Abstract
ObjectivesTo explore the clinical value of subendometrial enhancement (SEE), irregular thin-layered peritumoral early enhancement (ITLPE) and focal irregular peritumoral early enhancement (FIPE) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for myometrial invasion in patients with low-risk endometrial carcinoma.MethodsSeventy-seven patients with low-risk endometrial carcinoma who preoperatively underwent DCE-MRI were included. Two radiologists independently evaluated and recorded the occurrences of SEE, ITLPE and FIPE on DCE-MRI in all patients. Interobserver agreement was calculated between the two radiologists, and the relationships between SEE, ITLPE, FIPE, and myometrial invasion were analyzed based on histologic findings. For statistically significant findings, the sensitivity and specificity were calculated, and the differences in myometrial invasion evaluations were analyzed. For those with no statistical significance, images were compared with the histopathologic sections.ResultsInter-observer agreement was good (k = 0.80; 95%CI, 0.577–0.955) for SEE, and very good (k = 0.88; 95%CI, 0.761–0.972) (k = 0.86; 95%CI, 0.739–0.973) for ITLPE and FIPE. After consensus, SEE was identified in 12/77 (15.6%) patients; ITLPE and FIPE were found in 53/77 (68.8%) and 30/77 (39.0%) patients, respectively. SEE and ITLPE were significantly correlated with myometrial infiltration (P = 0.000), but FIPE were not (P = 0.725).The sensitivity and specificity of SEE and ITLPE for myometrial invasion in patients with low-risk endometrial carcinoma were 95.0 and 52.9%, and 85.0 and 88.0%, respectively. The area under the curve (AUC) of SEE and ITLPE for myometrial invasion were 0.740 (95%CI, 0.584–0.896), and 0.866 (95%CI, 0.763–0.970), respectively. The sensitivity and specificity were statistically different between SEE and ITLPE for the detection of myometrial invasion (P = 0.031, 0.016). According to the comparison between FIPE and histopathologic findings, the irregular endomyometrial junction was found in 30/77 (38.9%) cases, 24/30 (80.0%) with myometrial infiltration and 6/30 (20.0%) cases without myometrial infiltration.ConclusionsFIPE was the irregular endomyometrial junction. It can be found in patients with or without myometrial infiltration and may lead to the overestimation of myometrial invasion by SEE on DCE-MRI. ITLPE presented high diagnostic performance and specificity for myometrial invasion in patients with low-risk endometrial carcinoma.
Highlights
Endometrial carcinoma is the most common gynecologic malignancy in women worldwide
Endometrioid adenocarcinoma, G1 and G2, Stage IA are at low risk according to the European Society for Medical Oncology (ESMO) clinical practice guideline for risk classification of endometrial cancer [17]
A statistically significant relationship was found between subendometrial enhancement (SEE), Irregular thin-layered peritumoral early enhancement (ITLPE), and myometrial infiltration (P = 0.000), but not focal irregular peritumoral early enhancement (FIPE) (P = 0.725)
Summary
Endometrial carcinoma is the most common gynecologic malignancy in women worldwide. The tumor has a global incidence of 417, 000 new cases and 97, 000 deaths in 2020 [1]. 5–30% of all reported endometrial carcinoma cases were diagnosed in younger women [6,7,8] For those patients, fertility preservation should be taken into consideration when deciding optimal management. Progestogen therapy might be an option in patients with low-grade endometrioid carcinoma in the absence of any myometrial invasion based on medical imaging [9, 10]. The younger women diagnosed with endometrial carcinoma usually have a better outcome, because the tumor tends to present with favorable disease features, such as a favorable histologic subtype, with a lower grade lesion and minimal or absent myometrial invasion [11,12,13,14,15,16]. Myometrium infiltration assessments are needed preoperatively in patients with low-risk endometrial carcinoma so that fertility-sparing progestogen therapy can be prescribed in these patients
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