Pre-surgical staging in endometrial cancer: An opportunity for risk stratification and triage?

Jose, Tony; Singh, Amarinder; Vardhan, Shakti

doi:10.1016/j.mjafi.2020.09.009

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…Two radiologists retrospectively analyzed the MRI images of each patient, and the sensitivity and specificity of the diagnosis of DMI, CSI, and LNM were consistent with those of previous studies ( 19 – 21 ). Many studies ( 5 , 22 – 24 ) have confirmed that patient age, DMI, CSI, and LNM are important prognostic factors in high-risk patients with EC.…”

Section: Discussionsupporting

confidence: 66%

Multiparametric magnetic resonance imaging-based radiomics nomogram for predicting tumor grade in endometrial cancer

Yue

et al. 2023

Front. Oncol.

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BackgroundTumor grade is associated with the treatment and prognosis of endometrial cancer (EC). The accurate preoperative prediction of the tumor grade is essential for EC risk stratification. Herein, we aimed to assess the performance of a multiparametric magnetic resonance imaging (MRI)-based radiomics nomogram for predicting high-grade EC.MethodsOne hundred and forty-three patients with EC who had undergone preoperative pelvic MRI were retrospectively enrolled and divided into a training set (n =100) and a validation set (n =43). Radiomic features were extracted based on T2-weighted, diffusion-weighted, and dynamic contrast-enhanced T1-weighted images. The minimum absolute contraction selection operator (LASSO) was implemented to obtain optimal radiomics features and build the rad-score. Multivariate logistic regression analysis was used to determine the clinical MRI features and build a clinical model. We developed a radiomics nomogram by combining important clinical MRI features and rad-score. A receiver operating characteristic (ROC) curve was used to evaluate the performance of the three models. The clinical net benefit of the nomogram was assessed using decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination index (IDI).ResultsIn total, 35/143 patients had high-grade EC and 108 had low-grade EC. The areas under the ROC curves of the clinical model, rad-score, and radiomics nomogram were 0.837 (95% confidence interval [CI]: 0.754–0.920), 0.875 (95% CI: 0.797–0.952), and 0.923 (95% CI: 0.869–0.977) for the training set; 0.857 (95% CI: 0.741–0.973), 0.785 (95% CI: 0.592–0.979), and 0.914 (95% CI: 0.827–0.996) for the validation set, respectively. The radiomics nomogram showed a good net benefit according to the DCA. NRIs were 0.637 (0.214–1.061) and 0.657 (0.079–1.394), and IDIs were 0.115 (0.077–0.306) and 0.053 (0.027–0.357) in the training set and validation set, respectively.ConclusionThe radiomics nomogram based on multiparametric MRI can predict the tumor grade of EC before surgery and yield a higher performance than that of dilation and curettage.

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Section: Discussionsupporting

confidence: 66%

Multiparametric magnetic resonance imaging-based radiomics nomogram for predicting tumor grade in endometrial cancer

Yue

et al. 2023

Front. Oncol.

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“…MRI is widely recognized as the most accurate imaging modality for preoperative staging of EC, particularly for assessing myometrial invasion and cervical stromal involvement [ 8 ]. Conventional MRI protocols typically include high-resolution T2-weighted imaging (T2WI) and dynamic contrast-enhanced MRI (DCE-MRI) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Enhancing Preoperative Assessment of Endometrial Cancer: The Role of Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Myometrial Invasion

Raja,

Sharma,

Subramonian

et al. 2024

Cureus

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Background: Endometrial cancer (EC) is the most common gynecological malignancy. Accurate preoperative staging is essential for guiding treatment. The depth of myometrial invasion is a key prognostic factor. This prospective study aimed to evaluate the added benefit of diffusion-weighted imaging (DWI) compared to T2-weighted imaging (T2WI) and dynamic contrast-enhanced MRI (DCE-MRI) for the preoperative assessment of myometrial invasion in EC. Aim and objectives: The aim of this prospective study was to evaluate the added benefit of DWI in the preoperative assessment of myometrial invasion in EC, in comparison with T2WI and DCE-MRI. The objectives were to assess the imaging characteristics of endometrial carcinoma on T2WI, DCE, and DW MR, to assess the depth of myometrial invasion and overall stage in EC patients, to compare the diagnostic performance of DCE-MRI with that of DW-MRI combined with T2WI, to describe how MR imaging findings can be combined with tumor histologic features and grading to guide treatment planning, and to evaluate the pitfalls and limitations of DCE and DW MR in the assessment of EC. Materials and methods: Thirty-one patients with histologically confirmed EC underwent preoperative pelvic MRI on a 1.5T scanner. T2WI, DWI (b-values 0, 1000 s/mm 2 ), and DCE-MRI were performed. Two radiologists independently assessed myometrial invasion on T2WI, T2WI + DWI, and T2WI + DCE-MRI. Histopathology after hysterectomy was the reference standard. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each MRI protocol, with separate analyses for superficial (<50%) and deep (≥50%) myometrial invasions. Results: The accuracy for assessing superficial invasion was 61.3% for T2WI, 87.1% for T2WI + DWI, and 87.1% for T2WI + DCE-MRI. For deep invasion, accuracy was 64.5% for T2WI, 90.3% for T2WI + DWI, and 90.3% for T2WI + DCE-MRI. Sensitivity, specificity, PPV, and NPV for T2WI + DWI and T2WI + DCE-MRI were high and comparable (88.9-91.7%) for both superficial and deep invasions. T2WI had markedly lower sensitivity and specificity. The differences between T2WI and the functional MRI protocols were statistically significant (p < 0.01). Conclusion: DWI and DCE-MRI significantly improve the diagnostic performance of MRI for the preoperative assessment of myometrial invasion depth in EC compared to T2WI alone. DWI + T2WI and DCE-MRI + T2WI demonstrate comparable high accuracy. DWI may be preferable since it is faster and avoids contrast administration.

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Pre-surgical staging in endometrial cancer: An opportunity for risk stratification and triage?

Cited by 2 publications

References 29 publications

Multiparametric magnetic resonance imaging-based radiomics nomogram for predicting tumor grade in endometrial cancer

Multiparametric magnetic resonance imaging-based radiomics nomogram for predicting tumor grade in endometrial cancer

Enhancing Preoperative Assessment of Endometrial Cancer: The Role of Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Myometrial Invasion

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