Clinical Impact of Preoperative Magnetic Resonance Imaging in the Evaluation of Myometrial Infiltration and Lymph-Node Metastases in Stage I Endometrial Cancer.

Dorottya Bús,György Vajda,Gyöngyi Nagy,Róbert Póka

doi:10.3389/pore.2021.611088

Abstract

: Purpose: In the developed world, endometrial cancer is one of the most common malignant gynecological cancer types. Due to the highly available diagnostic modalities and patient education, the early detection of the tumor leads to high overall survival. Methods: In this study we analyzed the reliability of preoperative MRI findings in the staging of early stage endometrial cancer, as well as the clinical characteristics of patients underwent radical hysterectomy and the histopathologic evaluation of their tumor, with the retrospective data of radical hysterectomies performed in our hospital between 2010 and 2019. Results: The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI regarding stage were 94.7, 63.3, 94.8, 83.8, and 83.8%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of the myometrial invasion were 69.8, 80.0, 60.8, 64.3, and 77.5%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of lymph node metastases were 78.1, 28.6, 82, 11.1, and 93.6%, respectively. Conclusions: Based on our results, MRI is the method of choice in terms of evaluating overall staging, as well as myometrial invasion, as its specificity and negative predictive value are relatively high. However, systematic lymphadenectomy showed improved cancer-related survival and recurrence-free survival. Our studies showed that the diagnosis of lymph node metastases is difficult with MRI modality since hyperplastic and metastatic nodes cannot easily differentiate, leading to a high percentage of false-positive results. Therefore, other imaging modalities may be used for more accurate evaluation. New findings of our study were that the role of the radiologist’s expertise in the evaluation of MR imaging plays an essential role in lowering false-negative and false-positive results. Therefore, findings evaluated by a radiologist with high-level expertise in gynecological imaging can complement the clinical findings and help substantially define the needed treatment.

Highlights

Endometrial cancer is the ninth most common tumor among women in developing countries
Most endometrial cancer cases are diagnosed in women aged between 45 and 74.67.2% of the tumors are diagnosed at an early stage
Our study aimed to examine the accuracy of magnetic resonance imaging in TNM T1 stage cancers in evaluation of myometrial invasion and lymph node metastases compared with final histopathologic results

Summary

Introduction

Endometrial cancer is the ninth most common tumor among women in developing countries. According to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the International Agency for Research on Cancer (IARC) [1], and the Hungarian National Cancer databases [2], the incidence and mortality of uterine cancer is increasing. The 5-years relative survival rate is still around 81.2% overall, with a 95% survival rate in localized tumors—based on SEER 18 data of 2009–2016 [3]. Most endometrial cancer cases are diagnosed in women aged between 45 and 74.67.2% of the tumors are diagnosed at an early stage. Risk factors include extended hyperestrogenism, obesity, diabetes, and hypertension. Symptoms of the cancer are postmenopausal bleeding and premenopausal menstrual disorder [4]

Methods

Results

Discussion

Conclusion