Imaging In Endometrial Cancer Research Articles

Diagnostic Performance of Preoperative Imaging in Endometrial Cancer.

Endometrial cancer is one of the most common gynecological malignancies. Because the findings mentioned in radiogram interpretation reports issued by diagnostic radiologists influence treatment strategies, we aimed to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) interpretation results in clinically relevant settings. The clinical records of patients diagnosed with endometrial cancer treated at Tohoku University Hospital from January 2012 to December 2021 were reviewed. The preoperative and pathologically estimated cancer stages were compared based on the results mentioned in the radiogram interpretation report. The preoperative and postoperative cancer stages were concordant in 70.0% of the patients. By contrast, the cancer stage was underdiagnosed and overdiagnosed in 21.7% and 8.2% of the patients, respectively. The sensitivities of MRI for deep myometrial invasion, cervical stromal invasion, vaginal invasion, and adnexal metastasis were 65.1%, 58.2%, 33.3%, and 18.4%, respectively. The sensitivity and specificity for pelvic lymph node metastasis using a combination of CT and MRI were 40.9% and 98.4%, respectively. Those for para-aortic lymph node metastases using CT were 37.0% and 99.5%, respectively. The low sensitivity observed in this study clarified the limitations of preoperative diagnostic performance in current clinical practice.

Evaluation of the role of intraoperative frozen section and magnetic resonance imaging in endometrial cancer.

To evaluate the accuracy of preoperative endometrial biopsy and magnetic resonance imaging (MRI) of endometrial cancer compared with that of intraoperative frozen section. This retrospective study included 264 patients who underwent surgery with intraoperative frozen section for endometrial cancer at our institution between 2014 and 2018. Diagnosis was determined by histologic type, grade, and myometrial invasion. Concordance rate, sensitivity, and specificity of preoperative diagnosis and intraoperative frozen diagnosis were calculated, in comparison to the final pathologic diagnosis. Preoperative and intraoperative diagnoses showed no statistically significant difference in determining histologic type and grade (P= 0.152). Intraoperative diagnosis showed higher sensitivity for endometrioid carcinoma grade 3 and other types, and higher specificity for grade 1. For myometrial invasion, intraoperative diagnosis showed significantly higher concordance rate than preoperative MRI findings (P< 0.01). Intraoperative diagnosis showed higher sensitivity and specificity in patients with and without myometrial invasion, respectively. Higher agreement between intraoperative and final diagnoses, especially in myometrial invasion, suggests that intraoperative frozen section is a good indicator for appropriate surgical procedure decision making.

Risk factors for failure of sentinel lymph node mapping using indocyanine green/near-infrared fluorescent imaging in endometrial cancer.

Side-specific systematic lymphadenectomy is suggested if sentinel lymph node (SLN) mapping failed in early stages endometrial cancer. This study aimed to evaluate the risk factors associated with failed mapping which may lead to modify SLN mapping technique, increase the success of SLN mapping and reduce the necessity of systematic lymphadenectomy. Patients with early stage endometrial cancer were included in this study. All patients underwent SLN mapping with indocyanine green/near-infrared compatible surgical platforms. Indocyanine green was injected intracervical. "Bilateral mapping" and "failed bilateral SLN mapping (unilateral or bilateral failed mapping)" groups were compared for demographic, clinical, surgical, and pathological features. 101 cases were analyzed. The overall, unilateral, and bilateral SLN detection rates were 94.1%, 19.8%, and 74.3%, respectively. The failed (unilateral or no mapping) bilateral detection rate was 25.7%. Failed bilateral mapping rates were higher in patients with longer cervical and uterine longitudinal lengths, deep myometrial invasion and larger tumor size without statistical significance. Body mass index and operation type were not related with failed mapping. Increasing number of operations or injection of larger volume of indocyanine green (4mL vs. 2mL) did not improve mapping rate significantly. Cervical indocyanine green injection may overcome the negative effect of obesity on bilateral mapping. Although there was a negative correlation trend between the longitudinal cervical and uterine lengths and bilateral mapping, this possible relation needs to be confirmed in further studies.

Surveillance Imaging in Patients With Endometrial Cancer in First Remission

The clinical benefit of surveillance imaging in endometrial cancer remains undefined. This retrospective study was conducted to evaluate the positive predictive value (PPV) of surveillance imaging in endometrial cancer. A total of 128 patients in first remission after treatment for endometrial cancer (uterine papillary serous, clear cell, stage III endometroid) who had surveillance imaging were retrospectively identified. The surveillance period was defined from the time of first-negative scan after treatment to the time when treatment was started for recurrent disease. Reports of surveillance scans were reviewed for the presence or absence of findings. The primary outcome was PPV of surveillance imaging. Cost and radiation exposure from surveillance imaging were also evaluated. A total of 128 patients had 707 surveillance scans (computed tomography, positron emission tomography-computed tomography with 2-deoxy-2-[18F]fluoro-d-glucose, magnetic resonance image, and bone scans). Median follow-up was 54 months (range: 9-173). Of all, 47 patients (37%) started therapy for recurrent endometrial cancer at the discretion of the treating physician. PPV of all surveillance imaging was 57.7%. Per patient, the mean number of surveillance scans was 5.6 (range: 2-21). The mean cost of imaging was $4200 (range: $1200-$18,700) and mean radiation exposure was 109.6mSV (range: 16-445mSv). Surveillance imaging detected a significant number of recurrences in patients with high-risk endometrial cancer at a reasonable cost related to the overall risk. Well-designed prospective imaging trials are warranted to assess the clinical benefit of surveillance imaging.

Preoperative staging of endometrial cancer using reduced field-of-view diffusion-weighted imaging: a preliminary study.

To compare the image quality and diagnostic performance of reduced field-of-view (rFOV) versus conventional full field-of-view (fFOV) diffusion-weighted (DW) imaging of endometrial cancer. Fifty women with endometrial cancer underwent preoperative rFOV and fFOV DW imaging. Two radiologists compared the image qualities of both techniques, and five radiologists assessed superficial and deep myometrial invasion using both techniques. The statistical analysis included the Wilcoxon signed-rank test and paired t-test for comparisons of image quality and mean diagnostic values. Distortion, tumour delineation, and overall image quality were significantly better with rFOV DW imaging, compared to fFOV DW imaging (P < 0.05); however, the former was inferior in noise (P < 0.05). Regarding superficial invasion, the mean accuracies of the techniques did not differ statistically (rFOV, 58.0% versus fFOV, 56.0%; P = 0.30). Regarding deep myometrial invasion, rFOV DW imaging yielded significantly better mean accuracy, specificity, and positive predictive values (88.4%, 97.8%, and 91.7%, respectively), compared with fFOV DW imaging (84.8%, 94.1%, and 77.4%, respectively; P = 0.009, 0.005, and 0.011, respectively). Compared with fFOV DW imaging, rFOV DW imaging yielded less distortion, improved image quality and, consequently, better diagnostic performance for deep myometrial invasion of endometrial cancer. • rFOV DWI yields better assessment of deep myometrial invasion in endometrial cancer. • rFOV DWI could not sufficiently evaluate superficial invasion in endometrial cancer. • Distortion, tumour delineation, and overall image quality were improved with rFOV DWI.

Sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial cancer. A pilot study and review of the literature

ObjectivesIndocyanine green (ICG) with near-infrared (NIR) fluorescence imaging is a new tracer modality used for lymphatic mapping. We report our initial experience with ICG for SLN mapping in cervical and endometrial cancer using a new endoscopic fluorescence imaging system. MethodsWe reviewed all patients who underwent primary surgery for early-stage endometrial and cervical carcinoma with SLN mapping using fluorescence imaging followed by pelvic lymphadenectomy from February to July 2014. Intracervical injection of ICG at 3 and 9 o'clock was performed in all cases. SLNs were ultrastaged on final pathology. Sensitivity and specificity values were calculated. ResultsA total of 50 patients were included in the study (42 endometrial and 8 cervical cancers). The median age was 62 (24–88) and median BMI 29 (19–56). The median SLN count was 3.1 (0–7) and median lymph node count was 15 (2–37). The overall and bilateral detection rate was 96% (48/50) and 88% (44/50). Positive SLNs were identified in 22% of patients (11/50), including 8 isolated tumor cells (ITC), 2 micrometastasis and 1 macrometastasis. There was one side-specific false negative case. Sensitivity, specificity and NPV were 93.3%, 100% and 98.7% respectively per side. Paraaortic node dissection was performed in 22% of cases. Two had paraaortic node metastasis both in patients with positive pelvic SLN. There were no allergic reactions to the ICG. ConclusionsBased on our pilot experience, NIR fluorescence imaging with ICG is an excellent and safe tracer modality for SLN mapping with a very high overall (96%) and bilateral (88%) detection rate.

OP09.09: Dynamic contrast‐enhanced MR imaging of endometrial cancer: optimising the imaging delay for tumor‐myometrium contrast

<scp>OP</scp>09.09: Dynamic contrast‐enhanced <scp>MR</scp> imaging of endometrial cancer: optimising the imaging delay for tumor‐myometrium contrast

Imaging in endometrial cancer

The prognosis for women with endometrial cancer is generally good. This is because the disease is often diagnosed at an early treatable stage, as women seek care owing to postmenopausal bleeding. The prognosis is, however, worse for women with high-risk endometrial cancer. These women may benefit from more extensive surgery, including pelvic- and para-aortic lymph-node dissection, whereas such surgery is of no benefit for women with low-risk cancer. It is, therefore, important to correctly identify women with high-risk cancer before surgery. No consensus has been reached on how and when to use imaging to assess local extension of the disease. Nevertheless, evidence shows that imaging will improve the identification of women with high-risk cancer. The primary aim of this review is to present the examination technique, accuracy, imaging findings, benefits, and shortcomings of ultrasound and magnetic resonance imaging in the assessment of local tumour extension, in women with endometrial cancer. A secondary goal is to discuss the role of positron emission tomography and computed tomography, diagnostic modalities that primarily are used to detect lymph node and distant metastasis.

Diagnostic Accuracy of Magnetic Resonance Imaging in Endometrial Cancer

The objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging. This was a diagnostic accuracy study of prospective cases in conjunction with STARD guidelines using collected data from a tumor board within a cancer network. Consecutive series of all endometrial cancers in Northern Ireland over a 21-month period was discussed at the Gynaecological Oncology Multidisciplinary Team/tumor board meeting. This study concerns 183 women who met all the inclusion criteria. Main outcome measure was the correlation between the depth of myometrial invasion suggested by preoperative MRI study and the subsequent histopathological findings following examination of the hysterectomy specimen. Secondary end point was how MRI changed management of women who required surgery to be performed at a central cancer center. For the detection of outer-half myometrial invasion, overall sensitivity of MRI was 0.73 (95% confidence interval [CI], 0.59-0.83), and specificity was 0.83 (95% CI, 0.76-0.89). The positive predictive value was 0.63 (95% CI, 0.50-0.74), and negative predictive value was 0.89 (95% CI, 0.82-0.93). Positive likelihood ratio was 4.35 (95% CI, 2.87-6.61), and negative likelihood ratio was 0.33 (95% CI, 0.21-0.52). Magnetic resonance imaging improved the sensitivity and negative predictive value of endometrial biopsy alone in predicting women with endometrial cancer who require full surgical staging (0.73 vs 0.65 and 0.80 vs 0.78, respectively). Preoperative pelvic MRI is a moderately sensitive and specific method of identifying invasion to the outer half of myometrium in endometrial cancer. Addition of MRI to preoperative assessment leads to improved preoperative assessment, triage, and treatment.

Application of 1.5 T magnetic resonance imaging in endometrial cancer

To determine the diagnostic accuracy, sensitivity and specificity of magnetic resonance imaging (MRI) in detecting myometrial invasion, cervical involvement and disease stage in endometrial cancer. 168 consecutive patients with endometrial carcinoma underwent preoperative MRI. We classified myometrial invasion as no invasion, ≤50% invasion or >50% invasion and cervical involvement as positive or negative. The preoperative MRI findings and stagings were compared with final surgical and histological staging; the latter was taken as the gold standard. Standard statistical calculations were used. The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion >50% were 64.7, 92.5, and 86.9%, respectively. Positive and negative predictive values were 68.8 and 91.2%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 52.63, 93.08, and 83.93%, respectively. Positive and negative predictive values were 68.97 and 87.05%, respectively. 102 cases were classified as stage IA (early disease) by histology. MRI accurately predicted the degree of invasion in 88 cases and overestimated in 14, giving a sensitivity of 86.3% and specificity of 69.1%. However, MRI showed reduced sensitivity for predicting stage IB and advanced endometrial cancer (stages III and IV) at 33.3 and 30.3%, respectively, but was found to be specific for predicting these stages; the specificity were 94.7 and 85.1%, respectively. MRI also showed good accuracy for predicting stage IA, IB, II and advanced endometrial cancer at 80.4, 86.9, 91.7, and 83.9, respectively. MRI assists in planning the surgical treatment of endometrial cancer with good accuracy and specificity, although sensitivity is suboptimal.

Advances in imaging techniques for diagnosis of endometrial cancer

Endometrial cancer is the most common gynecologic malignancy diagnosed in Western countries, and its care is rapidly evolving towards more personalized treatment recommendations to improve outcome and minimize toxicity and cost. Evaluation of the accuracy of preoperative assessment by imaging of the depth of myometrial invasion, cervical invasion and nodal metastasis is very important for optimizing surgical procedures and therapeutic strategies. This review focuses on research published within the past decade and draws extensively on the texts and summaries of the articles referenced to imaging of the depth of myometrial invasion, cervical invasion and nodal metastasis in endometrial cancer. Less recent citations are also included when deemed useful to provide background information. The reader will be introduced to recent advances, techniques and applications of system approach to assess by imaging of endometrial cancer. The reader will learn fundamental research principles and tasks required in the implementation of these approaches and applications. The reader will gain a better understanding of the role of imaging for endometrial cancer, as well as of potential opportunities and advances. The utility of new techniques, including contrast material-enhanced dynamic magnetic resonance imaging (MRI), diffusion-weighted magnetic resonance imaging, higher Tesla machines, MRI using nanoparticle contrast media, and positron-emission tomography with (18)F-deoxy-glucose and/or radiotracers of 16α-[(18)F]fluoro-17β-estradiol binding to the estrogen receptor are promising methods, although some limitations remain. Further advances in molecular imaging technology will eventually overcome these current limitations in diagnosis of endometrial cancer.