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European Radiology

, Volume 24, Issue 6, pp 1327–1338 | Cite as

MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis

  • Anita Andreano
  • Gilda Rechichi
  • Paola Rebora
  • Sandro Sironi
  • Maria Grazia Valsecchi
  • Stefania Galimberti
Magnetic Resonance

Abstract

Objectives

To compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MR imaging in detecting deep myometrial invasion in endometrial cancer, using surgical-pathological staging as reference standard.

Methods

After searching a wide range of electronic databases and screening titles/abstracts, we obtained full papers for potentially eligible studies and evaluated according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. From each study, we extracted information on diagnostic performance of DW and DCE sequences. After exploring heterogeneity, we adopted a bivariate generalized linear mixed model to compare the effect of the two MR sequences jointly on sensitivity and specificity.

Results

Nine studies (442 patients) were considered. Significant evidence of heterogeneity was found only for specificity, both in DW and DCE imaging (I 2  = 70.8 % and 70.6 %). Pooled sensitivity of DW and DCE was 0.86 and specificity did not significantly differ (p = 0.16) between the two sequences (DW = 0.86 and DCE = 0.82). No difference was found between 3-T and 1.5-T MR. There was no evidence of publication bias.

Conclusions

MR diagnostic accuracy in presurgical detection of deep myometrial infiltration in endometrial cancer is high. DCE and DW imaging do not differ in sensitivity and specificity.

Key Points

Myometrial invasion is the most important morphological prognostic feature of endometrial cancer

MR diagnostic accuracy in presurgical detection of deep myometrial infiltration is high

MR examination including T2 and DCE imaging is considered the reference standard

DW imaging has been increasingly employed with heterogeneous results

This meta-analysis shows that DCE and DW do not differ in diagnostic accuracy

Keywords

Endometrial neoplasms Magnetic resonance imaging Diffusion magnetic resonance imaging Meta-analysis Review 

Abbreviations and acronyms

ADC

apparent diffusion coefficient

AIC

Akaike information criterion

CI

confidence interval

CT

computed tomography

DCE

dynamic contrast-enhanced

DOR

diagnostic odds ratio

DW

diffusion-weighted

ESS

effective sample size

FIGO

International Federation of Gynecology and Obstetrics

GLMM

generalized linear mixed model

LR+ and LR−

positive and negative likelihood ratio

MR

magnetic resonance

QUADAS-2

Quality Assessment of Diagnostic Accuracy Studies-2

ROC

receiver operating characteristic

SNR

signal to noise ratio

US

ultrasound

Notes

Acknowledgments

We thanks Laura Colombo for her thoughtful help during bibliographic research and Liu Xiaoqiu for her translation from Chinese.

The scientific guarantor of this publication is Maria Grazia Valsecchi. 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. Three of the authors have significant statistical expertise. Institutional review board approval was not required because the manuscript is a meta-analysis of already published studies and there are no patient level data. Written informed consent was not required for this study because the manuscript is a meta-analysis and there are no patient level data. Methodology: meta-analysis, performed at one institution.

Supplementary material

330_2014_3139_MOESM1_ESM.doc (86 kb)
ESM 1 (DOC 86 kb)

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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Anita Andreano
    • 1
  • Gilda Rechichi
    • 2
  • Paola Rebora
    • 1
  • Sandro Sironi
    • 1
    • 2
  • Maria Grazia Valsecchi
    • 1
  • Stefania Galimberti
    • 1
  1. 1.Center of Biostatistics for Clinical Epidemiology, Department of Health SciencesUniversity of Milano-BicoccaMonzaItaly
  2. 2.Department of RadiologyS. Gerardo HospitalMonza, MBItaly

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