The performance of preoperative MRI in service-based centers in diagnosing deep myometrial invasion by endometrial carcinoma

Objectives: This study investigates the performance of MRI performed in service-based centers in diagnosing deep myometrial invasion by endometrial cancer. It also investigates if the combined use of MRI and intraoperative gross examination of uterine specimen improve sensitivity. Materials and Methods: Endometrial cancer patients who had hysterectomy in Prince of Wales Hospital in Hong Kong from January 2007 to November 2014 were identified retrospectively. Those who had preoperative MRI assessment for myometrial invasion were included. Patient’s records were reviewed for demographic, operative, MRI and pathology findings. The accuracy of MRI and operative findings were determined by correlating them with pathological findings. Results: This study included 343 patients. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and positive likelihood ratio (NLR) of MRI in diagnosing deep myometrial invasion were 78.4%, 68%, 81.3%, 50.5%, 90.1%, 3.64, and 0.39, respectively. Area under the curve (AUC) was 0.75. MRI performed within 20 days were more reliable than MRI performed more than 20 days before surgery (80.4% vs. 61%, p=0.01). The accuracy, sensitivity, and specificity of gross examination were 81.5%, 58.9%, and 87.6%, respectively. The accuracy, sensitivity, and specificity of combined assessment with MRI and gross examination were 75.3%, 76.7%, and 74.9%, respectively. Conclusions: The performance of MRI in service-based centers is comparable to research centers. The accuracy was lower if MRI was performed more than 20 days before surgery. The authors recommend combined assessment with MRI and intra-operative gross examination in view of the higher sensitivity in diagnosing deep myometrial invasion.

MRI; Myometrial invasion; Endometrial cancer; Hysterectomy.

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