子宫内膜癌肌层浸润深度的评估

目的　探讨术前B超、术中肉眼观察、术后大体标本测量和血清CA12 5测定 ,对判断子宫内膜癌肌层浸润深度的价值。方法　采用术前B超、术中肉眼观察和术后大体标本测量对 13 3例手术病理分期Ⅰ期子宫内膜癌患者的肌层浸润深度的判断进行评估 ,并分析 91例 (79例为Ⅰ期 ,12例为同期的Ⅱ～Ⅳ期患者 )子宫内膜癌患者血清CA12 5水平与子宫内膜癌的关系。结果　术前B超判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 62 6%和 47 8% ,特异性分别为 67 7%和90 0 % ;术中肉眼观察判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 5 9 6%和 73 9% ,特异性分别为 76 5 %和 94 6% ;术后大体标本测量判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 70 0 %和 94 4% ,特异性分别 92 0 %和 97 7%。子宫内膜癌手术病理分期Ⅰ期患者血清CA12 5水平异常 (≥ 3 5kU/L)的发生率为 8% (6/79) ,Ⅱ～Ⅳ期患者的发生率为 5 8% (7/12 ) ,血清CA12 5水平异常的发生率与手术病理分期的期别有极显著相关性 (P <0 0 0 1) ,而与子宫内膜癌肌层浸润深度无显著相关性 (P >0 0 5 )。结论　术前B超、术中肉眼观察和术后大体标本测量对判断Ⅰ期子宫内膜癌肌层浸润深度有一定帮助 ,其中术后大体标本测量的准确性相对较好。血     

Intraoperative gross examination of myometrial invasion and cervical infiltration in patients with endometrial cancer: decision-making accuracy

OBJECTIVES: We sought to determine the accuracy of gross evaluation of the depth of myometrial invasion and the involvement of the cervix, and its value in determining the need for extensive surgery in patients with endometrial carcinoma. METHODS: The intraoperative records of 256 patients operated for endometrial cancer were used to compare the gross evaluations with the final microscopic histopathological findings. In the theater, the uterus was opened and inspected after its removal. The depth of myometrial invasion was noted as less or greater than 50% using a full-thickness incision through the tumor, while cervical involvement was noted as positive or negative, based on extension of the tumor below the internal cervical os. Standard statistical calculations were used to determine accuracy, sensitivity, specificity, positive and negative predictive values, and false-positive and false-negative rates of the method. RESULTS: Regarding the depth of myometrial invasion, gross evaluation could accurately predict the final result in 88.2% of patients. Sensitivity, specificity, positive, and negative predictive values were 83.7, 90.6, 82.8, and 91.1%, respectively. False-positive results were noted in 9.4% of cases and false-negative in 16.3%. Analysis of the characteristics of the false-negative patients showed that they had aggressive variant tumors, tumors of advanced grade, and tumors that more frequently had developed from an atrophic endometrium. With respect to cervical involvement, gross evaluation had an overall accuracy of 98.5%, 0% false-positive rate, 11.5% false-negative rate, 88.5% sensitivity, 100% specificity, 100% positive predictive value, and 98.3% negative predictive value. CONCLUSION: Our data suggest that visual gross examination of the uterus provides safe and reliable estimates of both myometrial invasion and cervical infiltration. So, the surgeon can rely on the procedure to decide the need for further operative manipulations.     

Assessment of depth of myometrial invasion in endometrial adenocarcinoma

Depth of myometrial invasion in stage I adenocarcinoma of the endometrium is recognized as a prognostic factor for lymph node metastasis and overall survival. To determine if depth of myometrial invasion estimated by gross examination correlated with final histologic depth of invasion, we retrospectively reviewed all cases of surgical stage I endometrial adenocarcinoma treated at our institution between July 1985 and July 1988. Of the 113 evaluable patients, 63 had grade 1 lesions, 37 grade 2 lesions, and 13 grade 3 lesions. The depth of invasion was accurately determined by gross examination in 55 of 63 (87.3%) grade 1 lesions, 24 of 37 (64.9%) grade 2 lesions, and only 4 of 13 (30.8%) grade 3 lesions. Thus, gross examination of fresh tissue to estimate depth of myometrial invasion in endometrial adenocarcinoma is less reliable as the grade of the tumor increases. Alternative methods, such as frozen section, should be considered when evaluating depth of invasion, especially when this affects intraoperative decisions regarding lymph node sampling.     

Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection

Abstract. Cunha TM, Félix A, Cabral I. Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection.
This study aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of deep myometrial invasion and cervical extension by endometrial carcinoma. We also aimed to compare MRI results to surgical staging of endometrial carcinoma. Forty women with a histologic diagnosis of endometrial carcinoma underwent a preoperative pelvic MRI. In 33 cases intraoperative gross visual inspection (GVI) of the surgical specimen was also evaluated. The results obtained were compared with the histologic diagnosis. Pathologic evaluation of the myometrium determined that superficial invasion was present in 25 patients and deep invasion in 15. The uterine cervix was found to be involved in 12 cases. The accuracy, sensitivity, and specificity of MRI and GVI were 93%/91%, 80%/77%, and 100%/100%, respectively, in detecting deep myometrial invasion and 80%/79%, 33%/36% and 100%/100%, respectively, in determining cervical invasion. When the Kappa statistical measurement was applied, the results from each technique, MRI and GVI, showed an agreement on the evaluation of myometrial and cervical invasion by endometrial carcinoma. In conclusion, MRI, in this series, was demonstrated to be a reliable method for preoperative endometrial carcinoma "imagiological staging". The high accuracy achieved by MRI and GVI suggests that they may be used interchangeably.     

Value of the intraoperative assessment of the depth of myometrial invasion in endometrial carcinoma

OBJECTIVES: The aim of the study was to evaluate the value of intraoperative assessment of depth of myometrial invasion in patients with FIGO stage I of the endometrial carcinoma. MATERIAL AND METHODS: A total number of 112 patients with FIGO stage I of the endometrial carcinoma undergoing surgery were enrolled in the study. All patients had undergone intraoperative assessment of the depth of myometrial invasion performed by a surgeon. The depth was determined as more or less than 50% of myometrial thickness according to FIGO classification. Gross visual estimation of the depth of myometrial invasion at the time of the operation was compared with the final histopathological report. Sensitivity, specificity and positive and negative predictive values of the method were determined by means of statistical analyses. RESULTS: The depth of the myometrial invasion was accurately determined by the surgeon in 82.1% of cases. Sensitivity and specificity were 68% and 82.1%, respectively. The accurate prediction rate of the myometrial invasion in the group of patients with well differentiated (G1) endometrial carcinoma was higher (88.4%) than in group with moderately and low differentiated tumour (78.3%). CONCLUSIONS: The accuracy of macroscopic evaluation of myometrial invasion is high and reaches up to 82.1%. The accurate determination rate increases if the differentiation of tumour is higher.     

Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma. METHODS: Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist. RESULTS: The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%). CONCLUSION: If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.     

Significance of preoperative diagnosis of endometrial carcinoma by angio-CT

Angio computed tomography (CT) was performed in 87 previously untreated patients with endometrial carcinoma to study its clinical usefulness. All the patients subsequently underwent surgery and the angio CT findings were correlated with the surgical and pathologic findings. The results were as follows: 1. The tumor appeared as areas of low density in comparison with the surrounding myometrium after intraarterial infusion of contrast medium. 2. Angio CT proved to be useful in determining the depth of myometrial invasion. The myometrial invasion measured from the serosal surface in millimeters was assessed on angio CT. The CT findings were correlated well with pathologic findings. 3. Patients with intact myometrium greater than 10mm from the serosal surface assessed by angio CT had no nodal metastases. Angio CT provides a better display of cross-sectional uterine pathology than CT after intravenous infusion of contrast medium. The depth of myometrial invasion measured from the serosa on angio CT seems to be a useful prognostic factor in patients with endometrial carcinoma.     

Assessment of uterine wall thickness and position of the vascular plexus in the deep myometrium: implications for the measurement of depth of myometrial invasion of endometrial carcinomas.

Accurate discrimination between FIGO stages IB and IC endometrial carcinomas has important prognostic and therapeutic implications, but depth of invasion as a percentage of myometrial thickness can be difficult to ascertain. In such cases, pathologists often presume that infiltration that reaches the arcuate vascular plexus (AVP) in the myometrium indicates >50% myoinvasion. The further assumption is sometimes made that the anterior and posterior uterine walls are of the same thickness. To our knowledge, neither supposition is based on published data. We performed a prospective study of myometrial thickness and the position of the AVP in 50 normal uteruses from patients aged 27 to 84 years. Myometrial thickness varied inversely with age (p < 0.0001); however, anterior and posterior wall myometrial thickness did not differ significantly in the cohort as a whole (p = 0.059) and in individual cases was highly correlated (p < 0.0001). The position of the AVP was variable. On average, its inner limit was situated at a depth of 47.3% of the thickness of the myometrium in both uterine walls, but the position varied between individuals and sometimes differed considerably between the anterior and posterior walls of the same uterus. The position of the AVP did not differ significantly with age. We conclude that carcinomatous infiltration well into or through the AVP usually signifies >50% myoinvasion; however, if infiltration barely extends into the AVP, the depth of invasion should be calculated with reference to the thickness of the myometrium in the opposite uterine wall.     

Magnetic resonance imaging in stage I endometrial carcinoma

A prospective study was conducted on 50 consecutive patients with stage I endometrial cancer who had primary surgical treatment. The purpose of the study was to assess the value of magnetic resonance imaging (MRI) for accurate staging of early disease and determination of myometrial invasion. Features identified by MRI were correlated with surgical pathology. Preliminary MRI results provided additional valuable information. All but one of 18 patients with histologically proven deep myometrial invasion were predicted preoperatively by MRI. Of 17 patients with detached fragments of malignant tissue in the endocervical curettage (ECC) but with results inconclusive for actual cervical invasion, MRI revealed all three patients with true cervical tissue involvement. Magnetic resonance imaging detected all six patients with gross extrauterine spread and also precisely measured uterine enlargement by myomata. The extent and location of tumor growth in the uterus could be mapped out in the majority of cases. Based on these findings, a pretreatment MRI scan of the pelvis in presumably stage I endometrial carcinoma resulted in an advance in staging in 18% of the patients, and accurately predicted deep myometrial invasion in 94% of the cases. Inclusion of MRI in the routine work-up in stage I endometrial carcinoma should be considered for proper clinical staging, particularly in patients with a positive but nondiagnostic ECC, uterine papillary serous carcinoma, or grade 3 tumor.     

Intraoperative evaluation of depth of myometrial invasion in stage I endometrial adenocarcinoma

In patients with stage I endometrial adenocarcinoma, the incidence of pelvic and para-aortic lymph node metastasis is related to the grade of the tumor and the depth of myometrial invasion. Although the grade of the tumor may be predicted preoperatively by endometrial sampling, the depth of myometrial invasion cannot be determined until after the uterus has been removed. Although complications have been attributed to lymph node sampling, failure to perform the procedure in patients at risk for nodal metastasis may result in underdiagnosis of extrauterine disease, leading to inadequate therapy. Gross visual examination of the cut surface of the tumor at the time of hysterectomy accurately determined the depth of myometrial invasion in 135 of 148 prospectively studied patients (91%) (P less than .001). The sensitivity of the test was 0.71, the specificity was 0.96, and the positive predictive value was 0.80. Intraoperative assessment of the depth of myometrial invasion is a simple, inexpensive, and useful technique for selecting those patients with stage I endometrial adenocarcinoma who might benefit from selective para-aortic lymphadenectomy.     

Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma

OBJECTIVES: To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging for the prediction of depth of myometrial invasion in the preoperative assessment of women with endometrial carcinoma. METHODS: We retrospectively reviewed the medical records and MR imaging reports of 120 women with pathologically-proven endometrial carcinoma who underwent preoperative pelvic MR imaging between June 1997 and February 2006. Tumor signal intensity, the appearance of the junctional zone (JZ), the presence of large polypoid tumors and leiomyomas were analyzed. Univariate logistic-regression analysis was performed to identify associations between incorrect MR staging and the study variables. RESULTS: Data from 120 patients were registered for the current study and analyzed. The sensitivity, specificity and accuracy of the MR imaging in assessment of myometrial invasion among patients with endometrial carcinoma were: 50.6%, 89.2% and 62.5% respectively. MR differentiation of deep myometrial invasion from superficial disease had an 83.3% accuracy (100 of 120 cases). Isointense JZ to myometrium (P<0.001), and the presence of polypoid tumors (P=0.037) on MR imaging were significantly associated with an underestimation of myometrial invasion by endometrial carcinoma. CONCLUSIONS: Isointense JZ to myometrium and polypoid tumors are difficult to accurately evaluate for myometrial invasion of endometrial carcinoma by MR imaging.     

Intraoperative frozen section examination of myometrial invasion depth in patients with endometrial carcinoma

The objective of this study was to evaluate the accuracy of frozen sections (FS) as a method for estimation of the depth of myometrial invasion in patients with stage I endometrial carcinoma. During a 3-year period (1989–1992), 46 consecutive patients with FIGO stage I endometrial carcinoma were included in this study. The depth of myometrial invasion was estimated by FS examination performed during surgery. The final histologic findings of the surgical specimen were compared to the FS evaluation. The results of this study demonstrate that deep or superficial myometrial invasions were correctly diagnosed by FS in 42 out of 46 cases (91.3%). Three cases (6.6%) with deep myometrial invasion were falsely diagnosed as superficially invasive. One case with superficial invasion (2.1%) was falsely diagnosed as deeply invasive. In conclusion, intraoperative FS examination of depth of myometrial invasion by endometrial carcinoma is a simple and accurate method, providing a good correlation with the final histologic report of the surgical specimen.     

Predictors of final histology in patients with endometrial cancer

OBJECTIVE: To assess the usefulness of preoperative tumor grade and intraoperative assessment of gross depth of myometrial invasion as "predictors" of final grade, final depth of myometrial invasion and surgical stage in patients with "low-risk" endometrial cancer. METHODS: We retrospectively compared preoperative histology and intraoperative gross depth of invasion with final pathologic evaluation on hysterectomy specimens. For patients traditionally considered intraoperatively to be "low-risk" for lymph node metastasis (grade 1 or 2 adenocarcinoma with less than 50% myometrial invasion), "predictors" combining preoperative histology and intraoperative gross depth of myometrial invasion were established; that is, a preoperative biopsy of grade 1 adenocarcinoma with an intraoperative gross depth of myometrial invasion of 30% was assigned the predictor IbG1 (Stage Ib, grade 1). These predictors were then compared to final grade and surgical stage. Sensitivity, specificity, and positive predictive value were then calculated. RESULTS: A total of 153 patients had both a preoperative biopsy and intraoperative assessment of gross depth of invasion. Twenty-four patients had the IaG1 predictor; eight had stage IaG1 on final pathologic evaluation (sensitivity, 0.50; specificity, 0.88; positive predictive value, 0.33). Eight patients had the IaG2 predictor; none had stage IaG2 on final pathologic evaluation (sensitivity, 0; specificity, 0.95; positive predictive value, 0). Eighty-nine patients had the IbG1 predictor; forty-six had stage IbG1 on final pathologic evaluation (sensitivity, 0.72; specificity, 0.52; positive predictive value, 0.52). Thirty-two patients had the IbG2 predictor; 11 had stage IbG2 on final pathologic evaluation (sensitivity, 0.46; specificity, 0.84; positive predictive value, 0.34). CONCLUSION: A clinically significant number of patients will have more advanced disease than predicted by preoperative or intraoperative prognostic factors. These predictors should not be relied on in the staging of endometrial cancer.     

Accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with endometrial cancer

BACKGROUND AND AIMS: Preoperative prediction of metastases to the regional lymph nodes in women with endometrioid endometrial cancer is a challenge. According to the Danish Gynaecological Cancer Society guidelines, a pelvic lymphadenectomy is warranted in all poorly differentiated tumors and all stage Ic disease. We have evaluated the accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion, in predicting the need for a pelvic lymphadenectomy. METHODS: Preoperative tumor grade and intraoperative gross examination of myometrial invasion were prospectively registered in 72 women with stage I endometrioid endometrial cancer, operated between 1 September 2004 and 18 April 2006. The pre- and intraoperative findings were compared with the final pathology report. RESULTS: The preoperative prediction of grade (well, moderate or poorly differentiated) was correct in 96% (69/72) of the patients. Gross examination of myometrial invasion correctly differentiated between stage Ia, Ib, and Ic disease in 89% (64/72) of the patients. The combination of preoperative tumor grade and intraoperative gross examination of myometrial invasion, led to wrong clinical decisions in 11% (8/72) of the patients. Three 'unnecessary' lymphadenectomies were performed, and 5 patients were primary operated upon without 'warranted' lymphadenectomy. CONCLUSIONS: Our data suggest that preoperative tumor grade and intraoperative gross examination of the uterus provide useful information for pre-and intraoperative planning of pelvic lymphadenectomy. However, wrong decisions were made in 11% of the patients, and more reliable evaluation methods are needed.     

Ultrasonographic studies on endometrial carcinoma

Pre-operative ultrasonographic examinations on endometrial carcinoma were carried out in 34 cases in Tokushima University Hospital for 9 years since 1976. The results were compared with post-operative histological findings. The cancer mass was seen as higher echoic part than normal myometrium and its characteristic echo patterns were grouped into 5 types (4 cases of anechoic, 3 of linear, 4 of cystic, 14 of small mass and 9 of large mass). Small and large mass types were seen in 86% of the cases whose cervix, pelvic lymph nodes or parametrium were involved. The degree of myometrial invasion could be estimated by measuring the thickness of the myometrial echo uninvolved, and its coefficient correlation was 0.65. Depending on the increase in tumor echo size, myometrial invasion sometimes developed more deeply. Cervical involvements were estimated accurately in 86% by ultrasonography. Ultrasonographic estimation of the invasion on endometrial carcinoma was thought to be useful.     

Preoperative assessment of myometrial invasion and cervical involvement of endometrial cancer by transvaginal ultrasonography

The aim of the study was to assess the depth of myometrial invasion and cervical involvement by endometrial cancer using preoperative 6.5-MHz, high-frequency transvaginal ultrasonography as compared with postoperative assessment using histopathological examination. The study included 47 patients with histologically proven cancers of the endometrium. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of the uterine wall, and outer half of the uterine wall. Cervical spread is recorded as positive or negative. Of 36 (76.6%) patients with proven myometrial invasion, 33 cases (91.66%) were revealed by sonography. Histologically proven cervical invasion that correlated with sonography was shown in 3 patients (75%). In 7 patients (14.9%) ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was underestimated in 4 (8.5%) cases and overestimated in 3 (6.4%) cases. Preoperative assessment of invasion of the uterine wall and cervical spread by transvaginal ultrasonography had an accuracy of 85 and 97.8% if correlated with the definitive histopathological examination. The role of transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion and cervical involvement in patients with endometrial cancer needs to be studied further before making reliable conclusions.     

Prediction of myometrial invasion in patients with endometrial carcinoma: comparison of magnetic resonance imaging, transvaginal ultrasonography, and gross visual inspection

This study evaluated the accuracy of magnetic resonance imaging (MRI) and transvaginal ultrasonography (TVUS) in preoperative detection of myometrial invasion by endometrial cancer. We also evaluated the results of gross visual inspection (GVI) of surgical specimens compared with histopathological diagnosis. One hundred and seventy-seven women underwent preoperative pelvic MRI, TVUS, and intraoperative GVI. Myometrial tumor invasion was evaluated histologically and classified as absent (depth a), superficial (depth b: < or = 50% invasion), or deep (depth c: > 50% invasion). The accuracy of MRI, TVUS, and GVI were 64.0, 66.9, and 63.8%, respectively. The positive predictive values of of each modality for depth a were 52.6, 51.4, and 52.2%, respectively. The accuracy of each in detecting deep myometrial invasion (depth c) were 84.0, 86.9, 83.1%. Although evaluation of depth a was limited with all modalities, MRI and TVUS were shown to be reliable for preoperative evaluation of deep myometrial invasion. The high accuracy of these three methods suggests that they are useful either interchangeably or in combination.     

Hysterography in patients with suspected uterine cancer: radiographic and histologic correlations and clinical implications

The present study correlated the hysterographic and nonradiation-affected uterine histologic findings in 91 patients with suspected uterine cancer. Hysterography helped diagnose correctly a benign or malignant lesion, and helped identify the correct primary site of a malignant lesion in 11 patients. In 65 patients with a final diagnosis of endometrial carcinoma, all five cases of true endocervical involvement were identified, 69% were determined to have either no residual tumor or no myometrial invasion, and 88% were predicted correctly to have a myometrial invasion of greater than one-half. Prediction of the volume, distribution, and point of maximum invasion permitted the uterus to be opened so as to permit the best histologic assessment of the depth and extent of the lesion.     

经阴道三维超声诊断子宫内膜癌的探讨

目的探讨经阴道三维超声（3-DTVS）诊断子宫内膜癌及肌层浸润的价值。方法收集2003年4月-2005年4月在我院经手术治疗的子宫内膜癌患者72例。其中，术前64例（3-DTVS组）应用3-DTV多平面和血管成像技术以及体积测量功能诊断子宫内膜癌及肌层浸润深度进行评估；25例（MRI组）经核磁共振（MRI）检查为对照组，以手术后病理结果判断符合率，对比两组诊断子宫内膜癌及其肌层浸润情况。结果经3-DTVS诊断子宫内膜癌的符合率为89．1％，判断肌层浸润的符合率为77．1％。应用3-DTVS与MRI诊断子宫内膜癌及肌层浸润准确率两组间无显著性差异（P〉0．05）。结论3-DTVS在诊断子宫内膜癌及肌层浸润深度有诊断价值。     

MRI in evaluation of myometrial invasion and staging of endometrial carcinoma

Recently, nuclear magnetic resonance (NMR)-CT has become available for clinical use. A number of reports have stressed its diagnostic usefulness for gynecologic diseases. In the present report, we studied the clinical usefulness of magnetic resonance imaging (MRI) in diagnosing endometrial carcinoma. 1. Determination of the extent of myometrial invasion. We applied following five parameters: 1) transverse area ratio of occupying tumor in the uterine body (TAR), 2) sagittal area ratio of occupying tumor in the uterine body (SAR), 3) volume ratio of occupying tumor in the uterine body (VR), 4) minimal thickness of normal myometrium (MT) and 5) ratio of the maximal thickness to the minimal thickness of normal myometrium (Min./Max.ratio). We compared the NMR-CT findings with those for the surgically removed uterus. The Min./Max.ratio showed a statistically significant difference (p less than 0.05) between cases with myometrial invasion less than 1/3 of the whole thickness and those with invasion from 1/3 to 2/3. VR showed a significant difference (p less than 0.01) between cases with invasion from 1/3 to 2/3 and those with invasion more than 2/3. Thus, we suggest that the Max./Min.-ratio may be useful in detecting invasion less than 1/3, and that VR might be useful in detecting invasion more than 2/3. 2. Determining the clinical stages (FIGO) Correct staging rates by MRI were 100% for stage Ia, 83.3% for stage Ib, 50% for stage II and 100% for stage III. We could completely differentiate stage III cases from those of the lower stages. These results indicate that MRI is quite useful in diagnosing endometrial carcinoma.