The performance of pre-operative MRI in service-based centers in diagnosing cervical invasion by endometrial carcinoma

Purpose of investigation: To investigate the performance of MRI and/or gross examination of specimen in detecting cervical invasion and factors that may influence MRI’s performance. 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 cervical invasion were included. Patient’s records were reviewed for demographic, operative, MRI, andpathological findings. The accuracy of MRI and operative findings were determined by correlating with pathological findings. Results: A total of 318 patients were included. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of MRI in diagnosing cervical invasion were 86.5%, 48%, 93.7%, 58.5%, 90.6%, 7.57, and 0.56, respectively. Area under the curve was 0.71. The accuracy, sensitivity, and specificity of gross examination were 89.6%, 51.9% and 96.4%, respectively. The accuracy, sensitivity and specificity of combined assessment with MRI and gross examination were 85.8%, 56.3%, and 91.2%, respectively. Conclusions: MRI has high accuracy and specificity but low sensitivity in detecting cervical invasion. The performance of gross examination of specimen is comparable to MRI. MRI cannot be recommended as sole assessment method to detect cervical invasion by endometrial cancer and a higher sensitivity can be achieved by the combined assessment approach.

Endometrial cancer; Cervical invasion; MRI; Gross examination of specimen.

[1] Howlader N., Noone A.M., Krapcho M., Garshell J., Miller D., Altekruse S.F., et al.: “SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, based on November 2013 SEER data submission, posted to the SEER web site, April 2014. Available at: http://seer.cancer.gov/csr/1975_2011/browse_csr.php? sectionSEL=7&pageSEL=sect_07_table.05.html

[2] Hong Kong Cancer Registry, Hospital Authority: “Cancer statistics, 1998-2012”. Available at: http://www3.ha.org.hk/cancereg/corpus_ 2012.pdf

[3] Kang W.D., Kim C.H., Cho M.K., Kim J.W., Kim Y.H., Choi H.S., Kim S.M.: “Lymphadenectomy for low-risk endometrial cancer based on preoperative and intraoperative assessments”. Int. J. Gynecol. Cancer, 2009, 19, 657.

[4] Mariani A., Webb M.J., Keeney G.L., Haddock M.G., Calori G., Podratz K.C.: “Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary?”. Am. J. Obstet. Gynecol., 2000, 182, 1506.

[5] Creasman W.T., Odicino F., Maisonneuve P., Quinn M.A., Beller U., Benedet J.L., et al.: “Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer”. Int. J. Gynaecol. Obstet., 2006, 95, S105.

[6] Creasman W.T., Morrow C.P., Bundy B.N., Homesley H.D., Graham J.E., Heller P.B., et al.: “Surgical pathologic spread patterns of endometrial cancer: A gynecologic oncology group study”. Cancer, 1987, 60, 2035.

[7] Cornelison T.L., Trimble E.L., Kosary C.L.: “SEER data, corpus uteri cancer: treatment trends versus survival for FIGO stage II, 1988-1994”. Gynecol. Oncol., 1999, 74, 350.

[8] Cohn D.E., Woeste E.M., Cacchio S., Zanagnolo V.L., Havrilesky L.J., Mariani A., et al.: “Clinical and pathologic correlates in surgical stage II endometrial carcinoma”. Obstet. Gynecol., 2007, 109, 1062.

[9] Gien L.T., Barbera L., Kupets R., Saskin R., Paszat L.: “Utilization of preoperative imaging in uterine cancer patients”. Gynecol. Oncol., 2009, 115, 226.

[10] Tong T., Yajia G., Huaying W., Weijun P.: “Application of 1.5 T magnetic resonance imaging in endometrial cancer”. Arch. Gynecol. Obstet ., 2012, 285, 1113.

[11] Celik C., Ozdemir S., Kiresi D., Emlik D., Tazegül A., Esen H.: “Evaluation of cervical involvement in endometrial cancer by transvaginal sonography, magnetic resonance imaging and frozen section”. J. Obstet. Gynaecol., 2010, 30, 302.

[12] Cunha T.M., Félix A., Cabral I.: “Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and gross visual inspection”. Int. J. Gynecol. Cancer, 2001, 11, 130-6.

[13] Vorgias G., Hintipas E., Katsoulis M., Kalinoglou N., Dertimas B., Akrivos T.: “Intraoperative gross examination of myometrial invasion and cervical infiltration in patients with endometrial cancer: decision-making accuracy”. Gynecol. Oncol., 2002, 85, 483.

[14] Sethasathien P., Charoenkwan K., Siriaunkgul S.: “Accuracy of intraoperative intraoperative gross examination of myometrial invasion in stage I-II endometrial cancer”. Asian Pac. J. Cancer Prev., 2014, 15, 7061.

[15] Hardesty L.A., Sumkin J.H., Hakim C., Johns C., Nath M.: “The ability of helical CT to preoperatively stage endometrial carcinoma”. AJR Am. J. Roentgenol., 2001, 176, 603.

[16] Savelli L., Ceccarini M., Ludovisi M., Fruscella E., De Iaco P.A., Salizzoni E., et al.: “Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging”. Ultrasound Obstet. Gynecol., 2008, 31, 560.

[17] Haldorsen I.S., Husby J.A., Werner H.M., Magnussen I.J., Rørvik J., Helland H., et al.: “Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists”. Eur. Radiol., 2012, 22, 1601.

[18] Nagar H., Dobbs S., McClelland H.R., Price J., McCluggage W.G., Grey A.: “The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer”. Gynecol. Oncol., 2006, 103, 431.

[19] Sanjuán A., Escaramís G., Ayuso J.R., Román S.M., Torné A., Ordi J., et al.: “Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer”. Arch Gynecol Obstet., 2008, 278, 535.

[20] Antonsen S.L., Jensen L.N., Loft A., Berthelsen A.K., Costa J., Tabor A., et al.: “MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer - a multicenter prospective comparative study”. Gynecol. Oncol., 2013, 128, 300.

[21] Ørtoft G., Dueholm M., Mathiesen O., Hansen E.S., Lundorf E., Møller C., et al.: “Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy”. Acta Obstet. Gynecol. Scand., 2013, 92, 536.

[22] Polyzos N.P., Mauri D., Tsioras S., Messini C.I., Valachis A., Messinis I.E.: “Intraperitoneal dissemination of endometrial cancer cells after hysteroscopy: a systematic review and meta-analysis”. Int. J. Gynecol. Cancer, 2010, 20, 261.

[23] Chang Y.N., Zhang Y., Wang Y.J., Wang L.P., Duan H.: “Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis”. Fertil. Steril., 2011, 96, 957.

[24] Hahn H.S., Song H.S., Lee I.H., Kim T.J., Lee K.H., Shim J.U., et al.: “Magnetic resonance imaging and intraoperative frozen sectioning for the evaluation of risk factors associated with lymph node metastasis in endometrial cancer”. Int. J. Gynecol. Cancer, 2013, 23, 1411.