Abstract
ObjectivesTo explore the diagnostic accuracy of preoperative magnetic resonance imaging (MRI)-derived tumor measurements for the prediction of histopathological deep (≥ 50%) myometrial invasion (pDMI) and prognostication in endometrial cancer (EC).MethodsPreoperative pelvic MRI of 357 included patients with histologically confirmed EC were read independently by three radiologists blinded to clinical information. The radiologists recorded imaging findings (T1 post-contrast sequence) suggesting deep (≥ 50%) myometrial invasion (iDMI) and measured anteroposterior tumor diameter (APD), depth of myometrial tumor invasion (DOI) and tumor-free distance to serosa (iTFD). Receiver operating characteristic (ROC) curves for the prediction of pDMI were plotted for the different MRI measurements. The predictive and prognostic value of the MRI measurements was analyzed using logistic regression and Cox proportional hazard model.ResultsiTFD yielded highest area under the ROC curve (AUC) for the prediction of pDMI with an AUC of 0.82, whereas DOI, APD and iDMI yielded AUCs of 0.74, 0.81 and 0.74, respectively. Multivariate analysis for predicting pDMI yielded highest predictive value of iTFD < 6 mm with OR of 5.8 (p < 0.001) and lower figures for DOI ≥ 5 mm (OR = 2.8, p = 0.01), APD ≥ 17 mm (OR = 2.8, p < 0.001) and iDMI (OR = 1.1, p = 0.82). Patients with iTFD < 6 mm also had significantly reduced progression-free survival with hazard ratio of 2.4 (p < 0.001).ConclusionFor predicting pDMI, iTFD yielded best diagnostic performance and iTFD < 6 mm outperformed other cutoff-based imaging markers and conventional subjective assessment of deep myometrial invasion (iDMI) for diagnosing pDMI. Thus, iTFD at MRI represents a promising preoperative imaging biomarker that may aid in predicting pDMI and high-risk disease in EC.
Highlights
Endometrial cancer (EC) is the sixth most common neoplasm in women worldwide, and the incidence has been increasing over the past decades [1, 2]
APD, anteroposterior tumor diameter; confidence interval (CI), 95% Confidence interval; depth of myometrial tumor invasion (DOI), depth of invasion; invasion based on conventional magnetic resonance imaging (MRI) reading (iDMI), deep myometrial invasion (DMI) based on imaging findings; LR +, likelihood ratio for positive results: LR + = sensitivity/(1-specificity); LR, likelihood ratio for negative results: LR- = (1-sensitivity)/specificity; odds ratios (ORs), odds ratio; pDMI, Deep myometrial invasion (DMI) based on pathology findings; iTFD, tumor-free distance to serosa based on imaging findings
APD, DOI, iDMI (presence of deep (≥ 50%) myometrial invasion based on standard imaging reading) and iTFD. p value refers to the test of equal area under the ROC curve (AUC) values across the different tumor measurements primary surgical resection with hysterectomy and bilateral salpingo-oophorectomy
Summary
Endometrial cancer (EC) is the sixth most common neoplasm in women worldwide, and the incidence has been increasing over the past decades [1, 2]. Surgical treatment is normally individualized based on putative risk profile. Primary treatment consists of simple total hysterectomy and bilateral salpingooophorectomy in patients assumed to have low FIGO stage and low-risk histological subtype. In patients with putative advanced FIGO stage, high-risk histological subtype and/or hormone receptor loss, surgical treatment may include radical hysterectomy (if suspected cervical stroma invasion) and/or pelvic and/or paraaortic lymphadenectomy or lymph node dissection [3, 4]. Lymphadenectomy can cause unfavorable side effects such as lower-extremity lymphedema and lymphocele development [5, 6], and there is an unmet need for preoperative methods that identify which patients that are likely to benefit from these procedures
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