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Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology

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Abstract

Objective

To investigate the added value of secondary reports issued by radiologists subspecializing in gynaecologic imaging for determining deep myometrial invasion of endometrial cancer on MRI.

Methods

Initial (from referring institutions) and secondary (by subspecialized radiologists) interpretations of MRI of 55 patients with endometrial cancer were retrospectively reviewed. A radiologist blinded to clinicopathological information assessed both reports for the presence of deep myometrial invasion. Reference standard was based on hysterectomy specimens. Kappa coefficients (k) were used to measure their concordance. McNemar testing and receiver operating characteristic (ROC) analysis was used to compare sensitivities, specificities and areas under the curves (AUCs).

Results

Deep myometrial invasion was present in 25 (45.5 %) patients. Among 27.3 % (15/55; k = 0.458) patients with discrepant results, secondary interpretations were correct in 10 (66.7 %) cases. Sensitivity was higher in secondary than in initial reports (76.0 % vs. 48.0 %, p = 0.039) while no significant difference was seen in specificity (70.0 % vs. 76.7 %, p = 0.668). At ROC analysis, there was a tendency for higher AUCs in secondary reports (0.785 vs 0.669, p = 0.096).

Conclusion

Secondary readings of MRI by subspecialized gynaecologic oncologic radiologists may provide incremental value in determining deep myometrial invasion of endometrial cancer.

Key Points

• Deep myometrial invasion is an important prognostic factor in endometrial cancer.

• Assessment of deep myometrial invasion is often discrepant between initial and secondary reports.

• Secondary reports showed higher sensitivity and accuracy.

• Secondary review of MRI may provide incremental value in endometrial cancer patients.

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Abbreviations

AUC:

Area under the curve

CT:

Computed tomography

FIGO:

International Federation of Gynaecology and Obstetrics

MRI:

Magnetic resonance imaging

ROC:

Receiver operating curve

T2WI:

T2-weighted imaging

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917

    Article  CAS  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

  3. Amant F, Mirza MR, Creutzberg CL (2012) Cancer of the corpus uteri. Int J Gynaecol Obstet 119(Suppl 2):S110–S117

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. 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 60:2035–2041

    Article  CAS  PubMed  Google Scholar 

  6. Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718

    Article  CAS  PubMed  Google Scholar 

  7. Balleyguier C, Sala E, Da Cunha T et al (2011) Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology. Eur Radiol 21:1102–1110

    Article  PubMed  Google Scholar 

  8. Woo S, Cho JY, Kim SY, Kim SH (2014) Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade. Acta Radiol 55:1270–1277

    Article  PubMed  Google Scholar 

  9. Rauch GM, Kaur H, Choi H et al (2014) Optimization of MR imaging for pretreatment evaluation of patients with endometrial and cervical cancer. Radiographics 34:1082–1098

    Article  PubMed  PubMed Central  Google Scholar 

  10. Saba L, Guerriero S, Sulis R et al (2011) Learning curve in the detection of ovarian and deep endometriosis by using Magnetic Resonance: comparison with surgical results. Eur J Radiol 79:237–244

    Article  PubMed  Google Scholar 

  11. Alfieri J, Portelance L, Souhami L et al (2012) Development and impact evaluation of an e-learning radiation oncology module. Int J Radiat Oncol Biol Phys 82:e573–e580

    Article  PubMed  Google Scholar 

  12. Cohen P, Tan AL, Penman A (2009) The multidisciplinary tumor conference in gynecologic oncology--does it alter management? Int J Gynecol Cancer 19:1470–1472

    Article  PubMed  Google Scholar 

  13. Kinkel K, Forstner R, Danza FM et al (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574

    Article  CAS  PubMed  Google Scholar 

  14. Wibmer A, Vargas HA, Donahue TF et al (2015) Diagnosis of extracapsular extension of prostate cancer on prostate MRI: impact of second-opinion readings by subspecialized genitourinary oncologic radiologists. AJR Am J Roentgenol 205:W73–W78

    Article  PubMed  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  17. Greer HO, Frederick PJ, Falls NM et al (2010) Impact of a weekly multidisciplinary tumor board conference on the management of women with gynecologic malignancies. Int J Gynecol Cancer 20:1321–1325

    PubMed  Google Scholar 

  18. Lakhman Y, D'Anastasi M, Micco M et al (2015) Second-opinion interpretations of gynecologic oncologic MRI examinations by sub-specialized radiologists influence patient care. Eur Radiol

  19. Haldorsen IS, Husby JA, Werner HM et al (2012) Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists. Eur Radiol 22:1601–1611

    Article  PubMed  Google Scholar 

  20. Eakins C, Ellis WD, Pruthi S et al (2012) Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. AJR Am J Roentgenol 199:916–920

    Article  PubMed  Google Scholar 

  21. Jeffers AB, Saghir A, Camacho M (2012) Formal reporting of second-opinion CT interpretation: experience and reimbursement in the emergency department setting. Emerg Radiol 19:187–193

    Article  PubMed  Google Scholar 

  22. Andreano A, Rechichi G, Rebora P, Sironi S, Valsecchi MG, Galimberti S (2014) MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Eur Radiol 24:1327–1338

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Sang Youn Kim. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. None of the study subjects or cohorts have been previously reported in any studies. Methodology: retrospective, cross-sectional study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Sungmin Woo, Sang Youn Kim, Jeong Yeon Cho & Seung Hyup Kim

  2. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Sang Youn Kim

  3. Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 110-744, Korea

    Jeong Yeon Cho & Seung Hyup Kim

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  1. Sungmin Woo
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  2. Sang Youn Kim
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Correspondence to Sang Youn Kim.

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Woo, S., Kim, S.Y., Cho, J.Y. et al. Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology. Eur Radiol 27, 1877–1882 (2017). https://doi.org/10.1007/s00330-016-4582-1

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  • DOI: https://doi.org/10.1007/s00330-016-4582-1

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