Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study

Abstract

Preoperative identification of individuals at low risk of lymph node metastasis is key to the proper management of endometrial cancer. This study evaluated the role of preoperative assessment based on magnetic resonance imaging (MRI) and histological analysis in identifying a group having a low risk of lymph node metastasis. Data of 529 patients with endometrial cancer were obtained from a prospective multicenter database, between January 2012 and December 2014. Clinical staging, based on MRI and histological analysis, was compared with final pathology results after the surgical staging procedure. The preoperative low-risk criteria, based on current guidelines from Korea, France, and Canada, and criteria used for fertility-sparing therapies, were applied to our multicenter cohort and the accuracy of each set of criteria for identifying group at low risk of lymph node metastasis was evaluated. When considering grades or MR stages separately, the overall agreement between preoperative and postoperative findings was poor (Kappa 0.45 for grades; 0.41 for stages). However, when combining these two parameters, the low-risk group, as defined by any of the guidelines, had an acceptable rate of lymph node metastasis (below 3%). The French guidelines identified 249 patients (47.1%) as being in the low-risk group. Criteria used to define fertility-sparing therapy candidates identified 48 patients (9.1%) among the study population, only one of whom had extra-uterine disease. This study shows that the current guidelines, using preoperative assessment based on MRI and histological analysis, can identify low-risk patients, who may be candidates for omitting lymphadenectomy.

Assessment of Preoperative Endometrial Histopathological Sampling as a Predictor of Final Surgical Pathology in Endometrial Cancer

“…Faced with our results and literature findings demonstrating the under staging of endometrial cancer on preoperative endometrial samples, other parameters can be considered for surgical planning. Magnetic resonance imaging to evaluate myometrial invasion, 34 tumor volume, 35 and intraoperative staging estimation by the analysis of cryopreserved specimens 36 can also contribute to surgical planning.…”

Prediction of final pathology depending on preoperative myometrial invasion and grade assessment in low-risk endometrial cancer patients: A Korean Gynecologic Oncology Group ancillary study

“…On the other hand, fertility-sparing treatment (FST) might be considered a valid option for reproductive-aged patients with grade 1 or 2 endometrioid adenocarcinoma and no MI or MI <1/2 because they are commonly considered a ‘‘low-risk” population [ 2 – 5 ]. In low-risk populations, according to various criteria, the risk of lymph node metastasis ranged between 1.7% and 2.9% [ 6 , 7 ].…”

“…Whether EC patients are candidates for FST is usually determined by MRI and dilatation and curettage [ 1 ]. In previous studies, however, the matching rates between the preoperative assessment and postoperative pathology were not high enough, causing concern about extending the candidates for FST [ 7 – 12 ]. MRI is considered a suitable tool for the preoperative staging of ECs.…”

Preoperative MRI and immunohistochemical examination for the prediction of high-risk endometrial cancer

“…Liu et al (5) reported that ADC has the potential to discriminate intermediate-and high-risk stage I EC patients, whereas Lee et al (6) reported that preoperative MRI and histological results can be used for identification of low-risk EC patients. However, results of risk prediction of EC using MRI or IHC alone show significant variations (6)(7)(8)(9). Therefore, it is important to explore the effect of combining preoperative MRI features and IHC markers on the predictive value for high-risk EC.…”