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Diagnostic Value of Pelvic MRI for Assessment of the Depth of Myometrial Invasion and Cervical Involvement in Endometrial Cancer: Comparison of New Versus Old FIGO Staging.

Zamani F, Goodarzi S, Hallaji F, Zamiri A, Deilami T, Malek M, Modarress Gilani M - Iran J Radiol (2012)

Bottom Line: For cervical stromal involvement, these values were 54.54%, 100%, 90.74%, 100% and 89.58%, respectively.In case of cervical mucosal involvement (in old FIGO staging), the positive predictive value was only 50% and the accuracy decreased to 74.07%.Agreement between MRI and the final histology using the old and new FIGO classification was appropriate with Kappa = 0.62 and 0.72, respectively (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Endometrial carcinoma is a highly prevalent gynecologic malignancy. The International Federation of Gynecology and Obstetrics (FIGO) staging system underwent significant revision on 2009. Key changes in the FIGO staging system include simplification of stage I endometrial cancer and removal of cervical mucosal invasion as a separate stage. MRI is a noninvasive diagnostic method for preoperative staging of endometrial cancer.

Objectives: The main purpose of this study was to investigate the diagnostic efficacy of pelvic MRI in determining the depth of myometrial invasion and cervical involvement in endometrial carcinoma. The other aim was to compare the accuracy of pelvic MRI using the old and new FIGO staging systems in endometrial carcinoma.

Patients and methods: Between November 2010 and January 2012, 54 patients underwent primary surgical staging in our department due to endometrial adenocarcinoma. Pre-operative pelvic MRI was performed and MRI staging was done according to old and new FIGO staging, separately. The sensitivity, specificity, positive and negative predictive values as well as the accuracy of MRI for deep myometrial invasion and cervical infiltration were calculated. MRI accuracy was also compared for old and new FIGO staging. Pathological staging was the standard of reference.

Results: The mean age was 53.31 (SD = 11.52) and the most common histological subtype was the endometrioid type of endometrial adenocarcinoma (90.8%). In the evaluation of deep tumoral invasion of the myometrium (> 50%), sensitivity, specificity, diagnostic accuracy and positive and negative predictive values of MRI were 82.35%, 94.59%, 90.74%, 87.5% and 92.1%, respectively. For cervical stromal involvement, these values were 54.54%, 100%, 90.74%, 100% and 89.58%, respectively. In case of cervical mucosal involvement (in old FIGO staging), the positive predictive value was only 50% and the accuracy decreased to 74.07%. Agreement between MRI and the final histology using the old and new FIGO classification was appropriate with Kappa = 0.62 and 0.72, respectively (P < 0.001).

Conclusion: Using 2009 FIGO classification increases the accuracy of pelvic MR imaging for preoperative staging of patients with early stages of endometrial cancer.

No MeSH data available.


Related in: MedlinePlus

A 40-year-old woman with vaginal bleeding.Sagittal T2-weighted (A) and coronal T2-weighted (B) images show an intermediate signal lesion within the endometrial cavity in A and B. The junctional zone is intact. Histopathology revealed stage Іa endometrial carcinoma.
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fig606: A 40-year-old woman with vaginal bleeding.Sagittal T2-weighted (A) and coronal T2-weighted (B) images show an intermediate signal lesion within the endometrial cavity in A and B. The junctional zone is intact. Histopathology revealed stage Іa endometrial carcinoma.

Mentions: Among 54 patients included in this study, the mean age was 53.31 years (range 24-73years). The most common chief complaint was post-menopausal bleeding (57.4%) and abnormal bleeding before menopause (33.3%). Pelvic mass, ascites and inguinal lymph node were the first presentation in the other patients. The most common histological subtype was the endometrioid type detected in 90.8% (49) of the patients. Papillary serous, clear cell and adenosquamous types were the other subtypes. The most common grade was well differentiated type (G1) 53.7% (Table 3). In the surgicopathological report, in 51.9% (28/54), the myometrial depth of invasion was less than 50% and in 31.5% (17/54), there was an equal or greater than 50% involvement and nine patients (16.75%) had no involvement of the myometrium. Seven out of 16 patients (43.8%) who did not have any myometrial invasion in the MRI report, had lower than 50% myometrial involvement in the final pathological findings (Figure 1). Three out of 22 patients (13.6%) with less than 50% myometrial involvement in MRI ultimately had more than 50% myometrial involvement. Fourteen out of 16 patients (87.5%) with an MRI report of more than 50% myometrial invasion had the same findings in final pathology reports. In the evaluation of the deep myometrial invasion (more than 50%), the sensitivity, specificity, diagnostic accuracy, positive and negative predictive values and positive and negative likelihood ratios of MRI (calculated with 95% confidence intervals) were 82.35%, 94.59%, 90.74%, 87.5% ,92.1% ,15.22 and 0.1865, respectively. Table 4 shows the correlation of myometrial involvement in MRI and pathology.


Diagnostic Value of Pelvic MRI for Assessment of the Depth of Myometrial Invasion and Cervical Involvement in Endometrial Cancer: Comparison of New Versus Old FIGO Staging.

Zamani F, Goodarzi S, Hallaji F, Zamiri A, Deilami T, Malek M, Modarress Gilani M - Iran J Radiol (2012)

A 40-year-old woman with vaginal bleeding.Sagittal T2-weighted (A) and coronal T2-weighted (B) images show an intermediate signal lesion within the endometrial cavity in A and B. The junctional zone is intact. Histopathology revealed stage Іa endometrial carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569552&req=5

fig606: A 40-year-old woman with vaginal bleeding.Sagittal T2-weighted (A) and coronal T2-weighted (B) images show an intermediate signal lesion within the endometrial cavity in A and B. The junctional zone is intact. Histopathology revealed stage Іa endometrial carcinoma.
Mentions: Among 54 patients included in this study, the mean age was 53.31 years (range 24-73years). The most common chief complaint was post-menopausal bleeding (57.4%) and abnormal bleeding before menopause (33.3%). Pelvic mass, ascites and inguinal lymph node were the first presentation in the other patients. The most common histological subtype was the endometrioid type detected in 90.8% (49) of the patients. Papillary serous, clear cell and adenosquamous types were the other subtypes. The most common grade was well differentiated type (G1) 53.7% (Table 3). In the surgicopathological report, in 51.9% (28/54), the myometrial depth of invasion was less than 50% and in 31.5% (17/54), there was an equal or greater than 50% involvement and nine patients (16.75%) had no involvement of the myometrium. Seven out of 16 patients (43.8%) who did not have any myometrial invasion in the MRI report, had lower than 50% myometrial involvement in the final pathological findings (Figure 1). Three out of 22 patients (13.6%) with less than 50% myometrial involvement in MRI ultimately had more than 50% myometrial involvement. Fourteen out of 16 patients (87.5%) with an MRI report of more than 50% myometrial invasion had the same findings in final pathology reports. In the evaluation of the deep myometrial invasion (more than 50%), the sensitivity, specificity, diagnostic accuracy, positive and negative predictive values and positive and negative likelihood ratios of MRI (calculated with 95% confidence intervals) were 82.35%, 94.59%, 90.74%, 87.5% ,92.1% ,15.22 and 0.1865, respectively. Table 4 shows the correlation of myometrial involvement in MRI and pathology.

Bottom Line: For cervical stromal involvement, these values were 54.54%, 100%, 90.74%, 100% and 89.58%, respectively.In case of cervical mucosal involvement (in old FIGO staging), the positive predictive value was only 50% and the accuracy decreased to 74.07%.Agreement between MRI and the final histology using the old and new FIGO classification was appropriate with Kappa = 0.62 and 0.72, respectively (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Endometrial carcinoma is a highly prevalent gynecologic malignancy. The International Federation of Gynecology and Obstetrics (FIGO) staging system underwent significant revision on 2009. Key changes in the FIGO staging system include simplification of stage I endometrial cancer and removal of cervical mucosal invasion as a separate stage. MRI is a noninvasive diagnostic method for preoperative staging of endometrial cancer.

Objectives: The main purpose of this study was to investigate the diagnostic efficacy of pelvic MRI in determining the depth of myometrial invasion and cervical involvement in endometrial carcinoma. The other aim was to compare the accuracy of pelvic MRI using the old and new FIGO staging systems in endometrial carcinoma.

Patients and methods: Between November 2010 and January 2012, 54 patients underwent primary surgical staging in our department due to endometrial adenocarcinoma. Pre-operative pelvic MRI was performed and MRI staging was done according to old and new FIGO staging, separately. The sensitivity, specificity, positive and negative predictive values as well as the accuracy of MRI for deep myometrial invasion and cervical infiltration were calculated. MRI accuracy was also compared for old and new FIGO staging. Pathological staging was the standard of reference.

Results: The mean age was 53.31 (SD = 11.52) and the most common histological subtype was the endometrioid type of endometrial adenocarcinoma (90.8%). In the evaluation of deep tumoral invasion of the myometrium (> 50%), sensitivity, specificity, diagnostic accuracy and positive and negative predictive values of MRI were 82.35%, 94.59%, 90.74%, 87.5% and 92.1%, respectively. For cervical stromal involvement, these values were 54.54%, 100%, 90.74%, 100% and 89.58%, respectively. In case of cervical mucosal involvement (in old FIGO staging), the positive predictive value was only 50% and the accuracy decreased to 74.07%. Agreement between MRI and the final histology using the old and new FIGO classification was appropriate with Kappa = 0.62 and 0.72, respectively (P < 0.001).

Conclusion: Using 2009 FIGO classification increases the accuracy of pelvic MR imaging for preoperative staging of patients with early stages of endometrial cancer.

No MeSH data available.


Related in: MedlinePlus