Comparison of the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors

Abstract

Background Various modalities including ultrasonography and magnetic resonance imaging (MRI) have been developed as imaging technique for screening malignant myometrial tumors, but a few studies assessed the diagnostic value of these two techniques in differentiation of benign from malignant myometrial tumors that had been the main purpose of this study. Materials and methods This cross-sectional study was performed on 63 women underwent surgery for intrauterine masses that were initially assessed using MRI and ultrasound before surgery at a tertiary hospital in Tehran from 2016 to 2020. Their MRI was reviewed by a reputable radiologist in the field. The findings of histopathological assessment were considered as the gold diagnostic standard. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI to detect sarcoma were revealed to be 94.6%, 92.3%, 94.6%, 92.3%, and 93.7% respectively. Ultrasonography had not preferable applicability to differentiate sarcoma from benign tumors with sensitivity, specificity, PPV, NPV and accuracy of 35.1%, 88.4%, 81.2%, 48.9%, and 57.1% respectively. The diagnostic performance of both modalities was not affected by baseline clinical conditions including pain, abnormal uterine bleeding and menopausal status. Conclusion MRI but not ultrasonography can effectively differentiate benign from malignant myometrial tumors.

Sonographic and Magnetic Resonance Characteristics of Gynecological Sarcoma

“…Najibi et al [ 28 ] compared the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors. The cross-sectional study observed 63 patients that underwent surgery for intrauterine masses and were assessed using the ultrasound and MRI.…”

“…In a previously mentioned study, Najibi et al [ 28 ] compared the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography. In contrast to ultrasonography, with the MRI, the correct diagnosis was made in all but four cases, leading to a sensitivity of 94.6%, specificity of 92.3%, positive predictive value of 94.6%, negative predictive value of 92.3%, and accuracy of 93.7% for the MRI to detect sarcoma.…”

“…This may be a reason for the following results. Two studies evaluated the preoperative diagnostic accuracy of the ultrasound for sarcoma, but sensitivities of only 11% [ 27 ] and 35% [ 28 ], respectively, were reached. Gaetke-Udager et al [ 29 ] examined the diagnostic accuracy further using ultrasound features that match the above discussed features compiled in this review.…”

“…Li et al [ 27 ] evaluated 34 patients with sarcoma, for which a sensitivity of only 35% was reached; roughly half of the patients received a benign preoperative diagnosis. The study of Najibi et al [ 28 ] had more promising results with a correct diagnosis of sarcoma made in 94% of the cases. On the other hand, an evaluation of the qualitative features on conventional MRI by Gaetke-Udager et al [ 29 ] could not achieve an accuracy that differed from chance.…”

Advances in the Preoperative Identification of Uterine Sarcoma

“…American scientists [ 43 ] have achieved good performance in predicting mesenchymal malignant lesions in the uterus by applying a radiomics model of ultrasound images. Compared with ultrasonography, MRI has the advantages of good soft-tissue resolution and multidirectional and multiparametric imaging [ 44 ], which can more effectively differentiate uterine sarcomas from uterine fibroids; thus, when ultrasonography suggests the possibility of malignant uterine tumors, MRI should be continuously examined.…”