Abstract
BackgroundThe 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).MethodsA 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.ResultsMRI 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.ConclusionIn 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.
Highlights
Worldwide, there is an increase in the incidence of endometrial pathology that parallels the progressive ageing of the population and increase in the prevalence of obesity [1]
Patient population This retrospective study was drawn from the West Yorkshire and Humber NHS Deanery regional audit that assessed the use of magnetic resonance imaging (MRI) in complex endometrial hyperplasia with atypia (CEHA)
Group 1: Women with no additional imaging studies From the group of women who had no additional imaging (n = 51), 37 women had focal atypical changes of the endometrium and 14 women had a histology of complex atypical hyperplasia (CEHA) on the initial endometrial biopsy
Summary
There is an increase in the incidence of endometrial pathology that parallels the progressive ageing of the population and increase in the prevalence of obesity [1]. Endometrial cancer is the most common gynaecological malignancy in the Western world and the fourth most common cancer among women [2, 11]. Despite the fact that endometrial carcinoma is the most common gynaecologic cancer, less is known about the incidence of its precursor lesion, endometrial hyperplasia. It is estimated, that the incidence of endometrial hyperplasia is at least three times higher than endometrial cancer. Current estimates report incidence of endometrial hyperplasia to be around 133–208 per 100,000 woman-years in Western countries [3] and 37/100,000 woman-years in Korea [12]. 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)
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