The value of MRI in management of endometrial hyperplasia with atypia

Abstract

Background: The value of the magnetic resonance imaging (MRI) in the assessment of women with endometrial hyperplasia and its role in diagnosis of myometrial invasion or coexistence of cancer is not known. This study aimed to evaluate the accuracy and usefulness of MRI in the management of patients diagnosed on endometrial biopsy with complex endometrial hyperplasia with atypia (CEHA). Methods: A retrospective study of 86 cases diagnosed with endometrial hyperplasia with atypia on the initial endometrial biopsy in a tertiary university teaching hospital between 2010 and 2015 was carried out. The MRI accuracy in predicting malignant changes and influence the clinical management was compared among women who had either pelvic MRI, transvaginal ultrasound (TVUS), or no additional imagistic studies. Results: MRI was performed in 24 (28%) and TVUS in 11 (13%)cases, while 51 (59%) women had no additional imagistic studies. In the group of women with no imaging studies, 26/51 (51%) were surgically treated and 8/26 (31%) were diagnosed with endometrial cancer (EEC) stage 1a. In the group of women who had TVUS, 5/11 (45%) were surgically treated and none was diagnosed with EEC. In the group of women who underwent an MRI examination, 20/24 (83%) were surgically treated. Among these, 11/20 (55%) were diagnosed with EEC, 7 had EEC stage 1a, and 4 had EEC stage 1b. Although MRI was able to identify malignant changes with a good sensitivity (91.7%), it had a low specificity in characterisation of malignant transformation (8%). MRI correctly identified 31% of the stage 1a and 33% of the stage 1b endometrial cancer. Conclusion: In this study, we found a potential diagnostic value of MRI for identifying malignant transformation in patients with CEHA. However, pelvic MRI has a rather weak predictive value of myometrial invasion in women with CEHA and concurrent EEC. The diagnostic and therapeutic benefits of MRI assessment in patients with CEHA need further validation.

Preoperative detection of occult endometrial malignancies in endometrial hyperplasia to improve primary surgical therapy: A scoping review of the literature

“…The results of the scoping review were reported according to the Preferred Reporting Items for Systematic reviews and Meta-criteria and were included in our review. We included 24 primary studies, [9][10][11][13][14][15][16][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] three meta-analyses, [17][18][19] and one poster presentation. 12 The characteristics of the 28 included studies are shown in Table 2.…”

High diagnostic value of 18F-FDG PET/CT in detecting endometrial cancer in patients with precancerous endometrial lesions

“…Alternatives to PET/CT include magnetic resonance imaging (MRI). It, however, has been shown to have low specificity (15.4%) and positive predictive value (50%) in characterizing malignant transformation in women with precancerous endometrial lesions [35]. In another retrospective study, MRI failed to identify 9 out of 21 patients with endometrial cancer.…”

Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment

“…We considered that, at this stage of endometrial pathology, it does not provide significant data. Recent studies show that magnetic resonance imaging (MRI) is not considered an effective way to identify invasive lesions in EH cases and can give false positive results in 46% of cases [12,50,83].…”

“…Factors that increase the risk of malignancy in endometrial tissue include obesity, diabetes (DM) and high blood pressure (HBP) [11]. However, it is estimated that the incidence of EH is at least three times higher than of the EC [12].…”