Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer—A Swedish Gynecologic Cancer Group (SweGCG) study

Abstract

Introduction: Deep myometrial invasion (≥50%) is a prognostic factor for lymph node metastases and decreased survival in endometrial cancer. There is no consensus regarding which pre/intraoperative diagnostic method should be preferred. Our aim was to explore the pattern of diagnostic methods for myometrial invasion assessment in Sweden and to evaluate differences among magnetic resonance imaging (MRI), transvaginal sonography, frozen section, and gross examination in clinical practice. Material and methods:This is a nationwide historical cohort study; women with endometrial cancer with data on assessment of myometrial invasion and FIGO stage I-III registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) between 2017 and 2019 were eligible. Data on age, histology, FIGO stage, method and results of myometrial invasion assessment, pathology results, and hospital level were collected from the SQRGC. The final assessment by the pathologist was considered gold standard.Results: In the study population of 1401 women, 32% (n=448) had a myometrial invasion ≥50%.The methods reported for myometrial invasion assessment were transvaginal sonography in 59%, MRI in 28%, gross examination in 8% and frozen section in 5% of cases. Only minor differences were found for age and FIGO stage when comparing methods applied for myometrial invasion assessment. The sensitivity, specificity, and accuracy to find myometrial invasion ≥50% with transvaginal sonography was 65.6%, 80.3% and 75.8%, for MRI 76.9%, 71.9% and 73.8%, for gross examination 71.9%, 93.6% and 87.3% while for frozen section it was 90.0%, 92.7% and 92.0% respectively. Conclusions:In Sweden, the assessment of deep myometrial invasion is most often performed with transvaginal sonography, but the sensitivity is lower than for the other diagnostic methods. In clinical practice, the accuracy is moderate for transvaginal sonography and MRI.

Predicting Factors for Pelvic Lymph Node Metastasis in Patients with Apparently Early-Stage Endometrial Cancer

“…Our study and previous studies (Stalberg et al, 2017;Li et al, 2019) agreed that deep myometrial invasion was a significant co-risk factor for developing PLNM in EC patients. The diagnostic accuracies of magnetic resonance imaging (MRI), ultrasonography, and intraoperative gross examination for assessing the depth of myometrial invasion were 73-83%, 68-77%, and 74-87%, respectively (Akbayir et al,2011;Mavromatis et al, 2012;Christensen et al, 2016;Usta et al, 2017;Jonsdottir et al, 2021). Therefore, we would suggest to utilize both preoperative assessment of myometrial invasion using ultrasonography or MRI, and intraoperative gross myometrial invasion evaluation for selecting patients who would benefit from lymphadenectomy.…”

Current Approaches to the Management of Patients with Endometrial Cancer

“…It was observed that IFS had the highest sensitivity (90%), while IGE had the lowest sensitivity. For the preoperative methods, MRI had higher sensitivity than TVS, but both methods showed low positive predictive values [ 63 ]. IFS may be more time consuming, more expensive and demand the presence of a pathologist, which is not feasible in every center, but it prevails on determining tumor grade and its results are congruent with the results of histologic examination [ 64 ].…”

“…IGE, on the other hand, is quicker, cheaper, and simpler but vastly depends on the surgeon. It should be acknowledged that the tumor-invaded myometrium is not always macroscopically visible [ 62 , 63 ].…”

Multi-Parameter MR Radiomics Based Model to Predict 5-Year Progression-Free Survival in Endometrial Cancer

“…Many clinical studies have shown that deciding whether to conduct radiotherapy or chemotherapy according to the risk of tumors can not only avoid unnecessary pain and economic burden brought by overtreatment of early-stage patients, but also avoid undertreatment of high-risk tumors, delay recurrence and improve the quality of life ( 2 – 4 ). Previous studies have proposed predicting the myometrial invasion and clinical outcome of EC by combining clinical and pathological indicators ( 5 , 6 ). Tumor size, myometrial invasion, lymph vascular space invasion (LVSI) and other parameters obtained by postoperative tumor pathology can certainly be used to evaluate the EC prognosis.…”