Abstract
Objective
To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting myometrial invasion and cervical involvement in endometrial cancer.
Study design
Seventy two consecutive patients with endometrial carcinoma underwent preoperative MRI. We compared the MRI results with the final histopathological findings. We classify myometrial invasion as <50 or ≥50% and cervical involvement as positive or negative. Standard statistical calculations were used.
Results
The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion ≥50% were 71, 86, and 58%, respectively. Positive and negative predictive values are 77 and 83%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 41, 97, and 46%, respectively. Positive and negative predictive values are 71 and 89%, respectively. The possible causes of misdiagnosis included a tumor isointense with the myometrium, polypoid tumor, myometrial thinning, exceedingly irregular myometrium, presence of adenomiosis, and presence of leiomyomas.
Conclusion
MRI assists in planning the surgical treatment of endometrial cancer with an acceptable accuracy and a good specificity, although sensitivity is suboptimal.
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References
Jemal A, Murray T, Samuels A et al (2003) Cancer statistics, 2003. CA Cancer J Clin 53:5–26
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. Cancer 60:2035–2041
Benedet JL, Bender H, Jones H, Ngan HYS, Pecorelli S (2000) FIGO staging classifications and clinical practices guidelines in the management of gynaecological cancers. Inter J Gynaecol Obstet 70:209–262
Burger MPM (2001) Management of stage I endometrial carcinoma. BMJ 322:568–569
Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718
Nakao Y, Yokoyama M, Hara K, Koyamatsu Y, Yasunaga M, Araki Y, watanabe Y, Iwasaka T (2006) MRI in endometrial cancer as a diagnostic tool for the absence of myometrial invasion. Gynecol Oncol 102:343–347
Nagar H, Dobbs S, Raymond McClelland H, Price J, Glenn McCluggage W, Grey A (2006) The diagnostic accuracy of MRI in detecting cervical involvement in endometrial cancer. Gynecol Oncol 103:431–434
Sironi S, Taccagni G, Garancini P, Belloni C, Del Maschio A (1992) Myometrial invasion by endometrial carcinoma: assessment by MR imaging. AJR 158:565–569
Selman TJ, Khan KS, Mann CH (2005) An evidence-based approach to test accuracy studies in gynecologic oncology: the STARD checklist. Gynecol Oncol 96(3):575–578
Boronow RC, Morrow CP, Creasman WT et al (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63:825–832
Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC (2000) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 182:1506–1519
Franchi M, Ghezzi F, Riva C, Miglierina M, Buttarelli M, Bolis P (2001) Postoperative complications after pelvic lymphadenectomy for the surgical staging of endometrial cancer. J Surg Oncol 78:232–240
Chung HH, Kang SB, Cho JY, Kim JW, Park NH, Song YS, Kim SH, Lee HP (2007) Accuracy of MRI for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 104:654–659
Sanjuán A, Cobo T, Pahisa J, Escaramís G, Ordi J, Ayuso JR, Garcia S, Hernández S, Torné A, Martínez Román S, Lejárcegui JA, Vanrell JA (2006) Preoperative and intraoperative assessment of myometrial invasion and histological grade in endometrial cancer: role of magnetic resonance imaging and frozen section. Int J Gynecol Cancer 16:385–390
Barwick TD, Rockall AG, Barton DP, Sohaib SA (2006) Imaging of endometrial adenocarcinoma. Clin Radiol 61:545–555
Ortashi O, Jain S, Emannuel O, Henry R, Wood A, Evans J (2007) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperativr MRI for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obs Gynecol Reprod Biol (in press)
Todo Y, Sakuragi N, Nishida R, Yamada T, Ebina Y, Yamamoto R, Fujimoto S (2003) Combined use of MRI, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol 188:1265–1272
Todo Y, Okamoto K, Hayashi M, Minobe S, Nomura E, Hareyama H, Takeda M, Ebina Y, Watari H, Sakuragi N (2007) A validation study of a scoring system to estimate the risk of lymph node metastases for patients with endometrial cancer for tailoring the indication of lymphadenectomy. Gynecol Oncol 104(3):623–628
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Sanjuán, A., Escaramís, G., Ayuso, J.R. et al. Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer. Arch Gynecol Obstet 278, 535–539 (2008). https://doi.org/10.1007/s00404-008-0636-1
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DOI: https://doi.org/10.1007/s00404-008-0636-1