Reson Imaging 30(3):621–630

    Article  PubMed  Google Scholar 

  55. Manfredi R, Gui B, Maresca G, Fanfani F, Bonomo L (2005) Endometrial cancer: magnetic resonance imaging. Abdom Imaging 30(5):626–636

    Article  CAS  PubMed  Google Scholar 

  56. Duncan KA, Drinkwater KJ, Frost C, Remedios D, Barter S (2012) Staging cancer of the uterus: a national audit of MRI accuracy. Clin Radiol 67(6):523–530

    Article  CAS  PubMed  Google Scholar 

  57. Wu WJ, Yu MS, Su HY, Lin KS, Lu KL, Hwang KS (2013) The accuracy of magnetic resonance imaging for preoperative deep myometrium assessment in endometrial cancer. Taiwan J Obstet Gynecol 52(2):210–214

    Article  PubMed  Google Scholar 

  58. McComiskey MH, McCluggage WG, Grey A, Harley I, Dobbs S, Nagar HA (2012) Diagnostic accuracy of magnetic resonance imaging in endometrial cancer. Int J Gynecol Cancer 22(6):1020–1025

    Article  PubMed  Google Scholar 

  59. Wu LM, Xu JR, Gu HY, Hua J, Haacke EM, Hu J (2013) Predictive value of T2-weighted imaging and contrast-enhanced MR imaging in assessing myometrial invasion in endometrial cancer: a pooled analysis of prospective studies. Eur Radiol 23(2):435–449

    Article  PubMed  Google Scholar 

  60. Beddy P, Moyle P, Kataoka M, Yamamoto AK, Joubert I, Lomas D, Crawford R, Sala E (2012) Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 262(2):530–537

    Article  PubMed  Google Scholar 

  61. Haldorsen IS, Husby JA, Werner HM, Magnussen IJ, Rorvik J, Helland H, Trovik J, Salvesen OO, Espeland A, Salvesen HB (2012) Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists. Eur Radiol 22(7):1601–1611

    Article  PubMed  Google Scholar 

  62. Rechichi G, Galimberti S, Oriani M, Perego P, Valsecchi MG, Sironi S (2013) ADC maps in the prediction of pelvic lymph nodal metastatic regions in endometrial cancer. Eur Radiol 23(1):65–74

    Article  PubMed  Google Scholar 

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Bonatti, M., Zantedeschi, L., Corso, F.D., Manfredi, R., Mucelli, R.P. (2015). MRI of Endometrial Carcinoma. In: Manfredi, R., Pozzi Mucelli, R. (eds) MRI of the Female and Male Pelvis. Springer, Cham. https://doi.org/10.1007/978-3-319-09659-9_2

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  • DOI: https://doi.org/10.1007/978-3-319-09659-9_2

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