MR imaging evaluation of endometrial carcinoma: results of an NCI cooperative study.

Abstract

A prospective study to assess the usefulness of magnetic resonance (MR) imaging in the evaluation of endometrial carcinoma was undertaken by five institutions under the auspices of the National Cancer Institute. Six different MR imagers were used, ranging in magnetic field strength from 0.15 T to 1.5 T. For each unit, appropriate T1- and T2-weighted sequences in the transverse plane and T2-weighted sequences in the sagittal plane were used. Initially, 107 patients were entered in the study, but only 88 fulfilled all the criteria and provide the basis for this study. The abnormality within the endometrial cavity was demonstrated with MR imaging in 81% of the patients. The overall accuracy with MR imaging for staging endometrial carcinoma was 85%. In the evaluation of depth of myometrial invasion for stage I disease, overall accuracy with MR imaging was 74%. The accuracy of MR imaging in assessing tumors confined to endometrium or tumor with superficial myometrial invasion was 89% and decreased to 54% in assessing deep myometrial invasion. The results of this prospective study performed by multiple examiners with vastly different equipment demonstrate the inherent value of MR imaging in the evaluation of this neoplasm.

Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and histopathologic evaluation

“…Treatment and prognosis depend on several factors, including stage, tumour grade, depth of myometrial penetration, cervical penetration and nodal metastasis (Manfredi et al 2004;Kinkel et al 1999;Hricak et al 1991;Sironi et al 1992a).…”

Treatment Strategies and Prognosis of Endometrial Cancer

“…In a recent study by Case et al, concordance between frozen and final pathology was noted only in 67% patients for depth of myometrial invasion and 58% patients for tumor grade (Case et al 2006). The sensitivity of MRI has similarly been found to be only 54%-75% in this regard (Hricak et al 1991;Nakao et al 2006). The use of imaging (CT, MRI, and PET-CT) has been evaluated for the pre-operative assessment of lymph node metastasis in endometrial cancer.…”

What is the proper work-up of the patient with clinical early stage uterine adenocarcinoma?

“…The authors noted that CT had limited usefulness in determining the extent of myometrial invasion because of the absence of a lateral view) or the presence of small disease in the retroperitoneal lymph nodes [5]. Interestingly, no mention was made of use of transvaginal sonography in the preoperative workup but MRI was rejected as a cost-effective method for preoperative evaluation patients with endometrial cancer because of its limited accuracy in evaluating para-aortic lymph nodes [6]. Lastly, elevated serum CA-125 levels were also mentioned, with the authors noting that elevated preoperative levels have been demonstrated to correlate with both advanced disease and positive lymph nodes [7].…”