Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging

Abstract

Objective: The aim of this retrospective cohort study is to evaluate the concordance between the preoperative MRI and histology data with the final histopathological examination. Method: This is a retrospective observational study of 183 patients operated for endometrioid cancer between January 2009 and December 2019 in the surgical oncology department of the Lorraine Cancer Institute (ICL) in Vandœuvre-lès-Nancy. The patients included are all women operated on for endometrioid-type endometrial cancer over this period. The exclusion criteria are patients for whom the pre-therapy check-up does not include pelvic MRI and those who have not had first-line surgery. The final anatomopathological results were compared with preoperative imaging data and with endometrial biopsy data. Results: For the myometrial infiltration, the sensitivity of MRI was of 37% and the specificity of 54%. To detect nodal metastases, the sensitivity of MRI was of 21% and the specificity of 93%. We observed an under estimation of the FIGO classification (p = 0.001) with the MRI in 42.7% of cases (n = 76) and an overestimation in 24.2% of cases (n = 43). There was a concordance in 33.1% of cases (n = 59). We had a poor agreement between the MRI and final histopathological examination with an adjusted kappa (κ) of 0.12 [95% IC (0.02; 0.24)]. There was a moderate concordance on the grade between the pretherapeutic biopsy and the final histopathological examination on excised tissue with an adjusted kappa of 0.52 [95% IC 0.42–0.62)]. Endometrial biopsy underestimated the tumor grade in 28.9% of cases (n = 50) (p < 0.001), overestimated the tumor grade in 6.9% of cases (n = 12) and we observed a concordance in 64.2% of cases (n = 111). Conclusion: The pre-operative assessment of endometrial cancer is inconsistent with the results obtained on final histopathological examination. A study with a systematic review should be done to assess the performance of MRI, only in expert centers, in order to consider a a specific care management for endometrial cancer patients: patients who have had an MRI in an outpatient center should have their imaging systematically reviewed, with the possibility of a new examination in case of incomplete sequences, by expert radiologists, and discussed in multidisciplinary concertation meeting in expert centers, before any therapeutic decision. The sentinel node biopsy must be used for low and intermediate risk endometrial cancer.

Analysis of correlation of pre-therapeutic assessment and the final diagnosis in endometrial cancer: role of tumor volume in the magnetic resonance imaging

“…Few studies specifically evaluated the accuracy of MRI to predict FIGO stage, describing concordance rates that vary from 33.1% to 86.3% ( 21 , 22 ). For instance, the reported accuracy rates of MRI assessment of myometrial invasion ranges from 65-89% ( 13 , 14 , 20 , 21 ), similarly to the 87.4% concordance rate found in our study. However, myometrial invasion shows more discrepancy in postmenopausal patients due to the thinning of myometrial tissue, while the concordance was higher for patients under sixty-years old ( 23 ).…”

“…However, there is a long-going problem regarding the surgical management of EC, which is the discrepancy between preoperative evaluation and the postoperative diagnosis. Reports on sensitivity of preoperative MRI staging of EC reflect a great diversity, ranging from 37% to 79% ( 13 , 14 , 20 , 21 ). Few studies specifically evaluated the accuracy of MRI to predict FIGO stage, describing concordance rates that vary from 33.1% to 86.3% ( 21 , 22 ).…”

Endometrial Cancer Staging: Is There Value in ADC?

“…The interpretation of MRI by a dedicated urogenital radiologist was found to have good agreement with histopathology (weighted kappa 0.75, p < 0.00) for staging endometrial cancer at our center. A similar agreement was observed by Karataşlı et al [ 26 ] when images were read by a dedicated pelvic radiologist, with a kappa coefficient of 0.73 between MRI and histology at early stages (differentiation between stages T1a and T1b), while Bouche et al [ 27 ] using a variety of imaging protocols from different centers and with the expertise of the reading radiologist unknown reported a poor agreement (kappa coefficient 0.12). This puts in evidence the importance of having dedicated radiologists interpreting these studies since the interpretation influences the accuracy of the endometrial cancer staging.…”

Prediction of Deep Myometrial Infiltration, Clinical Risk Category, Histological Type, and Lymphovascular Space Invasion in Women with Endometrial Cancer Based on Clinical and T2-Weighted MRI Radiomic Features

“…Endometrial cancer is the sixth most common malignant disorder worldwide with an estimated 382,000 new cases diagnosed annually [ 1 ]. Magnetic resonance imaging (MRI) has been extensively applied in endometrial cancer staging [ 2 , 3 , 4 , 5 ] and is usually the imaging modality of choice for assessment of deep myometrial invasion (DMI) [ 6 , 7 , 8 , 9 ]. Studies have shown that using MRI alone, endometrial cancer DMI prediction [ 10 ] accuracies were estimated to be 74% [ 11 ], 76% [ 12 ], and 89% [ 13 ].…”