Comparison of the determination of the local tumor extent of primary endometrial cancer using clinical examination and 3 Tesla magnetic resonance imaging compared to histopathology

  • Kerstin A. BrockerEmail author
  • Jan P. Radtke
  • Peter Hallscheidt
  • Christof Sohn
  • Heinz Peter Schlemmer
  • Céline D. Alt
Gynecologic Oncology



The aim of this study is to analyze the correct staging of primary endometrial cancer (EC) using clinical examination and 3 Tesla (T) magnetic resonance imaging (MRI) results compared to histopathology.


In this prospective, non-randomized, single-center study, 26 women with biopsy-proven EC were evaluated. All women underwent clinical examination including transvaginal ultrasound (CE/US) and 3T MRI (T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences) prior to surgery. Spearman’s correlation coefficient was employed to analyze the correlation between both staging methods and histopathology and generalized estimation equation analysis to compare their staging results. Main outcome measures are determinations of local tumor extent for EC on CE/US and 3T MRI compared to histopathology (gold standard).


Sixteen women had an early-stage pT1a tumor, 10 a locally advanced ≥ pT1b tumor. The early stage was correctly diagnosed at CE/US in 100%, by MRI in 81%. Spearman’s correlation coefficient was r = 1.0 (p < 0.001) for correlation of CE/US and histopathology, r = 0.93 (p < 0.001) for correlation of MRI and pathology. A locally advanced tumor stage was exactly diagnosed by MRI in 70% and at CE/US in 50%.


CE/US is sufficient for staging T1a endometrial cancer, while MRI provides higher sensitivity in detecting locally advanced tumors. Based on our results, combining CE/US and 3T MRI in patients with at least suspected deep myometrial invasion offers a more reliable workflow for individual treatment planning.


Endometrial cancer staging Myometrial invasion Ultrasound 3 Tesla magnetic resonance imaging 


Author contributions

KAB: project development, data collection, data analysis, and manuscript writing/editing. JPR: data analysis and manuscript editing. PH: protocol/project development and manuscript editing. CS: project development and manuscript editing. HPS: protocol/project development and manuscript editing. CDA: protocol/project development, data collection, and manuscript writing/editing.


The trial was self-funded.

Compliance with ethical standards

Conflict of interest

KA Brocker reports personal fees by Serag Wiessner, Naila, Germany, outside the submitted work. All the other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this trial involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. [1]
    Howlader N, Noone A, Krapcho M, et al. (2016) Cancer Statistics Review, 1975-2014 - SEER Statistics, National Cancer Institute. SEER Cancer Stat Rev 1975-2014
  2. 2.
    Baekelandt MM, Castiglione M (2009) Endometrial carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):29–31. Google Scholar
  3. 3.
    Chaudhry S, Reinhold C, Guermazi A et al (2003) Benign and malignant diseases of the endometrium. Top Magn Reson Imaging 14:339–357Google Scholar
  4. 4.
    Colombo N, Preti E, Landoni F et al. (2013) Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi33–8. 10.1093/annonc/mdt353Google Scholar
  5. 5.
    Savelli L, Ceccarini M, Ludovisi M et al (2008) Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obs Gynecol 31:560–566. Google Scholar
  6. 6.
    Brocker KA, Alt CD, Breyer U et al (2014) Endometrial cancer: results of clinical and histopathological staging compared to magnetic resonance imaging using an endorectal surface coil. Arch Gynecol Obstet 289:851–858. Google Scholar
  7. 7.
    Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN et al (2008) Current issues in the management of endometrial cancer. Mayo Clin Proc 83:97–112. Google Scholar
  8. 8.
    Vasconcelos C, Felix A, Cunha TM (2007) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and histopathologic evaluation. J Obs Gynaecol 27:65–70. Google Scholar
  9. 9.
    Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obs 105:103–104Google Scholar
  10. 10.
    Rockall AG, Meroni R, Sohaib SA et al (2007) Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer 17:188–196. Google Scholar
  11. 11.
    Sala E, Rockall AG, Freeman SJ et al (2013) The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 266:717–740. Google Scholar
  12. 12.
    Manfredi R, Mirk P, Maresca G et al (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378. Google Scholar
  13. 13.
    Ortashi O, Jain S, Emannuel O et al (2008) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obs Gynecol Reprod Biol 137:232–235. Google Scholar
  14. 14.
    Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718Google Scholar
  15. 15.
    Leone FPG, Timmerman D, Bourne T et al (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: A consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35:103–112. Google Scholar
  16. 16.
    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. Google Scholar
  17. 17.
    Alt CD, Brocker KA, Eichbaum M et al (2012) Accuracy of MRI with an endorectal coil for staging endometrial cancer. Acta Radiol 53:580–585. Google Scholar
  18. 18.
    Koyama T, Tamai K, Togashi K (2007) Staging of carcinoma of the uterine cervix and endometrium. Eur Radiol 17:2009–2019. Google Scholar
  19. 19.
    Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours 8th edition. Acad Leg Writ. 10.1002/ejoc.201200111Google Scholar
  20. 20.
    Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130. Google Scholar
  21. 21.
    Bossuyt PM, Reitsma JB, Bruns DE et al (2007) Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Vet Clin Pathol 36:8–12. Google Scholar
  22. 22.
    Wu LM, Xu JR, Gu HY et al (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 23:435–449. Google Scholar
  23. 23.
    Zuurendonk LD, Smit R, a, Mol BWJ, et al (2006) Routine pelvic lymphadenectomy in apparently early stage endometrial cancer. Eur J Surg Oncol 32:450–454. Google Scholar
  24. 24.
    Sala E, Rockall A, Kubik-Huch RA (2011) Advances in magnetic resonance imaging of endometrial cancer. Eur Radiol 21:468–473. Google Scholar
  25. 25.
    Beddy P, Moyle P, Kataoka M et al (2012) Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 262:530–537. Google Scholar
  26. 26.
    Beddy P, O’Neill AC, Yamamoto AK et al (2012) FIGO staging system for endometrial cancer: added benefits of MR imaging. Radiographics 32:241–254. Google Scholar
  27. [27]
    NCCN (2015) NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms. NccnGoogle Scholar
  28. 28.
    Haldorsen IS, Husby JA, Werner HMJ et al (2012) Standard 1.5-T MRI of endometrial carcinomas: Modest agreement between radiologists. Eur Radiol 22:1601–1611. Google Scholar
  29. 29.
    Emlik D, Kiresi D, Özdemir S et al (2010) Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: Comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging. J Med Imaging Radiat Oncol 54:202–210. Google Scholar
  30. 30.
    Lin G, Ng K-K, Chang C-J et al (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging–initial experience. Radiology 250:784–792. Google Scholar
  31. 31.
    Teng F, Zhang YF, Wang YM et al (2015) Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: diagnostic value and error analysis in endometrial carcinoma. Acta Obstet Gynecol Scand 94:266–273. Google Scholar
  32. 32.
    Manfredi R, Gui B, Maresca G et al (2005) Endometrial cancer: magnetic resonance imaging. Abdom Imaging 30:626–636. Google Scholar
  33. 33.
    Piver MS, Lele SB, Barlow JJ, Blumenson L (1982) Paraaortic lymph node evaluation in stage I endometrial carcinoma. Obstet Gynecol 59:97–100Google Scholar
  34. 36.
    Hardesty LA, Sumkin JH, Nath ME et al (2000) Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology 215:45–49. Google Scholar
  35. 34.
    Yamashita Y, Harada M, Sawada T et al (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501. Google Scholar
  36. 35.
    Chan JK, Cheung MK, Huh WK et al (2006) Therapeutic role of lymph node resection in endometrioid corpus cancer: A study of 12,333 patients. Cancer 107:1823–1830. Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Medical SchoolUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of RadiologyGerman Cancer Research CenterHeidelbergGermany
  3. 3.Radiology DarmstadtAlice-HospitalDarmstadtGermany
  4. 4.Department of Diagnostic and Interventional Radiology, Medical SchoolUniversity of HeidelbergHeidelbergGermany
  5. 5.Department of Diagnostic and Interventional Radiology, Medical FacultyUniversity DusseldorfDusseldorfGermany

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