Performances de l’IRM dans le bilan d’extension locale préopératoire des cancers de l’endomètre : l’expérience nantaise

Coussoou, C.; Laigle-Quérat, Valérie; Loussouarn, Delphine; Vaucel, Edouard; Frampas, É.

doi:10.1016/j.gofs.2020.02.001

Cited by 2 publications

(3 citation statements)

References 42 publications

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“…Furthermore, the myometrial infiltration could be difficult to evaluate because of menopausal status. In post-menopause, we observed a thinning of myometrial tissue, which could complicate the estimation of myometrial infiltration [23].…”

Section: Concordance Between Mri and Final Histopathological Examinationmentioning

confidence: 87%

Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging

et al. 2020

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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.

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Section: Concordance Between Mri and Final Histopathological Examinationmentioning

confidence: 87%

Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging

et al. 2020

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“…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 ). We evaluated factors that might affect the diagnosis according to previous publications ( 23 ), but we found that they did not affect our results.…”

Section: Discussionmentioning

confidence: 92%

“…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 ). We evaluated factors that might affect the diagnosis according to previous publications ( 23 ), but we found that they did not affect our results. Our sample was homogenous, consisting of patients with endometroid EC, with 85% of them being postmenopausal with a similar age at diagnosis.…”

Section: Discussionmentioning

confidence: 92%

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

López-González,

García-Jiménez,

Rodríguez-Jiménez

et al. 2023

Front. Oncol.

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ObjectiveTo evaluate whether the introduction of tumor volume as new parameter in the MRI assessment could improve both concordance between preoperative and postoperative staging, and the identification of histological findings.MethodsA retrospective observational study with 127 patients with endometrial cancer (EC) identified between 2016 and 2021 at the Juan Ramon Jimenez University Hospital, Huelva (Spain) was carried out. Tumor volume was measured in three ways. Analyses of Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) were performed.ResultsAlthough preoperative MRI had an 89.6% and 66.7% sensitivity for the detection of deep mucosal invasion and cervical stroma infiltration, preoperative assessment had an intraclass correlation coefficient of 0.517, underestimating tumor final stage in 12.6% of cases, with a poor agreement between preoperative MRI and postoperative staging (κ=0.082) and low sensitivity (14.3%) for serosa infiltration. The cut-off values for all three volume parameters had good/excellent AUC (0.73-0.85), with high sensitivity (70-83%) and specificity (64-84%) values for all histopathological variables. Excellent/good agreement was found all volume parameters for the identification of deep myometrial invasion (0.71), cervical stroma infiltration (0.80), serosa infiltration (0.81), and lymph node metastases (0.81).ConclusionTumor volume measurements have good predictive capacity to detect histopathological findings that affect final tumor staging and might play a crucial role in the preoperative assessment of patients with endometrial cancer in the future.

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Performances de l’IRM dans le bilan d’extension locale préopératoire des cancers de l’endomètre : l’expérience nantaise

Cited by 2 publications

References 42 publications

Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging

Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging

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

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