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Cancer Imaging

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Open Access 01-12-2014 | Research article

Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis

Authors: Sushant K Das, Xiang K Niu, Jing L Wang, Li C Zeng, Wen X Wang, Anup Bhetuwal, Han F Yang

Published in: Cancer Imaging | Issue 1/2014

Abstract

Background

The objective of this study was to perform a systematic review and a meta-analysis in order to estimate the diagnostic accuracy of diffusion weighted imaging (DWI) in the preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma.

Methods

Studies evaluating DWI for the detection of deep myometrial invasion in patients with endometrial carcinoma were systematically searched for in the MEDLINE, EMBASE, and Cochrane Library from January 1995 to January 2014. Methodologic quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies tool. Bivariate random-effects meta-analytic methods were used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and receiver operating characteristic (ROC) curves. The study also evaluated the clinical utility of DWI in preoperative assessment of deep myometrial invasion.

Results

Seven studies enrolling a total of 320 individuals met the study inclusion criteria. The summary area under the ROC curve was 0.91. There was no evidence of publication bias (P = 0.90, bias coefficient analysis). Sensitivity and specificity of DWI for detection of deep myometrial invasion across all studies were 0.90 and 0.89, respectively. Positive and negative likelihood ratios with DWI were 8 and 0.11 respectively. In patients with high pre-test probabilities, DWI enabled confirmation of deep myometrial invasion; in patients with low pre-test probabilities, DWI enabled exclusion of deep myometrial invasion. The worst case scenario (pre-test probability, 50%) post-test probabilities were 89% and 10% for positive and negative DWI results, respectively.

Conclusion

DWI has high sensitivity and specificity for detecting deep myometrial invasion and more importantly can reliably rule out deep myometrial invasion. Therefore, it would be worthwhile to add a DWI sequence to the standard MRI protocols in preoperative evaluation of endometrial cancer in order to detect deep myometrial invasion, which along with other poor prognostic factors like age, tumor grade, and LVSI would be useful in stratifying high risk groups thereby helping in the tailoring of surgical approach in patient with low risk of endometrial carcinoma.

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Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I: Endometrial cancer. Lancet 2005, 366: 491–505. 10.1016/S0140-6736(05)67063-8PubMedCrossRef

Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, De Winter KA, Lutgens LC, van den Bergh AC, van de Steen-Banasik E, Beerman H, van Lent M: Surgery and postoperative radiotherapy versus surgery alone for patients with stage 1 endometrial carcinoma: multicenter randomized trial. PORTEC study group. Post-operative radiation Therapy in Endometrial Cancer. Lancet 2000, 355(9213):1404–1411. 10.1016/S0140-6736(00)02139-5PubMedCrossRef

Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, Pearlman A, Maiman MA, Bell JG: A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: A Gynecologic Oncology Group study. Gynecol Oncol 2004, 94(1):241–242. 10.1016/j.ygyno.2004.04.002CrossRef

Gadducci A, Cavazzana A, Cosio S, DI Cristofano C, Tana R, Fanucchi A, Teti G, Cristofani R, Genazzani AR: Lymph-vascular space involvement and outer one-third myometrial invasion are strong predictors of distant haematogeneous failures in patients with stage I-II endometrioid-type endometrial cancer. Anticancer Res 2009, 29: 1715–1720.PubMed

Beddy P, Moyle P, Kataoka M, Yamamoto AK, Joubert I, Lomas D, Crawford R, Sala E: Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 2012, 262: 530–537. 10.1148/radiol.11110984PubMedCrossRef

Zhang G-y, Wu L-y, Li B, Huang M-n, Zhang R, Li X-g: Retrospective analysis of prognostic variables and clinical outcomes in surgically staged intermediate risk endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 2013, 169: 309–316. 10.1016/j.ejogrb.2013.02.025PubMedCrossRef

Boronow RC: Advances in diagnosis, staging, and management of cervical and endometrial cancer, stages I and II. Cancer 1990, 65: 648–659. 10.1002/1097-0142(19900201)65:3+<648::AID-CNCR2820651307>3.0.CO;2-HPubMedCrossRef

Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK: Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol 1996, 88: 394–398. 10.1016/0029-7844(96)00161-5PubMedCrossRef

Berman ML, Ballon SC, Lagasse LD, Watring WG: Prognosis and treatment of endometrial cancer. Am J Obstet Gynecol 1980, 136: 679–688.PubMed

10.

Uterine Cancers. National Comprehensive Cancer, ᅟ; ᅟ.

11.

Wang CB, Wang CJ, Huang HJ, Hsueh S, Chou HH, Soong YK, Lai CH: Fertility- preserving treatment in young patients with endometrial adenocarcinoma. Cancer 2002, 94: 2192–2198. 10.1002/cncr.10435PubMedCrossRef

12.

Manfredi R, Mirk P, Maresca G, Margariti PA, Testa A, Zannoni GF, Giordano D, Scambia G, Marano P: Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 2004, 231: 372–378. 10.1148/radiol.2312021184PubMedCrossRef

13.

Hricak H, Rubinstein L, Gherman G, Karstaedt N: MR imaging evaluation of endometrial carcinoma: results of an NCI cooperative study. Radiology 1991, 179: 829–832. 10.1148/radiology.179.3.2028000PubMedCrossRef

14.

Sironi S, Colombo E, Villa G, Taccagni G, Belloni C, Garancini P, DelMaschio A: Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium enhanced MR imaging. Radiology 1992, 185: 207–212. 10.1148/radiology.185.1.1523309PubMedCrossRef

15.

Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H: Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 1999, 212: 711–718. 10.1148/radiology.212.3.r99au29711PubMedCrossRef

16.

Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H: Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 1993, 186: 495–501. 10.1148/radiology.186.2.8421757PubMedCrossRef

17.

Seki H, Kimura M, Sakai K: Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images. Clin Radiol 1997, 52: 18–23. 10.1016/S0009-9260(97)80300-5PubMedCrossRef

18.

Savci G, Ozyaman T, Tutar M, Bilgin T, Erol O, Tuncel E: Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging. Eur Radiol 1998, 8: 218–223. 10.1007/s003300050365PubMedCrossRef

19.

Sadowski EA, Bennett LK, Chan MR, Wentland AL, Garrett AL, Garrett RW, Djamali A: Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 2007, 243: 148–157. 10.1148/radiol.2431062144PubMedCrossRef

20.

Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S: Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 2010, 20: 754–762. 10.1007/s00330-009-1597-xPubMedCrossRef

21.

Koyama T, Togashi K: Functional MR imaging of the female pelvis. J Magn Reson Imaging 2007, 25: 1101–1112. 10.1002/jmri.20913PubMedCrossRef

22.

Khan KS: Systematic reviews of diagnostic tests: a guide to methods and application. Best Pract Res Clin Obstet Gynaecol 2005, 19: 37–46. 10.1016/j.bpobgyn.2004.10.012PubMedCrossRef

23.

Devillé WL, Buntinx F, Bouter LM, Montori VM, de Vet HC, van der Windt DA, Bezemer PD: Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2002, 2: 9. 10.1186/1471-2288-2-9PubMedCentralPubMedCrossRef

24.

Bachmann LM, Bischof DB, Bischofberger SA, Bonani MG, Osann FM, Steurer J: Systematic quantitative overviews of the literature to determine the value of diagnostic tests for predicting acute appendicitis: study protocol. BMC Surg 2002, 2: 2. 10.1186/1471-2482-2-2PubMedCentralPubMedCrossRef

25.

Honest H, Khan KS: Reporting of measures of accuracy in systematic reviews of diagnostic literature. BMC Health Serv Res 2002, 2: 4. 10.1186/1472-6963-2-4PubMedCentralPubMedCrossRef

26.

Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J: The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003, 3: 25–37. 10.1186/1471-2288-3-25PubMedCentralPubMedCrossRef

27.

van Houwelingen HC, Arends LR, Stijnen T: Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 2002, 21: 589–624. 10.1002/sim.1040PubMedCrossRef

28.

Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH: Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005, 58: 982–990. 10.1016/j.jclinepi.2005.02.022PubMedCrossRef

29.

Rutter CM, Gatsonis CA: A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 2001, 20: 2865–2884. 10.1002/sim.942PubMedCrossRef

30.

Harbord RM, Deeks JJ, Egger M, Whiting P, Sterne JA: A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics 2007, 8: 239–251. 10.1093/biostatistics/kxl004PubMedCrossRef

31.

Swets JA: Measuring the accuracy of diagnostic systems. Science 1988, 240: 1285–1293. 10.1126/science.3287615PubMedCrossRef

32.

Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM: The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003, 56: 1129–1135. 10.1016/S0895-4356(03)00177-XPubMedCrossRef

33.

Jaeschke R, Guyatt GH, Sackett DL: The evidence-based medicine working group. User’s guides to the medical literature. III. How to use an article about a diagnostic test. B. what are the results and will they help me in caring for my patients? JAMA 1994, 271: 703–707. 10.1001/jama.1994.03510330081039PubMedCrossRef

34.

Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003, 327: 557–560. 10.1136/bmj.327.7414.557PubMedCentralPubMedCrossRef

35.

Chu H, Cole SR: Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach. J Clin Epidemiol 2006, 59: 1331–1332. 10.1016/j.jclinepi.2006.06.011PubMedCrossRef

36.

Zamora J, Abraira V, Muriel A, Khan K: A Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006, 6: 31. 10.1186/1471-2288-6-31PubMedCentralPubMedCrossRef

37.

Moses LE, Shapiro D, Littenberg B: Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 1993, 12: 1293–1316. 10.1002/sim.4780121403PubMedCrossRef

38.

Deeks JJ, Macaskill P, Irwig L: The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005, 58: 882–893. 10.1016/j.jclinepi.2005.01.016PubMedCrossRef

39.

Inoue C, Fujii S, Kaneda S, Fukunaga T, Kaminou T, Kigawa J, Harada T, Ogawa T: Correlation of apparent diffusion coefficient value with prognostic parameters of endometrioid carcinoma. J Magn Reson Imaging 2013, ᅟ: ᅟ. doi:10.1002/jmri.24534

40.

Rechichi G, Galimberti S, Signorelli M, Franzesi CT, Perego P, Valsecchi MG, Sironi S: Endometrial Cancer: Correlation of Apparent Diffusion Coefficient With Tumor Grade, Depth of Myometrial Invasion, and Presence of Lymph Node Metastases. AJR Am J Roentgenol 2011, 197: 256–262. doi:10.2214/AJR.10.5584 10.2214/AJR.10.5584PubMedCrossRef

41.

Cao K, Gao M, Sun YS, Li YL, Sun Y, Gao YN, Zhang XP: Apparent diffusion coefficient of diffusion weighted MRI in endometrial carcinoma-relationship with local invasiveness. Eur J Radiol 2012, 81: 1926–1930. 10.1016/j.ejrad.2011.04.019PubMedCrossRef

42.

Nakamura K, Imafuku N, Nishida T, Niwa I, Joja I, Hongo A, Kodama J, Hiramatsu Y: Measurement of the minimum apparent diffusion coefficient (ADCmin) of the primary tumor and CA125 are predictive of disease recurrence for patients with endometrial cancer. Gynecol Oncol 2012, 124: 335–339. 10.1016/j.ygyno.2011.10.014PubMedCrossRef

43.

Dogan D, Inan N, Sarisoy HT, Gumustas S, Akansel G, Muezzinoğlu B, Yücesoy I, Demirci A: Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI. Abdom. Imaging 2013, 38: 388–396. 10.1007/s00261-012-9915-1PubMedCrossRef

44.

Seo JM, Kim CK, Choi D, Kwan PB: Endometrial Cancer: Utility of diffusion-weighted magnetic resonance imaging with background body signal suppression at 3T. J Magn Reson Imaging 2013, 37: 1151–1159. 10.1002/jmri.23900PubMedCrossRef

45.

Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, Wu TI, Wang CC, Chen YR, Huang YT, Ng SH, Jung SM, Chang TC, Lai CH: Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging - initial experience. Radiology 2009, 250: 784–792. 10.1148/radiol.2503080874PubMedCrossRef

46.

Shen SH, Chiou YY, Wang JH, Yen MS, Lee RC, Lai CR, Chang CY: Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol 2008, 190: 481–488. 10.2214/AJR.07.2155PubMedCrossRef

47.

Takeuchi M, Matsuzaki K, Nishitani H: Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion. Acta Radiol 2009, 50: 947–953. 10.1080/02841850903099981PubMedCrossRef

48.

Hori M, Kim T, Onishi H, Imaoka I, Kagawa Y, Murakami T, Nakamoto A, Ueguchi T, Tatsumi M, Enomoto T, Kimura T, Tomiyama N: Endometrial cancer: preoperative staging using three-dimensional T2-weighted turbo spin-echo and diffusion-weighted MR imaging at 3.0 T: a prospective comparative study. Eur Radiol 2013, 23: 2296–2305. 10.1007/s00330-013-2815-0PubMedCrossRef

49.

Thorlund K, Imberger G, Johnston BC, Walsh M, Awad T, Thabane L, Gluud C, Devereaux PJ, Wetterslev J: Evolution of heterogeneity (I²) estimates and their 95% confidence intervals in large meta-analyses. PLoS One 2012, 7(7):e39471. doi:10.1371/journal.pone.0039471. Epub 2012 Jul 25 10.1371/journal.pone.0039471PubMedCentralPubMedCrossRef

50.

Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, Blessing JA: Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 1984, 63: 825–832.PubMed

51.

Larson DM, Copeland LJ, Gallager HS, Wharton JT, Gershenson DM, Edwards CL, Malone JM Jr, Rutledge FN: Prognostic factors in stage II endometrial carcinoma. Cancer 1987, 60: 1358–1361. 10.1002/1097-0142(19870915)60:6<1358::AID-CNCR2820600633>3.0.CO;2-OPubMedCrossRef

52.

Hording U, Hansen U: Stage I endometrial carcinoma: a review of 140 patients primarily treated by surgery only. Gynecol Oncol 1985, 22: 51–58. 10.1016/0090-8258(85)90007-1PubMedCrossRef

53.

Hori M, Kim T, Murakami T, Imaoka I, Onishi H, Nakamoto A, Nakaya Y, Tomoda K, Tsutsui T, Enomoto T, Kimura T, Nakamura H: MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: comparison with imaging at 1.5 T. J Magn Reson Imaging 2009, 30: 621–630. 10.1002/jmri.21879PubMedCrossRef

54.

Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK: Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomized study. Lancet 2009, 373(9658):125–136. 10.1016/S0140-6736(08)61766-3PubMedCrossRef

55.

Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Croce C, Mangioni C: Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008, 100(23):1707–1716. 10.1093/jnci/djn397PubMedCrossRef

56.

Falcone F, Balbi G, Di Martino L, Grauso F, Salzillo ME, Messalli EM: Surgical management of early endometrial cancer: an update and proposal of a therapeutic algorithm. Med Sci Monit 2014, 20: 1298–1313. doi:10.12659/MSM. 890478 10.12659/MSM.890478PubMedCentralPubMedCrossRef

57.

Rathod PS, Shakuntala PN, Pallavi VR, Kundaragi R, Shankaranand B, Vijay CR, Devi KU, Bafna UD: The risk and pattern of pelvic and para aortic lymph nodal metastasis in patients with intermediate and high risk endometrial cancer. Indian J Surg Oncol 2014, 5(2):109–114. doi:10.1007/s13193–014–0303-x. Epub 2014 March 28 10.1007/s13193-014-0303-xPubMedCentralPubMedCrossRef

58.

Niikura H, Okamura C, Utsunomiya H, Yoshinaga K, Akahira J, Ito K, Yaegashi N: Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol 2004, 92(2):669–674. 10.1016/j.ygyno.2003.10.039PubMedCrossRef

59.

Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N: Survival effect of para-aortic lymphade-nectomy in endometrial cancer (SEPAL study): a retrospective cohort anal-ysis. Lancet 2010, 375(9721):1165–1172. 10.1016/S0140-6736(09)62002-XPubMedCrossRef

60.

Patterson DM, Padhani AR, Collins DJ: Technology insight: water diffusion MRI - a potential new biomarker of response to cancer therapy. Nat Clin Pract Oncol 2008, 5: 220–233. 10.1038/ncponc1073PubMedCrossRef

61.

Tsushima Y, Takano A, Taketomi-Takahashi A, Endo K: Body diffusion-weighted MR imaging using high b-value for malignant tumor screening: usefulness and necessity of referring to T2-weighted images and creating fusion images. Acad Radiol 2007, 14: 643–650. 10.1016/j.acra.2007.02.006PubMedCrossRef

62.

Kuhl CK, Textor J, Gieseke J, von Falkenhausen M, Gernert S, Urbach H, Schild HH: Acute and subacute ischemic stroke at high-fieldstrength (3.0-T) diffusion-weighted MR imaging: intra-individual comparative study. Radiology 2005, 234: 509–516. 10.1148/radiol.2342031323PubMedCrossRef

63.

Gallego JC, Porta A, Pardo MC, Fernandez C: Evaluation of myometrial invasion in endometrial cancer: comparison of diffusion-weighted magnetic resonance and intraoperative frozen sections. Abdom Imaging 2014, 39(5):1021–1026. 10.1007/s00261-014-0134-9PubMedCrossRef

64.

Komori T, Narabayashi I, Matsumura K, Matsuki M, Akagi H, Ogura Y, Aga F, Adachi I: 2-[Fluorine-18]-fluoro- 2-deoxy-D-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience. Ann Nucl Med 2007, 21: 209–215. 10.1007/s12149-007-0010-6PubMedCrossRef

65.

Murtz P, Krautmacher C, Traber F, Gieseke J, Schild HH, Willinek WA: Diffusion-weighted whole-body MR imaging with background body signal suppression: a feasibility study at 3.0 Tesla. Eur Radiol 2007, 17: 3031–3037. 10.1007/s00330-007-0717-8PubMedCrossRef

66.

Szafer A, Zhong J, Gore JC: Theoretical model for water diffusion in tissues. Magn Reson Med 1995, 33: 697–712. 10.1002/mrm.1910330516PubMedCrossRef

67.

Castillo M, Smith JK, Kwock L, Wilber K: Apparent diffusion coefficients in the evaluation of high-grade cerebral gliomas. AJNR Am J Neuroradiol 2001, 22: 60–64.PubMed

68.

Lyng H, Haraldseth O, Rofstad EK: Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic resonance imaging. Magn Reson Med 2000, 43: 828–836. 10.1002/1522-2594(200006)43:6<828::AID-MRM8>3.0.CO;2-PPubMedCrossRef

69.

Uhl M, Altehoefer C, Kontny U, Il’yasov K, Buchert M, Langer M: MRI-diffusion imaging of neuroblastomas: first results and correlation to histology. Eur Radiol 2002, 12: 2335–2338. 10.1007/s00330-002-1310-9PubMedCrossRef

70.

Nonomura Y, Yasumoto M, Yoshimura R, Haraguchi K, Ito S, Akashi T, Ohashi I: Relationship between bone marrow cellularity and apparent diffusion coefficient. J Magn Reson Imaging 2001, 13: 757–760. 10.1002/jmri.1105PubMedCrossRef

71.

Fujii S, Matsusue E, Kigawa J, Sato S, Kanasaki Y, Nakanishi J, Sugihara S, Kaminou T, Terakawa N, Ogawa T: Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Eur Radiol 2008, 18: 384–389. 10.1007/s00330-007-0769-9PubMedCrossRef

72.

Inada Y, Matsuki M, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Yamada T, Tsuji M: Body diffusion-weighted MR imaging of uterine endometrial cancer: is it helpful in the detection of cancer in non-enhanced MR imaging? Eur J Radiol 2009, 70: 122–127. 10.1016/j.ejrad.2007.11.042PubMedCrossRef

73.

Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, Togashi K: Diffusion- weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 2007, 26: 682–687. 10.1002/jmri.20997PubMedCrossRef

74.

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: Preoperative and intraoperative assessment of myometrial invasion and histologic grade in endometrial cancer: role of magnetic resonance imaging and frozen sections. Int J Gynecol Cancer 2006, 16: 385–390. 10.1111/j.1525-1438.2006.00414.xPubMedCrossRef

75.

Sorosky JI: Endometrial cancer. Obstet Gynecol 2012, 111: 436–447. 10.1097/AOG.0b013e318162f690CrossRef

76.

Signorelli M, Guerra L, Buda A, Picchio M, Mangili G, Dell'Anna T, Sironi S, Messa C: Role of the integrated FDG PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer: detection of pelvic nodal metastases. Gynecol Oncol 2009, 115(2):231–235. 10.1016/j.ygyno.2009.07.020PubMedCrossRef

Title: Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis
Authors: Sushant K Das
Xiang K Niu
Jing L Wang
Li C Zeng
Wen X Wang
Anup Bhetuwal
Han F Yang
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Cancer Imaging / Issue 1/2014
Electronic ISSN: 1470-7330
DOI: https://doi.org/10.1186/s40644-014-0032-y

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