Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging.

Sironi, Sandro; Colombo, Emilio; Villa, Giulia; Taccagni, G; Belloni, C; Garancini, Paola; DelMaschio, A

doi:10.1148/radiology.185.1.1523309

Cited by 132 publications

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“…To date, the combination of dynamic contrast material-enhanced (DCE) and T2-weighted MR imaging has been accepted as the examination with the highest accuracy for staging of endometrial cancer. This protocol has been implemented by most European cancer centers and is also recommended in the European Society of Urogenital Radiology Endometrial Cancer Staging guidelines (5,9,14). However, the added benefit of diffusion-weighted imaging (DWI) (15) and quantitative methods have been described in studies of other pelvic cancers (16,17), especially in rectal and cervical cancer (17)(18)(19).…”

Section: Author Contributionsmentioning

confidence: 99%

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

143

114

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Purpose:To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. Materials and Methods:The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. Results:No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P , .0001).There was no significant difference in the ADCs between grades 1 and 2 tumors (P . .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P , .02). Conclusion:The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.q RSNA, 2015

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Section: Author Contributionsmentioning

confidence: 99%

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

143

114

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“…Treatment and prognosis depend on several factors, including stage, tumour grade, depth of myometrial penetration, cervical penetration and nodal metastasis (Manfredi et al 2004;Kinkel et al 1999;Hricak et al 1991;Sironi et al 1992a).…”

Section: Introductionmentioning

confidence: 99%

“…Symptomatic abnormal bleeding occurs in about 80% of patients, and most of the cases are diagnosed in an early-stage (Sironi et al 1992a), and cured (Lien et al 1991).…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic MRI is an examination accepted in the characterisation of pelvic tumours due to its multiplanar capacity and its excellent resolution of soft tissue contrast (Cunha et al 2001;Sironi et al 1992a;Sironi et al 1992b). High accuracy in the assessment of the depth of myometrial infiltration (superficial/deep) as well as the extent of cervical invasion and identification of enlarged pelvic and para-aortic lymph nodes has been described in the literature (Cunha et al 2001;Manfredi et al 2004).…”

Section: Introductionmentioning

confidence: 99%

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Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and histopathologic evaluation

Vasconcelos

Félix²,

Cunha³

2007

Journal of Obstetrics and Gynaecology

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SummaryThis study aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of deep myometrial invasion and cervical extension by endometrial carcinoma. This prospective study included 101 patients with histologically documented endometrial carcinoma, between July 1998 and April 2004. The findings of preoperative pelvic MRI were compared with histological diagnosis. From 101 cases studied by pelvic MRI, 43 were classified as deep myometrial invasion (50% of myometrium), where the pathological evaluation confirmed as having deep myometrial invasion. Cervical extension in the MRI study was found in 19 cases. Pathologic study found cervical extension and/or invasion in 31 cases including all cases identified by MRI. The accuracy, sensitivity and specificity of MRI were 95%, 89%, 100%, detecting deep myometrial invasion and 88%, 61%, 100%, detecting cervical invasion, respectively. The high accuracy achieved makes MRI an adequate method for determine the depth of myometrial and cervical invasion in endometrial carcinoma.

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“…Nevertheless, there is no consensus in the literature regarding the added value of DCE-MRI in staging of endometrial cancer. Although the majority of the published studies demonstrate that the addition of multiphase DCE-MRI to T2W imaging leads to a significant improvement in the accuracy of assessment of the deep myometrial invasion [8,9,[11][12][13][14][15], some authors have found no significant difference [16,17].…”

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confidence: 99%

Advances in magnetic resonance imaging of endometrial cancer

Sala

Rockall

2010

Eur Radiol

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Endometrial cancer is the most commonly diagnosed gynaecological malignancy in affluent societies [1]. It occurs most frequently in white women, with peak incidence between ages 55 and 65. Risk factors include unopposed oestrogen intake, use of tamoxifen, nulliparity, obesity, and diabetes. The incidence of endometrial cancer in the United Kingdom has increased by more than 40% between 1993 and 2007. This significant rise is predominantly due to a large increase in incidence in women aged 60-79 [1]. These trends are very similar for most European countries [2]. The increase in prevalence of obesity and decreases in fertility may partly account for the observed rapid increase in incidence and imply that endometrial cancer in postmenopausal women will become a more substantial public health problem in the future.Prognosis depends on a number of factors, including stage, depth of myometrial invasion, lymphovascular invasion, nodal status and histological grade. Depth of myometrial invasion is the single most important morphologic prognostic factor, correlating with tumour grade, lymph node metastases and overall patient survival. Incidence of lymph node metastases increases from 3% with superficial myometrial invasion (stage IA) to 46% with deep myometrial invasion (stage IB) [3]. Preoperative knowledge of these factors is crucial in tailoring the surgical approach. The histological grade can be determined at endometrial sampling, whereas depth of myometrial invasion can only be assessed preoperatively by MRI. Therefore, MRI can assist in preoperative assessment and treatment planning by accurately predicting depth of myometrial invasion, cervical stromal invasion and lymph node involvement. This information allows selection of patients for pelvic or para-aortic lymph node sampling whilst obviating the need for surgery in patients with low risk disease. MRI can also provide additional useful information such as uterine size, tumour volume, ascites and adnexal pathology which in turn may determine whether the surgical approach is transabdominal, transvaginal or laparoscopic.Lymphadenectomy in early (stage I) endometrial cancer remains a controversial issue. Two large prospective multicentre studies investigated whether pelvic lymphadenectomy could improve survival of women with endometrial cancer [4,5]. Both studies reported no benefit in overall or recurrence free survival in the patients randomized to lymphadenectomy. Conversely, the SEPAL study [6] showed that in patients with intermediate or high risk of endometrial cancer recurrence, combined pelvic and paraaortic lymphadenectomy reduced the risk of death compared with pelvic lymphadenectomy alone. The authors acknowledged that MRI is an important factor for predicting lymph node metastasis, and in combination with tumour grade and histology could be helpful to discriminate patients with very low risk of recurrence. Therefore,

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Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging.

Cited by 132 publications

References 0 publications

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and histopathologic evaluation

Advances in magnetic resonance imaging of endometrial cancer

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