Diagnostic Value of Pelvic MRI for Assessment of the Depth of Myometrial Invasion and Cervical Involvement in Endometrial Cancer: Comparison of New Versus Old FIGO Staging

Abstract

BackgroundEndometrial carcinoma is a highly prevalent gynecologic malignancy. The International Federation of Gynecology and Obstetrics (FIGO) staging system underwent significant revision on 2009. Key changes in the FIGO staging system include simplification of stage I endometrial cancer and removal of cervical mucosal invasion as a separate stage. MRI is a noninvasive diagnostic method for preoperative staging of endometrial cancer.ObjectivesThe main purpose of this study was to investigate the diagnostic efficacy of pelvic MRI in determining the depth of myometrial invasion and cervical involvement in endometrial carcinoma. The other aim was to compare the accuracy of pelvic MRI using the old and new FIGO staging systems in endometrial carcinoma.Patients and MethodsBetween November 2010 and January 2012, 54 patients underwent primary surgical staging in our department due to endometrial adenocarcinoma. Pre-operative pelvic MRI was performed and MRI staging was done according to old and new FIGO staging, separately. The sensitivity, specificity, positive and negative predictive values as well as the accuracy of MRI for deep myometrial invasion and cervical infiltration were calculated. MRI accuracy was also compared for old and new FIGO staging. Pathological staging was the standard of reference.ResultsThe mean age was 53.31 (SD = 11.52) and the most common histological subtype was the endometrioid type of endometrial adenocarcinoma (90.8%). In the evaluation of deep tumoral invasion of the myometrium (> 50%), sensitivity, specificity, diagnostic accuracy and positive and negative predictive values of MRI were 82.35%, 94.59%, 90.74%, 87.5% and 92.1%, respectively. For cervical stromal involvement, these values were 54.54%, 100%, 90.74%, 100% and 89.58%, respectively. In case of cervical mucosal involvement (in old FIGO staging), the positive predictive value was only 50% and the accuracy decreased to 74.07%. Agreement between MRI and the final histology using the old and new FIGO classification was appropriate with Kappa = 0.62 and 0.72, respectively (P < 0.001).ConclusionUsing 2009 FIGO classification increases the accuracy of pelvic MR imaging for preoperative staging of patients with early stages of endometrial cancer.

Prognostic value of human epididymis protein 4 in endometrial cancer and its utility for surgical staging

“…analyzed 53 patients and stated that MRI is limited in its ability to detect deep myometrial invasion with respect to the results (sensitivity, specificity, and overall diagnostic accuracy were 50.0%, 89.7% and 79.2%, respectively). Conversely, Zamani et al . reported higher sensitivity (82.4%), specificity (94.6%) and diagnostic accuracy (90.7%) in the sample of 54 patients.…”

“…Significantly more of the published work sources focus on evaluating the stage of the disease . Published studies comparing transvaginal ultrasound (TVS), MRI, and possibly PET‐CT in the diagnosis of myometrial invasion and cervical stromal involvement do not lead to entirely consensual conclusions.…”

“…Other authors evaluate the benefit of only MRI in the preoperative determination of myometrial invasion with different results . Horvath et al .…”

Accuracy of MR Imaging in endometrial cancer: our experience

“…7 Zamani F et al found a diagnostic accuracy of pelvic MRI for detection of deep myometrial invasion and cervical stromal involvement of 90.74%. 8 The authors used T2 weighted and DCE MRI sequences. Their results for diagnostic accuracy in detection of deep myometrial invasion are higher than those quoted by other authors.…”

Synchronous gynecologic cancer and the use of imaging for diagnosis

“…1,2 While endometrial cancer affects women in perimenopause, cervical cancer affects young women of lower socioeconomic status. 1,3 The histologic types most commonly found are adenocarcinomas followed by sarcomas in endometrial cancer, and squamous cell (80%) and mucinous carcinomas in cervical cancers.…”