Top

Archives of Gynecology and Obstetrics

Published in:

01-12-2008 | Original Article

Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer

Authors: A. Sanjuán, G. Escaramís, J. R. Ayuso, S. Martínez Román, A. Torné, J. Ordi, J. A. Lejárcegui, J. Pahisa

Published in: Archives of Gynecology and Obstetrics | Issue 6/2008

Abstract

Objective

To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting myometrial invasion and cervical involvement in endometrial cancer.

Study design

Seventy two consecutive patients with endometrial carcinoma underwent preoperative MRI. We compared the MRI results with the final histopathological findings. We classify myometrial invasion as <50 or ≥50% and cervical involvement as positive or negative. Standard statistical calculations were used.

Results

The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion ≥50% were 71, 86, and 58%, respectively. Positive and negative predictive values are 77 and 83%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 41, 97, and 46%, respectively. Positive and negative predictive values are 71 and 89%, respectively. The possible causes of misdiagnosis included a tumor isointense with the myometrium, polypoid tumor, myometrial thinning, exceedingly irregular myometrium, presence of adenomiosis, and presence of leiomyomas.

Conclusion

MRI assists in planning the surgical treatment of endometrial cancer with an acceptable accuracy and a good specificity, although sensitivity is suboptimal.

Jemal A, Murray T, Samuels A et al (2003) Cancer statistics, 2003. CA Cancer J Clin 53:5–26PubMedCrossRef

Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. Cancer 60:2035–2041PubMedCrossRef

Benedet JL, Bender H, Jones H, Ngan HYS, Pecorelli S (2000) FIGO staging classifications and clinical practices guidelines in the management of gynaecological cancers. Inter J Gynaecol Obstet 70:209–262CrossRef

Burger MPM (2001) Management of stage I endometrial carcinoma. BMJ 322:568–569PubMedCrossRef

Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMed

Nakao Y, Yokoyama M, Hara K, Koyamatsu Y, Yasunaga M, Araki Y, watanabe Y, Iwasaka T (2006) MRI in endometrial cancer as a diagnostic tool for the absence of myometrial invasion. Gynecol Oncol 102:343–347PubMedCrossRef

Nagar H, Dobbs S, Raymond McClelland H, Price J, Glenn McCluggage W, Grey A (2006) The diagnostic accuracy of MRI in detecting cervical involvement in endometrial cancer. Gynecol Oncol 103:431–434PubMedCrossRef

Sironi S, Taccagni G, Garancini P, Belloni C, Del Maschio A (1992) Myometrial invasion by endometrial carcinoma: assessment by MR imaging. AJR 158:565–569PubMed

Selman TJ, Khan KS, Mann CH (2005) An evidence-based approach to test accuracy studies in gynecologic oncology: the STARD checklist. Gynecol Oncol 96(3):575–578PubMedCrossRef

10.

Boronow RC, Morrow CP, Creasman WT et al (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63:825–832PubMed

11.

Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC (2000) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 182:1506–1519PubMedCrossRef

12.

Franchi M, Ghezzi F, Riva C, Miglierina M, Buttarelli M, Bolis P (2001) Postoperative complications after pelvic lymphadenectomy for the surgical staging of endometrial cancer. J Surg Oncol 78:232–240PubMedCrossRef

13.

Chung HH, Kang SB, Cho JY, Kim JW, Park NH, Song YS, Kim SH, Lee HP (2007) Accuracy of MRI for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 104:654–659PubMedCrossRef

14.

Sanjuán A, Cobo T, Pahisa J, Escaramís G, Ordi J, Ayuso JR, Garcia S, Hernández S, Torné A, Martínez Román S, Lejárcegui JA, Vanrell JA (2006) Preoperative and intraoperative assessment of myometrial invasion and histological grade in endometrial cancer: role of magnetic resonance imaging and frozen section. Int J Gynecol Cancer 16:385–390PubMedCrossRef

15.

Barwick TD, Rockall AG, Barton DP, Sohaib SA (2006) Imaging of endometrial adenocarcinoma. Clin Radiol 61:545–555PubMedCrossRef

16.

Ortashi O, Jain S, Emannuel O, Henry R, Wood A, Evans J (2007) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperativr MRI for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obs Gynecol Reprod Biol (in press)

17.

Todo Y, Sakuragi N, Nishida R, Yamada T, Ebina Y, Yamamoto R, Fujimoto S (2003) Combined use of MRI, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol 188:1265–1272PubMedCrossRef

18.

Todo Y, Okamoto K, Hayashi M, Minobe S, Nomura E, Hareyama H, Takeda M, Ebina Y, Watari H, Sakuragi N (2007) A validation study of a scoring system to estimate the risk of lymph node metastases for patients with endometrial cancer for tailoring the indication of lymphadenectomy. Gynecol Oncol 104(3):623–628PubMedCrossRef

Title: Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer
Authors: A. Sanjuán
G. Escaramís
J. R. Ayuso
S. Martínez Román
A. Torné
J. Ordi
J. A. Lejárcegui
J. Pahisa
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 6/2008
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-008-0636-1

At a glance: The STEP trials

Springer Medicine

Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer

Abstract

Objective

Study design

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Study design

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2008

Plasma homocysteine, vitamin B12 and folate levels in hydatidiform moles and histopathological subtypes

First trimester diagnosis of sirenomelia: a case report and review of the literature

Familial aggregation of endometriosis in the Yale Series

Fetal therapy in twin reversed arterial perfusion sequence pregnancies with alcohol ablation or bipolar cord coagulation

Ectopic pregnancy following embolisation of congenital arteriovenous malformation

Huge filarial elephantiasis vulvae in a Nigerian woman with subfertility