Detection Of Myometrial Invasion Research Articles

DIAGNOSTIC ACCURACY OF DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF MYOMETRIAL INVASION AMONG PATIENTS WITH ENDOMETRIAL CARCINOMA

OBJECTIVE: To determine the accuracy of magnetic resonance diffusion-weighted imaging in the diagnosis of myometrial invasion in patients with carcinoma endometrium keeping histopathology as the gold standard. MATERIALS AND METHODS: It was a descriptive cross-sectional study carried out from 11 July 2019 to 10 July 2021 at the Radiology Department, Khyber Teaching Hospital, Peshawar. The sample was collected via a Non-probability sampling technique. The sample size was 141 taking the prevalence of myometrial invasion 46% 12 with sensitivity and specificity of DW-MRI 90% and 73%,95% confidence level, and 10% margin of error. All women presenting with biopsy-proven endometrial carcinoma scheduled for hysterectomy, aged between 30 to 70 years were included. The myometrial invasion via MRI pelvis including DWI, with a 1.5 T machine (Philips), was evaluated for all patients. After a hysterectomy, myometrial invasion was confirmed on histopathology. RESULTS: Among 141 women, 58 (41%) patients were between 30-50 years of age, and 83(59%) patients were in the 51-70 years age group. DW-MRI had 91.11% sensitivity, 66.66% specificity, 98.4% Positive predictive value, 25% Negative predictive value, and 90.07% diagnostic accuracy CONCLUSION: In carcinoma endometrium, MR-DWI has good diagnostic accuracy in the detection of myometrial invasion. Keywords: Endometrial cancer, Diffusion-weighted magnetic resonance imaging, Histopathology.

Risk stratification of endometrial cancer and lymph node metastases prediction using 18F-FDG PET/CT: role of metabolic tumor volume and total lesion glycolysis

BackgroundEndometrial cancer is the commonest gynecologic malignancy. Pelvic lymph node metastasis is considered one of its most important prognostic factors. Surgery is considered the most important and effective treatment, still there is controversy about indication and necessity of pelvic lymph node dissection. 18F-fluorodeoxyglucose positron emission tomography/computed tomography is investigated in his study to evaluate its value in preoperative detection of lymph node metastases and risk stratification of endometrial cancer.ResultsReviewing the records of 33 women with endometrial cancer, all 18F-FDG PET/CT studied indices, SUVmax, SUVmean, MTV and TLG, mean difference was statistically significant in all the studied risk categories (tumor grade, Myometrial invasion, lymphovascular space invasion, tumor stage, and risk stratification). SUVmax and TLG showed highest area under the curve for detection of Myometrial invasion > 50% (AUC = 0.911) with cut-off value of SUVmax > 14.55 showing 88.89% sensitivity and 86.67% specificity, and TLG > 192.653 having 88.89% sensitivity and 80% specificity. TLG showed highest AUC (0.889 and 0.921) for detection of LVSI and LNMs with 100% sensitivity and 66.67% specificity for cut-off value > 179.374 and 88.89% sensitivity and 83.33% specificity for cut-off value > 249.366, respectively. Concerning risk stratification of EC, SUVmax and TLG showed highest AUC (0.839) with cut-off value > 14.55 showing 77.27% sensitivity and 90.91% specificity, and > 192.653 having 77.27% sensitivity and 81.82% specificity, respectively.ConclusionThe results of this study suggest that 18F-FDG PET/CT is a very valuable tool for prediction of lymph node metastases and risk stratification in endometrial cancer patients. Applying TLG cutoff values increases the accuracy and preoperative diagnosis of lymph node metastases which aids in sparing women with low-risk early stage EC unnecessary surgical risk and morbidity of lymphadenectomy.

Peritumoral Enhancement for the Evaluation of Myometrial Invasion in Low-Risk Endometrial Carcinoma on Dynamic Contrast-Enhanced MRI.

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.

Use of diffusion-weighted imaging and diffusion tensor imaging in assessment of myometrial invasion in patients of endometrial carcinoma and its correlation with histopathological grading (Prospective study)

BackgroundEndometrial cancer (EMC) is considered one of the most common gynecological cancers worldwide. In particular, the depth of myometrial invasion and histological grade of endometrial cancers (EMCs) are strong prognostic factors. Diffusion tensor measurements as mean diffusivity (MD) and fractional anisotropy (FA) values could be useful for assessing the depth of tumor invasion and its histological grade. The study aimed to evaluate the role of diffusion-weighted imaging (DWI) and diffusion tensor imaging in the detection of myometrial invasion in cases of endometrial carcinoma and prediction of its grade in vivo.ResultsThis study included 50 female patients with pathologically proved endometrial carcinoma, and their ages ranged from 38 to 67 years; the mean age was 56.15 years (± 8.229 standard deviation “SD”). There was a significant statistical difference regarding the mean values of diffusion tensor fractional anisotropy (DT-FA), diffusion tensor mean diffusivity (DT-MD) and diffusion-weighted apparent diffusion coefficient(DW-ADC) values in differentiating between intact and infiltrated myometrium with (P value ≤ 0.001). The accuracy of DT-MD, DT-FA and DWI-ADC was 98%, 90% and 86%, respectively, in the detection of myometrial invasion. There was a statistically significant difference in the mean values of DT-FA, DT-MD and DW-ADC for differentiating endometrioid adenocarcinoma grades with the overall P values (˂0.001). The accuracy of DT-FA, DT- MD and DWI-ADC for differentiating grade 3 from grade 1 or 2 endometrioid adenocarcinoma was 94.9%, 84.6% and 74.4%, respectively. For differentiating grade 1 from grade 2 or 3 endometrioid adenocarcinoma, the accuracy of DT-FA, DT-MD and DWI-ADC was 90%, 89.7% and 84.6%, respectively. Mean DT-FA, DT-MD and DW-ADC values were inversely proportional to the degree of pathological grading with r = − 0.867, − 0.762 and − 0.706, respectively.ConclusionDiffusion tensor imaging and DWI are helpful in the assessment of myometrial invasion and have a high negative correlation with histopathological grading in patients with endometrial cancer.

Preoperative predictive model of surgical planning in endometrial carcinoma using MRI and tumor grade in endometrial biopsy

Introduction: Endometrial cancer (EC) is the most common gynecological cancer in developed countries. Histological grade (G) and myometrial invasion (MI) are important risk factors, and together with the histological type and other postoperative data establish the risk of lymph node involvement and guide the adjuvant treatments. The objective of this study was to assess the validity of a preoperative stratification model that combines preoperative histological grade and MI as identified by magnetic resonance imaging (MRI) to select candidates for lymph node staging and optimize surgical planning for our patients. Material and methods: It´s an observational retrospective cohort study including 294 patients diagnosed with EC at Donostia University Hospital from January 2012 to December 2017. Preoperative endometrial biopsy, including histological type and grade, preoperative MRI was compared with the definitive histological diagnosis. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the MRI-based diagnosis were calculated. Results: After inclusion and exclusion criteria 242 cases of type I or II EC were analyzed. Our model was found to have a Se of 91.4% (95% CI 83.2-95.8) and a Sp of 90.7% (95% CI 85.2-94.3). Percentage of down staging was 6.2% (15 unnecessary lymphadenectomies) and the upstaging rate was 2.9%. The NPV of the model was very high (95.4%, 95% CI 90.9-97.8). The diagnostic odds ratio for our model was 147.95 (95% CI 52.9-410.5), with a diagnostic accuracy of 91.7% (95% 87.6-94.6). Conclusions: A preoperative strategy that includes the determination of the tumor grade based on an endometrial biopsy and an assessment of MI by MRI is of great help in pre-surgical planning for endometrial cancer surgery, allowing an extra peritoneal approach and optimizing the use of physical and human resources. MRI presents excellent discriminatory power in the detection of MI in EC, with no significant variation by pathological subtype.

Dynamic contrast‐enhanced ultrasound improves diagnostic performance in endometrial cancer staging

To compare the sensitivity and specificity of conventional two-dimensional transvaginal ultrasound/power Doppler (2D-TVU/PD) alone and 2D-TVU/PD combined with dynamic contrast-enhanced ultrasound (DCE-US) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) in women with endometrial cancer (EC), and to assess the association of DCE-US semiquantitative and qualitative variables with International Federation of Gynecology and Obstetrics (FIGO) Stage ≥ IB and 'high-risk' cancer. This was a prospective study of 101 consecutive women with biopsy-confirmed EC, undergoing expert ultrasound examination at Karolinska University Hospital, a tertiary referral center. All consenting women underwent DCE-US using a 1.5-2.5-mL intravenous bolus of SonoVue contrast agent, as well as conventional 2D-TVU/PD examination. DCE-US videoclips were analyzed with regard to filling (global or focal), wash-in (prior, simultaneous or after) and wash-out (global or focal) patterns of the contrast agent in the tumor compared with the surrounding tissue, as well as semiquantitative DCE-US parameters (wash-in slope, time-to-peak, peak intensity and area under the time-intensity curve (TIC)) obtained from a TIC. The study cohort was compared with a control cohort of women with EC examined at our center according to the International Endometrial Tumor Analysis protocol using 2D-TVU/PD only, matched at a ratio of 3:1 for FIGO stage and grade. The sensitivity and specificity of 2D-TVU/PD alone in the control cohort and in combination with DCE-US in the study cohort in the diagnosis of deep MI, CSI and high-risk cancer (defined as FIGO Stage ≥ IB and/or Grade 3 endometrioid and/or non-endometrioid histology) were compared, using pathological evaluation after hysterectomy as the 'gold standard'. After exclusions, 93 women were included in the study cohort and were matched to 279 women in the control cohort. The prevalence of FIGO Stage IA, Grade 1-2 EC was 52% in both cohorts. The sensitivity of 2D-TVU/PD with DCE-US in the study cohort was higher than that of 2D-TVU/PD alone in the control cohort in diagnosing both deep MI (0.74 vs 0.62; P = 0.036) and CSI (0.75 vs 0.51; P < 0.001), whereas the specificity was not significantly different (0.87 vs 0.85 and 0.96 vs 0.95, respectively). Compared with 2D-TVU/PD alone, the specificity of 2D-TVU/PD with DCE-US was higher in detecting high-risk cancer (0.94 vs 0.85; P = 0.024) but the sensitivity did not differ (0.73 vs 0.71). High-risk cancer and FIGO Stage ≥ IB were characterized by a 'focal' filling pattern, with a 'prior' wash-in pattern and a 'focal' wash-out pattern on subjective assessment of DCE-US videoclips. All semiquantitative DCE-US parameters were significantly predictive of FIGO Stage ≥ IB but not of high-risk cancer, despite a clear trend. Compared with 2D-TVU/PD alone, combining 2D-TVU/PD with DCE-US can significantly improve the detection of deep MI and CSI in women with EC, without increasing the false-positive rate. It can also improve the correct classification of high-risk disease, mainly by increasing specificity, thereby possibly reducing the number of unnecessarily extensive surgeries by almost 10%. Semiquantitative DCE-US parameters, as well as a 'focal' filling pattern, endometrial wash-in prior to the myometrium and a 'focal' wash-out pattern, are all associated with more advanced disease. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Diagnostic Accuracy of Diffusion Weighted Magnetic Resonance Imaging in the Detection of Myometrial Invasion in Endometrial Carcinoma.

To determine the diagnostic accuracy of Diffusion-Weighted Magnetic Resonance Imaging (DWMRI) in the detection of myometrial invasion in endometrial cancer taking histopathology as gold standard. Cross-sectional validation study. Department of Radiology, The Aga Khan University Hospital, Karachi, from January to December 2012. DWMRI (b-value = 50,400 and 800 s/mm2) was performed in 85 patients of biopsy-proven endometrial carcinoma before hysterectomy using body and spine coil at 1.5 Tesla. DWI was evaluated for presence of myometrial invasion by tumor with histopathology as gold standard. Sensitivity, specificity, the negative predictive value and positive predictive value and accuracy of DWI were assessed against the gold standard. On DWI, superficial myometrial invasion was found in 42 patients and deep myometrial invasion in 43. On histopathology, superficial myometrial invasion was found in 53 patients and deep myometrial invasion in 32. Hence sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the assessment of myometrial invasion by endometrial tumor on DW images was 90%, 73%, 67%, 92% and 80%, respectively. Diagnostic accuracy of diffusion-weighted magnetic resonance imaging in detection of myometrial invasion in endometrial cancer was 80%. DWI is highly accurate in assessing myometrial invasion and can be used as an adjunct to routine MRI for pre-operative evaluation of myometrial invasion of endometrial cancer.

Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus.

The aim of this study was to assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus. Waiving informed consent, the Institutional Review Board approved this Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study of 193 women with uterine papillary serous carcinomas, clear cell carcinomas, and carcinosarcomas, who underwent surgical staging between May 1998 and December 2011 and had preoperative CT within 6weeks before surgery. Two radiologists (R1, R2) independently reviewed all CT images. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve were calculated using operative notes and surgical pathology as the reference standard. The respective sensitivities and specificities achieved by R1/R2 were 0.79/0.64 and 0.87/0.75 for detecting deep myometrial invasion (MI) on CT; 0.56/0.63 and 0.93/0.79 for detecting cervical stromal invasion; 0.52/0.45 and 0.95/0.93 for detecting pelvic nodal metastases; and 0.45/0.30 and 0.98/0.98 for detecting para-aortic nodal metastases. Although CT had suboptimal sensitivity for the detection of omental disease, it had high PPV for omental seeding at surgical exploration (1.00 for R1 and 0.92 for R2). Inter-observer agreement ranged from moderate in the detection of deep MI (κ=0.42±0.06) to almost perfect in the detection of para-aortic nodal metastases (κ=0.88±0.08). In patients with uterine non-endometrioid carcinomas, CT is only moderately accurate for initial staging but may provide clinically valuable information by 'ruling-in' isolated para-aortic lymph node metastases and omental dissemination.

Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer: comparison of magnetic resonance imaging and frozen sections

To compare the diagnostic characteristics of the evaluation of myometrial invasion (MI) retrospectively between preoperative magnetic resonance imaging (MRI) and intraoperative frozen sections. A retrospective study. University hospital. 201 women diagnosed with endometrial carcinoma. All women underwent preoperative MRI and 111 of them also underwent intraoperative frozen section assessment. The final pathological evaluation was used as the definitive diagnosis. In women who underwent MRI and frozen sections (n=111), the accuracies of detection of MI and of deep invasion (defined as ≥50% invasion) were compared. The accuracy, sensitivity, and specificity of MRI for detection of MI were 65.8, 58.8, and 88.5%, and those in frozen sections were 90.1, 90.6, and 88.5%, respectively. The accuracy and sensitivity of frozen sections were significantly higher (p<0.001, p<0.001), whereas the specificity of the two methods did not differ (p=1.000). The accuracy, sensitivity, and specificity of MRI for detection of deep invasion were 83.8, 69.2, and 88.2%, and those of frozen sections were 93.7, 73.1, and 100.0%, respectively. The accuracy and specificity of frozen sections were significantly higher (p=0.007 and p<0.001, respectively), whereas sensitivity did not show a significant difference (p=0.999). In assessment of MI, the accuracy of frozen sections was significantly higher than that of MRI. Since the diagnostic characteristics differ between two methods, additional intraoperative frozen sections are recommended for more accurate assessment of MI when MRI is negative for the presence of any MI or positive for the presence of deep invasion.

Intérêt de l’échographie endovaginale préopératoire dans l’évaluation de l’infiltration myométriale des adénocarcinomes de l’endomètre

Objective. – To determine, according to histological tumor grade, the reliability of preoperative endovaginal ultrasound in the detection of myometrial invasion in patients with stage I endometrial cancer. Patients and methods. – Sixty-one patients with stage I endometrial carcinoma were evaluated with preoperative endovaginal ultrasound compared to postoperative results of pathologic examination, in a six-year retrospective study. Results. – Twenty-nine patients had a deep myometrial invasion (stage IC). The mean endometrial thickness was 9.5 mm in stage IA, 17.0 mm in stage IB and 20.0 mm in stage IC disease ( P = 0.01). The sensitivity and the specificity of the ultrasound in the assessment of myometrial invasion in grade 1 tumors were 100% and 93.7%, respectively. They fell to 69.2% and 88.9% for high-grade tumors. The global accuracy of ultrasound was 82%. Discussion and conclusions. – The performance of preoperative ultrasound varies according to the literature. The association of morphological and morphometric criteria enables an increase in the sensitivity of the exam. In grade 1 tumors, the preoperative endovaginal ultrasound could help in identifying a group of patients at low risk of lymph node metastasis for which a pelvic lymphadenectomy would be avoidable.