Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

Abstract

Objectives:To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer. Material and methods:This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion. Results:In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684-0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812-0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001). Conclusions:The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.

Preoperative Magnetic Resonance Imaging versus Intraoperative Frozen Section Diagnosis for Predicting the Deep Myometrial Invasion in Endometrial Cancer: Our Experience and Literature Review

“…To our knowledge, 11 studies directly compared the diagnostic performance of MRI and FS in predicting deep MI using both methods in the same subjects. [13][14][15][16][17][18][19][20][21][22][23] We compared MRI/FS data between our current study and these previous studies, and conducted a pooled analysis of these data (Figure 2). The diagnostic performance of MRI varies more widely among studies compared with that of FS, suggesting that the differences in MRI technology or the skills of the radiologists may strongly affect the diagnostic performance of MRI.…”

“…The diagnostic performance data of MRI and frozen section (FS) diagnosis in detecting deep myometrial invasion were pooled from 12 studies directly comparing both methods in the same patients. [13][14][15][16][17][18][19][20][21][22][23] Forest plot shows the sensitivity, specificity, and accuracy of MRI ( ) and FS reports ( ) with corresponding 95% confidence intervals in individual studies and the pooled analysis. The dotted lines indicate the pooled sensitivity, specificity, and accuracy of FS diagnosis.…”

“…We also examined the diagnostic performance of combining MRI and FS results, which were classified into four groups (MRI+/FS+, MRI+/FS-, MRI-/FS+, and MRI-/FS-). We compared our data with those from 11 studies reporting direct comparisons between MRI and FS by using both methods in a single study [13][14][15][16][17][18][19][20][21][22][23]. These relevant articles were identified from the National Library of Medicine (PubMed) database.…”

Clinical Impact of Preoperative Magnetic Resonance Imaging in the Evaluation of Myometrial Infiltration and Lymph-Node Metastases in Stage I Endometrial Cancer

“…Based on our results, MRI is the method of choice in evaluating overall staging and myometrial invasion, as its specificity and negative predictive value are relatively high [ 15 , 16 ]. The role of lymph-node status is essential in prognosis and guiding adjuvant treatment [ 17 , 18 ].…”

Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients

“…Among them, myometrial invasion is the quietly early action of cancer cells. In addition, three-dimensional ultrasound and magnetic resonance imaging are applied for preoperative assessment of the depth of myometrial invasion ( 3 ), and frozen sections are used for intraoperative estimation ( 4 ). It is meaningful to classify patients with initial stages as low-risk or high-risk patients for surgical planning when the above diagnostic methods are becoming more accurate with a better specificity and sensitivity.…”