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.     

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     

Magnetic resonance imaging in the preoperative staging of endometrial carcinoma

PURPOSE OF INVESTIGATION: Magnetic resonance imaging (MRI) has emerged as an important imaging modality in the evaluation of the extension of endometrial carcinoma which is essential in planning treatment and predicting prognosis. This study aimed to assess the value of MRI in the preoperative staging of endometrial carcinoma. METHODS: We included in this study 162 patients with a histological diagnosis of endometrial carcinoma who underwent MRI pelvic imaging and surgical staging. MRI images were compared with pathological findings to measure MRI's sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in what concerns myometrial, cervical and lymph node invasion. RESULTS: MRI differentiation of deep myometrial invasion from superficial disease agreed with pathological findings in 77% of cases, with a sensitivity of 83%, a specificity of 72% and a diagnostic accuracy of 77%. Concerning cervical invasion, MRI had a sensitivity, specificity and diagnostic accuracy of 42%, 92%, 81% respectively. In assessing lymph node invasion, MRI presented a sensitivity of just 17%, a specificity of 99% and a diagnostic accuracy of 89%. CONCLUSION: Our study confirmed the high accuracy of MRI imaging in assessing myometrial and cervical invasion in endometrial carcinoma. When evaluating lymph node invasion, micrometastases are responsible for the low sensitivy of MRI.     

The accuracy of magnetic resonance imaging for preoperative deep myometrium assessment in endometrial cancer

ObjectiveTo evaluate the accuracy of preoperative magnetic resonance imaging (MRI) to detect deep myometrial invasion in patients with endometrial cancer.Materials and MethodsWe retrospectively reviewed 66 cases of women with endometrial cancer, who underwent preoperative MRI assessment and surgical staging between January 2006 and October 2010. The MRI findings were then compared with the pathology results. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI in detecting deep myometrium invasion were evaluated.ResultsThe sensitivity, specificity, accuracy, PPV, and NPV results of MRI for the detection of deep myometrium invasion were 92.52%, 74.35%, 81.81%,71.42%, and 93.54%, respectively, with a kappa of 0.64. In the postmenopausal group, the values were 100%, 55.5%, 74.19%, 61.9%, and 100%. In the premenopausal women, they improved to 85.7%, 90.47%, 88.57%, 88.71%, and 90.47%. The sensitivity (100%) was better than the specificity (55.56%) in the postmenopausal women. The predictive value was markedly higher in the premenopausal women than the postmenopausal women (85.7% vs. 61.9%).ConclusionIn patients with endometrial cancer, a preoperative MRI contributes to accurate staging, allowing planning for the scale of surgery and preoperative counseling. In our study, the pretreatment identification of myometrium invasion provided the opportunity for small-scale surgery in the premenopausal women with early endometrial cancer. However, for the postmenopausal patients, the standard surgical procedure is indicated even if the degree of myometrium invasion is low.     

Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer

Objective  To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting myometrial invasion and cervical involvement in endometrial cancer. Study design  Seventy two consecutive patients with endometrial carcinoma underwent preoperative MRI. We compared the MRI results with the final histopathological findings. We classify myometrial invasion as <50 or ≥50% and cervical involvement as positive or negative. Standard statistical calculations were used. Results  The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion ≥50% were 71, 86, and 58%, respectively. Positive and negative predictive values are 77 and 83%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 41, 97, and 46%, respectively. Positive and negative predictive values are 71 and 89%, respectively. The possible causes of misdiagnosis included a tumor isointense with the myometrium, polypoid tumor, myometrial thinning, exceedingly irregular myometrium, presence of adenomiosis, and presence of leiomyomas. Conclusion  MRI assists in planning the surgical treatment of endometrial cancer with an acceptable accuracy and a good specificity, although sensitivity is suboptimal.     

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.     

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.     

磁共振成像在子宫内膜癌分期中的应用价值研究

目的 :探讨MRI在子宫内膜癌分期和判断子宫肌层浸润深度中的价值。方法 :经诊断性刮宫病理学证实的子宫内膜癌 30例经MRI检查后行手术治疗 ,依据FIGO分期原则 ,将MRI分期与手术后病理检查结果进行比较。MRI检查采取矢状位和轴位SE序列T1WI和T2 WI及T1和T2 频谱预饱和翻转恢复序列 (T1/SPIR和T2 /SPIR) ,其中 18例行增强后T1WI扫描。结果 :MRI分期准确率为 86 .6 % ,判断子宫肌层浸润深度的准确率为 85 .6 %。结论 :MRI对子宫内膜癌术前分期和子宫肌层浸润定位具有较高的价值。     

Magnetic resonance imaging to identify risk of lymph node metastasis in patients with endometrial cancer

Objective

To assess the value of magnetic resonance imaging (MRI) to identify endometrial cancer patients at risk of lymph node metastasis.

Methods

Retrospective review of data from 108 patients with clinical stage I endometrial cancer who underwent preoperative MRI and were treated surgically. Patients at risk of lymph node metastasis were defined as those who had more than 50% myometrial infiltration or cervical invasion. Preoperative MRI reports were compared with final pathologic results.

Results

The mean age of the patients was 69.5 years and most patients had endometrioid cancer. On final pathologic analysis, 59 patients had deep myometrial infiltration or cervical invasion. For diagnosis of deep myometrial infiltration, cervical invasion, or both, MRI sensitivity and specificity were 56% and 85%; 47% and 83%; and 67% and 77%, respectively.

Conclusion

MRI has limited value in identifying patients with endometrial cancer who are at risk of lymph node metastasis. Minimally invasive laparoscopic lymph node staging should be undertaken when it is feasible.     

Magnetic resonance imaging for assessment of deep endometrial invasion for patients with endometrial carcinoma

Aims: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion.
Methods: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results.
Results: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764.
Conclusion: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary.     

磁共振成像在子宫内膜癌FIGO2009新分期改动中的应用及误判分析

目的 评估增强磁共振成像（MRI）对子宫内膜癌肌层和宫颈浸润及盆腔淋巴结转移的诊断价值并分析误判的相关因素。方法 收集2009年3月至2013年3月天津医科大学总医院妇科收治的167例子宫内膜癌患者临床、增强MRI及病理资料进行回顾,将MRI分期与病理分期结果进行对照,并对肌层和宫颈浸润深度及淋巴结转移误判的相关因素进行分析。结果 （1）MRI诊断准确率随期别升高而降低,随子宫内膜样腺癌分化程度的降低而降低,差异有统计学意义（P<0.05）;MRI诊断子宫内膜样腺癌和特殊病理类型患者的准确率为79.74%和64.29%,差异有统计学意义(P<0.05)。（2）MRI诊断肿瘤浅肌层浸润的敏感度、特异度、准确率、阳性预测值（PPV）、阴性预测值（NPV）及与病理结果一致性的手捣直鹞?91.79%、90.91%、91.62%、97.62%、73.17%和0.758;深肌层浸润率分别为90.91%、91.79%、91.62%、73.17%、97.62%和0.758;宫颈浸润率分别为84.21%、95.95%、94.61%、72.73%、97.93%和0.750;盆腔淋巴结转移率分别为45.00%、91.16%、85.63%、40.91%、92.41%和0.347。（3）MRI错误评估肌层浸润、宫颈浸润及盆腔淋巴结转移,与患者分娩次数少、合并肌瘤、宫角部位病变、深肌层浸润、肿瘤体积大（包括肿瘤占宫腔面积≥1/2及肿瘤最大径较大）、子宫内膜样腺癌低分化及特殊病理类型正相关（P<0.05）。结论 增强MRI对术前子宫内膜癌深肌层浸润、宫颈浸润和盆腔淋巴结转移评估具有较高的准确率和阴性预测值。当患者合并肌瘤、宫角部位病变、肿瘤体积较大、特殊病理类型和子宫内膜样腺癌低分化等因素时较易误诊。     

MR imaging in endometrial carcinoma as a diagnostic tool for the absence of myometrial invasion

OBJECTIVE: To evaluate whether magnetic resonance imaging (MRI) is a reliable modality for verifying preoperative diagnosis of stage IA endometrial carcinoma. METHODS: One hundred sixteen patients with endometrial carcinoma underwent preoperative pelvic non-contrast T2-weighted or dynamic MRI. We compared the interpretations of the MRI results with the histological findings of the resected uterus. RESULTS: In assessing the depth of myometrial invasion, the accuracy of MRI was 62.1%. As to the presence of cancerous myometrial invasion, the positive predictive value was 94.4% as high as previously reported by other institutions. However, the negative predictive value, the probability of the absence of myometrial invasion, was only 42.2%. Even when dynamic study was applied to the patient, the value only improved up to 60.0%. CONCLUSION: MRI has a definite advantage in evaluating deep myometrial invasion, but not the absence of invasion. We should take precautions against the risk of under-diagnosis when selecting stage IA endometrial carcinoma with use of MRI to preserve fertility or to eliminate lymphadenectomy.     

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。     

Evaluation of the accuracy of intra-operative gross examination for the surgical management of endometrial cancer

Objective

The aim of this study was to explore the clinical value of intra-operative gross examination for the surgical management of endometrial carcinoma.

Study design

A retrospective study was conducted in 424 women who underwent surgical treatment for endometrial carcinoma between January 2002 and December 2006. The results of myometrial invasion and cervical infiltration as assessed by intra-operative gross examination were compared with the final microscopic histopathological results in 401 patients. The accuracy, sensitivity, and specificity were calculated. Chi-squared or Fisher’s exact tests were used for the comparison of categorical variables.

Results

Intra-operative gross examination correctly identified the depth of microscopic myometrial invasion in 90.3% of patients. The sensitivity in detecting myometrial invasion was 80.6% and the specificity was 92.4%. With regard to cervical involvement, gross examination had an overall accuracy of 84.3%. The sensitivity in detecting cervical involvement was 32.6% and the specificity was 99.0%. Usually, cervical involvement cannot be correctly identified by intra-operative gross examination in patients with diffuse foci.

Conclusion

The data suggest that intra-operative gross examination is a simple and good method of predicting myometrial invasion, but it may not be the ideal way to assess cervical involvement in endometrial carcinoma.     

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.     

Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre

OBJECTIVES: The objectives were to evaluate the sensitivity and specificity of preoperative magnetic resonance imaging (MRI) in predicting myometrial invasion and disease stage in cases of endometrial carcinoma. STUDY DESIGN: Prospective analytic study in 100 sequential cases of endometrial carcinoma referred to the Dorset Cancer Centre between January 1999 and July 2004. The study included 100 women with histologically proven endometrial malignancy, the mean age of the studied population being 68.6 years +/-2S.D. The preoperative MRI findings were compared with final surgical and histological staging; the latter was taken as the gold standard. The main outcome measures were the sensitivity and specificity of preoperative MRI for staging endometrial cancer. RESULTS: A total of 100 consecutive cases of endometrial cancer were analysed, of which 62 cases were classified as stage Ia/Ib (early disease) by histology. MRI accurately predicted the degree of invasion in 54 cases and overestimated in 8, giving a sensitivity of 87% and specificity of 90%. In stage Ic disease the sensitivity and specificity of MRI were 56 and 86%, respectively. However, MRI showed significantly reduced sensitivity for predicting stage II endometrial cancer at 19% but was found to be both sensitive and specific for predicting advanced endometrial cancer (stages III and IV); the sensitivity and specificity were 100 and 99%, respectively. CONCLUSIONS: The accuracy of MRI scanning in predicting early and advanced endometrial disease is very good, but there is reduced accuracy with stage Ic and stage II disease. MRI is a valuable imaging modality in the preoperative assessment of cases of endometrial cancer.     

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.     

Endometrial carcinoma: the relevance of cervical cytology

In patients with endometrial carcinoma, preoperative identification of poor prognostic factors is helpful in planning therapy. Extended surgical staging, including pelvic and periaortic node dissection, is indicated in patients with deep myometrial invasion or high-grade tumor, or when other risk factors for extrauterine spread are present. In this study, cervical cytology was reviewed in 86 patients with endometrial carcinoma, all of whom underwent surgical staging, to correlate the cytologic results with surgical and pathologic findings. Cervical cytology was normal in 20 patients (23%), whereas suspicious or malignant endometrial cells were present in 23 and 43 cases (27 and 50%), respectively. Suspicious or malignant cervical cytology was associated with deeper myometrial invasion (P = .011), higher postoperative tumor grade (P = .006), positive peritoneal washings (P = .012), and more advanced stage by International Federation of Gynecology and Obstetrics criteria (P = .024). When compared with patients with normal cervical cytology, those who had malignant endometrial cells had over twice the risk of deep myometrial invasion (67 versus 30%), twice the risk of grade 2 or 3 tumor (60 versus 30%), and three times the risk of positive peritoneal washings (33 versus 10%). Seventy-four percent of patients with malignant cervical cytology were stage IC or more. In contrast, 70% of patients with normal cervical cytology were stage IA or IB. Patients with endometrial carcinoma who have malignant endometrial cells detected by cervical cytology are at increased risk of having a deeply invasive, high-grade, advanced-stage tumor, and therefore are more likely to require extended surgical staging.     

Evaluation of endometrial carcinoma on magnetic resonance imaging

Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy.     

Preoperative assessment of myometrial invasion of endometrial adenocarcinoma by sonography (US) and magnetic resonance imaging (MRI)

The presence and/or depth of myometrial invasion of endometrial adenocarcinoma has important prognostic and therapeutic implications. Fifteen patients with histologically proven endometrial cancer underwent preoperative evaluation with sonography (US) and magnetic resonance imaging (MRI) to assess depth of invasion. Using criteria of greater than or equal to 50% of myometrial wall involvement as representing deep invasion, and less than 50% as superficial invasion, US was more accurate than MRI in five cases; in three MRI was more accurate than US; both MRI and US were equally accurate in four; neither was accurate in three. Polypoid lesions caused the greatest number of false positive reports of deep invasion with both MRI and US. Preliminary results indicate that US and MRI have promise as preoperative tests to assess the extent of myometrial invasion.