Evaluation of endometrial carcinoma on magnetic resonance imaging

Rockall, Andrea; Meroni, Roberta; Sohaib, S.A.; Reynolds, Karina; Alexander-Sefre, Farhad; Shepherd, J. H.; Jacobs, Ian; Reznek, Rodney H.

doi:10.1111/j.1525-1438.2007.00805.x

Cited by 138 publications

(88 citation statements)

References 35 publications

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“…In many institutions, MR imaging has become a standard method. Sensitivity reported for this technique ranges from 80% to 91% (16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

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Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Alcázar

Galván²,

Albela³

et al. 2009

Radiology

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Purpose:To describe and analyze the diagnostic performance of uterine virtual navigation with three-dimensional (3D) ultrasonography (US) for the assessment of the depth of myometrial infiltration by endometrial cancer. Materials and Methods:Institutional review board approval was obtained; patients gave oral informed consent. Women with endometrial cancer were evaluated by using 3D US prior to surgical staging. A 3D volume of the whole uterus was obtained and analyzed by using software. Virtual navigation through three orthogonal planes was performed to identify the shortest myometrial tumor-free distance to serosa (TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the myometrium. Myometrial infiltration was also assessed by subjective impression of an examiner. Histologic findings of myometrial infiltration and TDS measured by a pathologist were used as the reference standard. A receiver operating characteristic curve was plotted to identify the best cutoff for TDS for identifying myometrial infiltration of 50% or more. Results:Ninety-six women (mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included in the study. At histologic analysis, myometrial invasion was found to be less than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with US was positively correlated with histologically measured TDS (r ϭ 0.649; 95% confidence interval: 0.52, 0.76). The best cutoff for USmeasured TDS was 9.0 mm (sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a specificity of 82.3%, a negative predictive value of 96.6%, and a positive predictive value of 67.7%. Conclusion:Uterine virtual navigation with 3D US is a reliable method for the assessment of myometrial infiltration in patients with endometrial cancer.

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“…In many institutions, MR imaging has become a standard method. Sensitivity reported for this technique ranges from 80% to 91% (16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

“…Contrast material-enhanced magnetic resonance (MR) imaging is considered the most reliable method and has an accuracy ranging from 62% to 95% (14)(15)(16)(17)(18)(19)(20). However, MR imaging is costly, has limited availability, and cannot be performed in all patients.…”

mentioning

confidence: 99%

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Alcázar

Galván²,

Albela³

et al. 2009

Radiology

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“…To differentiate malignant from benign LNs, cross-sectional imaging techniques based on node size measurements, with a short-axis diameter of 8-10 mm the widely accepted size criterion for LN metastasis, are used for both CT and MRI, but these morphological imaging modalities are not satisfactory [9][10][11][12][13][14][15][16][17][18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

“…The identification of metastatic LNs by both CT and MRI is based on measurements of node size, with a short-axis diameter greater than 8-10 mm being the most widely accepted criterion for diagnosis of nodal involvement. However, these morphological imaging techniques have very low sensitivity: the sensitivity rate for the detection of LN metastasis in endometrial cancer is between 27% and 66%, while the specificity rate is between 73% and 99% [9][10][11][12][13][14] . The corresponding rates for LN metastasis in uterine cervical cancer are between 30% and 73% and between 44% and 93% [13,[15][16][17][18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer

Kitajima

Yamasaki²,

Kaji³

et al. 2012

WJR

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AIM:To investigate diffusion-weighted imaging (�WI) and positron emission tomography and computed tomography (�ET/CT) with Ⅳ contrast for the preoperative evaluation of pelvic lymph node (LN) metastasis in uterine cancer. METHODS:Twenty-five patients with endometrial or cervical cancer who underwent both �WI and �ET/CT before pelvic lymphadenectomy were included in this study. For area specific analysis, LNs were divided into eight regions: both common iliac, external iliac, internal iliac areas, and obturator areas. The classification for malignancy on �WI was a focally abnormal signal intensity in a location that corresponded to the LN chains on the T1WI and T2WI. The criterion for malignancy on �ET/CT images was increased tracer uptake by the LN. RESULTS:A total of 36 pathologically positive LN areas were found in 9 patients. With �WI, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detecting metastatic LNs on an LN area-by-area analysis were 83.3%, 51.2%, 27.3%, 93.3% and 57.0%, respectively, while the corresponding values for �ET/CT were 38.9%, 96.3%, 70.0%, 87.8% and 86.0%. Differences in sensitivity, specificity and accuracy were significant (� < 0.0005).CONCLUSION: �WI showed higher sensitivity and lower specificity than PET/CT. Neither DWI nor PET/CT were sufficiently accurate to replace lymphadenectomy.

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“…Nevertheless, there is no consensus in the literature regarding the added value of DCE-MRI in staging of endometrial cancer. Although the majority of the published studies demonstrate that the addition of multiphase DCE-MRI to T2W imaging leads to a significant improvement in the accuracy of assessment of the deep myometrial invasion [8,9,[11][12][13][14][15], some authors have found no significant difference [16,17].…”

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confidence: 93%

Advances in magnetic resonance imaging of endometrial cancer

Sala

Rockall

2010

Eur Radiol

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Endometrial cancer is the most commonly diagnosed gynaecological malignancy in affluent societies [1]. It occurs most frequently in white women, with peak incidence between ages 55 and 65. Risk factors include unopposed oestrogen intake, use of tamoxifen, nulliparity, obesity, and diabetes. The incidence of endometrial cancer in the United Kingdom has increased by more than 40% between 1993 and 2007. This significant rise is predominantly due to a large increase in incidence in women aged 60-79 [1]. These trends are very similar for most European countries [2]. The increase in prevalence of obesity and decreases in fertility may partly account for the observed rapid increase in incidence and imply that endometrial cancer in postmenopausal women will become a more substantial public health problem in the future.Prognosis depends on a number of factors, including stage, depth of myometrial invasion, lymphovascular invasion, nodal status and histological grade. Depth of myometrial invasion is the single most important morphologic prognostic factor, correlating with tumour grade, lymph node metastases and overall patient survival. Incidence of lymph node metastases increases from 3% with superficial myometrial invasion (stage IA) to 46% with deep myometrial invasion (stage IB) [3]. Preoperative knowledge of these factors is crucial in tailoring the surgical approach. The histological grade can be determined at endometrial sampling, whereas depth of myometrial invasion can only be assessed preoperatively by MRI. Therefore, MRI can assist in preoperative assessment and treatment planning by accurately predicting depth of myometrial invasion, cervical stromal invasion and lymph node involvement. This information allows selection of patients for pelvic or para-aortic lymph node sampling whilst obviating the need for surgery in patients with low risk disease. MRI can also provide additional useful information such as uterine size, tumour volume, ascites and adnexal pathology which in turn may determine whether the surgical approach is transabdominal, transvaginal or laparoscopic.Lymphadenectomy in early (stage I) endometrial cancer remains a controversial issue. Two large prospective multicentre studies investigated whether pelvic lymphadenectomy could improve survival of women with endometrial cancer [4,5]. Both studies reported no benefit in overall or recurrence free survival in the patients randomized to lymphadenectomy. Conversely, the SEPAL study [6] showed that in patients with intermediate or high risk of endometrial cancer recurrence, combined pelvic and paraaortic lymphadenectomy reduced the risk of death compared with pelvic lymphadenectomy alone. The authors acknowledged that MRI is an important factor for predicting lymph node metastasis, and in combination with tumour grade and histology could be helpful to discriminate patients with very low risk of recurrence. Therefore,

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Evaluation of endometrial carcinoma on magnetic resonance imaging

Cited by 138 publications

References 35 publications

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Assessing Myometrial Infiltration by Endometrial Cancer: Uterine Virtual Navigation with Three-dimensional US

Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer

Advances in magnetic resonance imaging of endometrial cancer

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