Local-Regional Staging of Endometrial Carcinoma: Role of MR Imaging in Surgical Planning

Manfredi, Roberto; Mirk, Paoletta; Maresca, G; Margariti, Pasquale Alessandro; Testa, Antonia Carla; Zannoni, Gian Franco; Giordano, Deborah; Scambia, Giovanni; Marano, P

doi:10.1148/radiol.2312021184

Cited by 323 publications

(213 citation statements)

References 22 publications

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“…47 Concerning the evaluation of extrauterine diffusion, several techniques currently used for staging purposes, such as hysteroscopy, transvaginal ultrasound, and magnetic resonance imaging have shown their substantial value in the prediction of pathologic stage. [48][49][50][51] Therefore, in our opinion, patients with aneuploid tumors and particularly those with evidence or suspicion of extrauterine diffusion might benefit from a more aggressive primary treatment. This treatment should include intensive surgical staging with pelvic/aortic lymphadenectomy and trial of new adjuvant systemic therapies.…”

Section: Discussionmentioning

confidence: 99%

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Susini

Amunni

Molino

et al. 2007

Cancer

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BACKGROUND.To improve the outcome of endometrial cancer patients, a more accurate prognostic assessment is mandatory. The aims of the study were to evaluate the role of flow cytometric DNA ploidy as an independent prognostic factor in patients with endometrial cancer and to verify if ploidy was able to distinguish patients with different prognosis into homogeneous subgroups for grade of differentiation and stage.METHODS.In a prospective study, DNA ploidy was evaluated from fresh tumor samples in 174 endometrial cancer patients who underwent surgery as the first treatment. Ploidy, as well as classical parameters, were analyzed in relation to the length of disease‐free survival and disease‐specific survival.RESULTS.DNA aneuploidy was found in 49 patients (28.2%). Patients with DNA‐aneuploid tumors had a significantly reduced disease‐free interval and disease‐specific survival (P < .0001). The 10‐year survival probability was 53.2% for DNA‐aneuploid patients and 91.0% for patients with DNA‐diploid tumors. By multivariate analysis DNA‐aneuploid type was the strongest independent predictor of poor outcome, followed by age and stage. Patients with DNA‐aneuploid tumor had a significantly higher risk ratio for recurrence (5.03) and death due to disease (6.50) than patients with DNA‐diploid tumors. Stratification by DNA‐ploidy within each group by grade of differentiation allowed identification of patients with significantly different outcome. In grade 2 tumors, 10‐year survival was 45.0% in aneuploid cases and 91.9% in diploid cases (P < .0001). Patients with advanced‐stage (>I) diploid tumor did significantly better than patients with stage I aneuploid tumor (P = .04).CONCLUSIONS.The presence of DNA‐aneuploid type in endometrial cancer identifies high‐risk cases among the patients considered ‘low risk’ according to stage and grade of differentiation. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Susini

Amunni

Molino

et al. 2007

Cancer

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“…Numerous studies have evaluated the use of MRI to assess the depth of myometrial invasion, and the reported accuracies have ranged from 71% to 97%. 9,10,12,14,22 To the best of our knowledge, a comparative study of the diagnostic accuracy between SH and MRI has not been reported previously. Our results showed that SH had sensitivity of 64.7%, specificity of 87.7%, a PPV of 61.1%, and an NPV of 89.3%, and the diagnostic performance of SH was comparable to that of MRI.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies showed that the overall diagnostic accuracies for TVS and MRI in assessment of the depth of myometrial invasion were about 80%. [9][10][11][12][13][14] We expected the overall accuracy of SH to be 80%. We set the 2-sided α level a priori at .05 with a power of at least 95%, set the level of acceptable error at 10%, and expected about 10% of patients to drop out before the study ended.…”

Section: Methodsmentioning

confidence: 99%

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Value of Sonohysterography in Preoperative Assessment of Myometrial Invasion for Patients With Endometrial Cancer

Chang

Lee

Kim

et al. 2010

Journal of Ultrasound in Medicine

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Objective. The aims of this study were to compare the diagnostic performance of sonohysterography (SH) with that of magnetic resonance imaging (MRI) in estimation of myometrial invasion and to evaluate the influence of SH on peritoneal cytologic results for patients with endometrial cancer. Methods. Seventy-four patients with endometrial cancer were included. Sonohysterography and MRI were performed before surgery. All patients had complete staging procedures, including peritoneal cytologic analyses. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for SH and MRI. Results. The concordance rates of myometrial invasion for SH and MRI were 82.4% and 81.1%, respectively. The sensitivity, specificity, PPV, and NPV for identification of deep myometrial invasion were 64.7%, 87.7%, 61.1%, and 89.3% on SH and 70.6%, 84.2%, 57.1%, and 90.6% on MRI. Two patients (2.7%) were found to have positive results for malignant cells on peritoneal cytologic analyses. Conclusions. Sonohysterography appears to be a useful preoperative method for predicting myometrial invasion, comparable to MRI.

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“…At the same time, imagebased diagnosis has become more important for diagnosing the clinical stage of uterine body cancers. Until now, magnetic resonance imaging MRI has been the most accurate method of obtaining such image diagnoses for pre-surgical evaluations of endometrial cancer and for assessing the depth of myometrial invasion [5][6][7] , and a recent meta-analysis rated contrast-enhanced T1-weighted MRI as more effective than ultrasonography, CT, or non-contrast MRI 8 . However, given the risk 9 of nephrogenic systemic fibrosis NSF resulting when gadolinium contrast agent is administered to patients with renal failure, the demand for non-contrast MRI will rise in the future.…”

Section: Introductionmentioning

confidence: 99%

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

Bell

Yagi

Hatano

et al. 2014

Showa Univ J Med Sci

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: Endometrial cancer is the seventh most common human malignancy and the most common form of cancer treated in women by obstetrics and gynecology departments. Until now, magnetic resonance imaging MRI has been used for pre-surgical evaluation of endometrial cancer and evaluating the depth of myometrial invasion, in addition to being a valuable diagnostic tool. Diffusion-weighted imaging DWI has been reported as useful in distinguishing between benign and malignant tumors when observing lesions in the endometrium. Subsequent reports suggest that DWI is also effective in identifying malignancy and diagnosing local extension in a range of tissues. Based on this, we implemented a study of the effectiveness of DWI in identifying local extension of endometrial cancer. This study enrolled patients undergoing surgery at this hospital for cancer of the uterine body during the six years from January 2008 to February 2014. Cases in which images were unclear or the lesions were too small to be described by MRI examination were excluded, leaving 61 patients in the study. Using the results from pre-surgical MRI, a sequence comprising a T2-weighted axial view alone and a T2-weighted axial view to which a diffusion-weighted axial view had been added was created for each patient. Two radiologists then independently examined the image sequence to determine localized extension. Following surgery, the presurgical assessment was compared to the localized extension determined by histopathology of post-surgical samples to evaluate the effectiveness of adding diffusionweighted imaging to the process. The rst radiographic interpreter s rate of correct diagnosis using the T2-weighted axial view alone was 45 out of 55 cases 81.8 , while using the T2-weighted axial view to which a diffusion-weighted axial view had been added gave a correct diagnosis rate of 51 out of 55 cases 92.7 . The second radiographic interpreter s rate of correct diagnosis using the T2-weighted axial view alone was 41 out of 55 cases 74.5 , while using the T2-weighted axial view with diffusion-weighted axial view added gave a correct diagnosis rate of 51 out of 55 cases 92.7 . These differences were statistically signi cant based on the McNemar testing. This study con rmed that DWI is an effective means of diagnosing localized extension from images. It is anticipated that DWI will be used in the future clinical workplace to provide more accurate pre-surgical diagnoses.

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Local-Regional Staging of Endometrial Carcinoma: Role of MR Imaging in Surgical Planning

Abstract: MR imaging coupled with contrast material-enhanced dynamic MR imaging is highly accurate in local-regional staging of endometrial carcinoma; more challenging is the assessment of pelvic and lumboaortic lymph nodes.

Cited by 323 publications

References 22 publications

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Value of Sonohysterography in Preoperative Assessment of Myometrial Invasion for Patients With Endometrial Cancer

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

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