Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma

Chung, Hyun Hoon; Kang, Soon Beom; Cho, Jeong Yeon; Kim, Jae Weon; Park, Noh-Hyun; Song, Yong Sang; Kim, Seung Hyup; Lee, Hyo-Pyo

doi:10.1016/j.ygyno.2006.10.007

Cited by 83 publications

(57 citation statements)

References 33 publications

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“…In many institutions, MR imaging has become a standard method. Sensitivity reported for this technique ranges from 80% to 91% (16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

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Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Alcázar

Galván²,

Albela³

et al. 2009

Radiology

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Purpose:To describe and analyze the diagnostic performance of uterine virtual navigation with three-dimensional (3D) ultrasonography (US) for the assessment of the depth of myometrial infiltration by endometrial cancer. Materials and Methods:Institutional review board approval was obtained; patients gave oral informed consent. Women with endometrial cancer were evaluated by using 3D US prior to surgical staging. A 3D volume of the whole uterus was obtained and analyzed by using software. Virtual navigation through three orthogonal planes was performed to identify the shortest myometrial tumor-free distance to serosa (TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the myometrium. Myometrial infiltration was also assessed by subjective impression of an examiner. Histologic findings of myometrial infiltration and TDS measured by a pathologist were used as the reference standard. A receiver operating characteristic curve was plotted to identify the best cutoff for TDS for identifying myometrial infiltration of 50% or more. Results:Ninety-six women (mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included in the study. At histologic analysis, myometrial invasion was found to be less than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with US was positively correlated with histologically measured TDS (r ϭ 0.649; 95% confidence interval: 0.52, 0.76). The best cutoff for USmeasured TDS was 9.0 mm (sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a specificity of 82.3%, a negative predictive value of 96.6%, and a positive predictive value of 67.7%. Conclusion:Uterine virtual navigation with 3D US is a reliable method for the assessment of myometrial infiltration in patients with endometrial cancer.

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“…In many institutions, MR imaging has become a standard method. Sensitivity reported for this technique ranges from 80% to 91% (16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

“…Contrast material-enhanced magnetic resonance (MR) imaging is considered the most reliable method and has an accuracy ranging from 62% to 95% (14)(15)(16)(17)(18)(19)(20). However, MR imaging is costly, has limited availability, and cannot be performed in all patients.…”

mentioning

confidence: 99%

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Alcázar

Galván²,

Albela³

et al. 2009

Radiology

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“…18 F-FDG PET/CT combines morphologic and physiologic techniques and is the preferred imaging method for various cancers (11). Although several studies have suggested that 18 F-FDG PET/CT can be beneficial preoperatively in endometrial cancer patients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), its clinical role in risk stratification of such patients is not well defined. Furthermore, the value of various quantitative tumor parameters and the corresponding optimal cutoffs for the prediction of tumor stage and prognosis are largely unexplored.…”

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confidence: 99%

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

et al. 2015

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Our objective was to prospectively explore the diagnostic value of 18 F-FDG PET/CT for preoperative staging in endometrial carcinomas and to investigate whether 18 F-FDG PET-specific quantitative tumor parameters reflect clinical and histologic characteristics. Methods: Preoperative 18 F-FDG PET/CT was prospectively performed on 129 consecutive endometrial carcinoma patients. Two physicians who did not know the clinical findings or staging results independently reviewed the images, assessing primary tumor, cervical stroma involvement and metastatic spread, and determining maximum and mean standardized uptake value (SUV max and SUV mean , respectively) for tumor, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). All parameters were analyzed in relation to histomorphologic and clinical tumor characteristics. Receiver-operatingcharacteristic curves for identification of deep myometrial invasion and lymph node metastases were generated, and MTV cutoffs for predicting deep myometrial invasion and lymph node metastases were calculated. Results: The sensitivity, specificity, and accuracy of 18 F-FDG PET/CT for the detection of lymph node metastases were 77%-85%, 91%-96%, and 89%-93%, respectively. SUV max , SUV mean , MTV, and TLG were significantly related to deep myometrial invasion, presence of lymph node metastases, and high histologic grade (P , 0.015 for all) and independently predicted deep myometrial invasion (P , 0.015) and lymph node metastases (P , 0.025) after adjustment for preoperative histologic risk (based on subtype and grade) in endometrial biopsies. Optimal cutoffs for MTV in predicting deep myometrial invasion (20 mL) and the presence of lymph node metastases (30 mL) yielded odds ratios of 7.8 (P , 0.001) and 16.5 (P 5 0.001), respectively. Conclusion: 18 F-FDG PET/CT represents a clinically valuable tool for preoperatively evaluating the presence of lymph node metastases in endometrial carcinoma patients. Applying MTV cutoffs for the prediction of deep myometrial invasion and lymph node metastases may increase diagnostic accuracy and aid preoperative identification of high-risk patients, enabling restriction of lymphadenectomy for patients with a low risk of aggressive disease.

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“…Many studies show that the accuracy of T2-weighted images in the determination of myometrial invasion by endometrial cancer ranges from 68 to 82% and dynamic MRI increases the accuracy up to 91%. [25][26][27] Our data showed that CA 125 level and myometrial invasion on MRI were significant factors in preoperatively predicting para-aortic lymph node metastasis. Of 6 patients with para-aortic lymph node metastases, 4 (66.7%) had preoperative CA 125 level of C31 U/ml and myometrial invasion C 1/2 on MRI.…”

Section: Discussionmentioning

confidence: 67%

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

et al. 2010

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Background. The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy. Materials and methods. A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.Results. Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of C31 U/ ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis. Conclusions. Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of [31 U/ml and deep myometrial invasion by MRI.

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Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma

Cited by 83 publications

References 33 publications

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

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Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma

Cited by 83 publications

References 33 publications

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients