Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging in Staging Endometrial Cancer: a Five-year Experience

Abstract

Objectives: To evaluate the accuracy of magnetic resonance imaging (MRI) in predicting deep myometrial invasion, cervical stromal invasion, and pelvic lymph node involvement in the preoperative assessment of women with endometrial cancer. Methods: Patients with endometrial cancer, having preoperative MRI available, and hysterectomy performed in a regional hospital in Hong Kong between 1 January 2010 and 31 December 2014 were included. Those treated with neoadjuvant therapy or without staging MRI were excluded. Primary outcome measure was the correlation between deep myometrial invasion suggested by preoperative MRI and subsequent histopathology of the hysterectomy specimen. Imaging-pathological correlation of cervical stromal invasion and pelvic node involvement was also assessed. Results: Overall 90 women met the criteria and were included in this study. Sensitivity, specificity, and accuracy of preoperative MRI was respectively 83.3%, 88.9%, and 87.8% for predicting deep myometrial invasion; 22.2%, 98.6%, and 83.3% for predicting cervical stromal invasion; and 60.0%, 96.6%, and 91.2% for predicting pelvic node disease. Conclusions: Preoperative MRI is highly accurate in the detection of deep myometrial invasion, which is the single most important prognostic factor. It is moderately accurate and highly specific in the diagnosis of cervical stromal invasion and pelvic node metastasis. The favourable performance of preoperative MRI allows better surgical planning that may then translate into better patient outcome. Although not formally included in the FIGO staging system, it is a highly valuable adjunct in preoperative assessment of women with endometrial cancer.

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

“…Based on title and abstract, 525 studies were relevant. After full‐text screening, 83 studies, comprising 18,205 patients, were included in the systematic review (supplemental online Appendix 2) . Three studies lacked raw data, and because the authors did not respond after being contacted, these publications were excluded .…”

Diagnostic Accuracy of MRI for Detecting Cervical Invasion in Patients with Endometrial Carcinoma: A Meta-Analysis

“…For the reference standard domain, only 7 studies explicitly stated that pathology results were blinded to MRI findings 18 , 20 , 24 , 26 , 31 , 38 , 41 , the remaining 35 studies lacked information for the reference domain. In relation to the flow and timing domain, twenty-four studies reported an appropriate interval between the MRI and pathological examination 5 , 6 , 8 , 10 , 12 - 16 , 18 - 21 , 23 , 24 , 26 , 30 , 31 , 38 , 39 , 41 , 44 , 45 , 50 , and the remaining 18 studies did not report the interval. All studies applied pathological evaluation of the removed uterus except for one study where the evaluation was not reported 22 .…”

“…Regarding the risk of bias and the patient selection domain, 14 studies explicitly reported that the patients were consecutive [10,12,13,16,21,23,[25][26][27][28]31,[37][38][39], and the remaining 28 studies only reported the start and end times of patient recruitment [5,6,8,11,14,15,[17][18][19][20]22,24,29,30,[40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Concerning the index test domain, 6 studies did not report that histopathology was blinded from the MRI findings [5,22,23,27,40,45].…”