The Role of Magnetic Resonance Imaging in the Pre-operative Evaluation of Women Diagnosed With Atypical Endometrial Hyperplasia

Abstract

Background/Aim: To evaluate the role of MRI in patients with atypical endometrial hyperplasia (AEH) and incorporate MRI findings in predictive models estimating the risk of co-existent endometrial cancer (EC). Patients and Methods: Data from 189 women diagnosed with AEH and had MRI scan prior to operation, over nine years, were retrospectively collected. Results: Histology showed EC in 51 (27%) cases. Presence of myometrial invasion on MRI was more commonly detected in patients with EC compared to those with benign pathology (37.3% versus 10.9%, p<0.001). The sensitivity and specificity of MRI in identifying cancer were 37% and 89%, respectively. Age, menopausal status and presence of invasion on MRI were the best predictors for the presence of malignancy. Conclusion: Myometrial invasion on MRI is associated with increased risk of EC in women with AEH. Its accuracy in detecting malignancy improves when combined with clinical parameters. This could be of value for conservativemanagement candidates.

Preoperative detection of occult endometrial malignancies in endometrial hyperplasia to improve primary surgical therapy: A scoping review of the literature

“…The results of the scoping review were reported according to the Preferred Reporting Items for Systematic reviews and Meta-criteria and were included in our review. We included 24 primary studies, [9][10][11][13][14][15][16][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] three meta-analyses, [17][18][19] and one poster presentation. 12 The characteristics of the 28 included studies are shown in Table 2.…”

“…12 The characteristics of the 28 included studies are shown in Table 2. Five studies were multicentric, 17-19, 27,35 five studies were from Turkey, 11,15,20,23,25 four studies were from the USA, 12,13,21,22 two studies were from the UK, 14,16 two studies were from Canada 10,34 and there was one study from each of Australia, 9 South Korea, 24 France, 26 Belgium, 28 Italy, 29 Denmark, 30 Greece, 31 Norway, 32 Taiwan, 33 and China. 36 These studies included the data of 7409 patients and recorded 2377 concurrent EC cases (32.1%).…”

“…Nine studies [9][10][11][12][13]16,17,20,27 studied the correlation between diabetes mellitus and concurrent EC. Six studies [9][10][11][12][13]16 found no statistical association between diabetes mellitus and concurrent EC; however, the meta-analysis by Raffone et al 17 revealed a significant association (OR 1.96; 95% CI 1.07-3.60; P = 0.030). Only two studies showed a statistically significant correlation between hypertension and concurrent EC.…”

“…Age and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) were the most studied clinical predictors across the studies. Eleven studies 15,16,20,[22][23][24][25][26][27]30,32 found a statistically significant correlation between age and concurrent EC. Antonsen et al 30 showed an incremental dose-response relationship between age and concurrent EC.…”

“…Chen et al 27 showed that the (95% CI, 1.60-10.10). 13 Two studies 14,16 examined whether pelvic magnetic resonance imaging (MRI) could be used as a predictor of occult EC in biopsy specimens with EH. Natarajan et al 14…”