Use and accuracy of magnetic resonance imaging (MRI) staging of network treated endometrial cancer (EC): an audit and comparison to best evidence

Abstract

Introduction: As a result of national and international guidelines, in recent years treatment of endometrial carcinoma (EC) has become more centralised. In the UK this has led to the development of regional cancer networks, with sub-specialists gynaecological-oncologists leading treatment in regional centres. A tool in appropriate triage of patients to treatment at central or peripheral units is magnetic resonance imaging (MRI). Objective: To assess if MRI is an effective tool in triaging place of treatment within the Cancer Network. Methods: Between March 2006 and December 2007 an audit was undertaken, comparing MRI and histology reports in women with tissue diagnosis of EC. The MRI reports were matched to histology and International Federation of Gynecology and Obstetrics (FIGO) staging was compared. A review of guidance and expected accuracy was also performed. Results: Forty-three cases were analysed. Sensitivity or MRI for overall myometrial invasion was 88%, a positive predictive value (ppv) of 94% and a negative predictive value (npv) of 56%. 65.2% of reports commented on cervical involvement clearly, which was accurate in 44.2% cases. For cervical involvement, sensitivity was 57%, specificity 75%, ppv 44% and npv 83%. Conclusions: Practical reporting in our Network structure falls short of expectations. Standardisation of reporting under named lead radiologists may help improve accuracy and thus the utility of MRI to the regional cancer network. Key words : MRI staging; endometrial cancer. DOI: 10.4038/sljog.v31i2.1754 Sri Lanka Journal of Obstetrics and Gynaecology 2009; 31 : 104-107