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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 46-year-old woman with biopsy-proven endometrial carcinoma. Sagittal T2-weighted MRI shows a large mass within the endometrial cavity invading the deep myometrium and cervical stroma. Histopathology confirmed stage ІІ endometrial carcinoma.
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fig607: A 46-year-old woman with biopsy-proven endometrial carcinoma. Sagittal T2-weighted MRI shows a large mass within the endometrial cavity invading the deep myometrium and cervical stroma. Histopathology confirmed stage ІІ endometrial carcinoma.

Mentions: According to the correlation of cervical invasion in MRI and the final pathology report, 29 out of 46 patients (63%) without cervical involvement in MRI did not have any cervical invasion in the surgicopthological report, 13 patients (28.3%) had only mucosal and four patients (8.7%) had stromal involvement. One out of two patients (50%) with mucosal involvement in MRI had mucosal and another one had stromal involvement (Figure 2). In case of cervical stromal involvement in the MRI report, all of them had stromal invasion in the pathology report (100% correlation between MRI and pathology). For cervical stromal involvement, the sensitivity, specificity, diagnostic accuracy, positive and negative predictive values and positive and negative likelihood ratios of MRI were 54.54%, 100%, 90.74%, 100%, 89.58%, 2.85 and 0.95, respectively (calculated with 95% confidence intervals). In the case of mucosal involvement, the positive predictive value was only 50% and the accuracy decreased to 74.07%. For agreement between MRI report and pathology of cervix, the Kappa was 0.347. According to old and new FIGO staging classifications, among the patients with stage Ia in MRI based on the old FIGO staging system, eight patients (57.1%) had the same pathological stage, two patients (14.3%) had Ib, one (7.1%) had IIa, one patient (7.1%) had IIb and two patients (14.3%) had IIIa. Six (85.7%) of the patients with Ic,had the same stage and one patient had stage IIa. Two (66.7 %) of the patients with stage IIb in MRI, had the same report and one (33.3%) had IIIa. The Kappa for agreement of old staging between MRI and pathology results was 0.628.


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 46-year-old woman with biopsy-proven endometrial carcinoma. Sagittal T2-weighted MRI shows a large mass within the endometrial cavity invading the deep myometrium and cervical stroma. Histopathology confirmed stage ІІ endometrial carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig607: A 46-year-old woman with biopsy-proven endometrial carcinoma. Sagittal T2-weighted MRI shows a large mass within the endometrial cavity invading the deep myometrium and cervical stroma. Histopathology confirmed stage ІІ endometrial carcinoma.
Mentions: According to the correlation of cervical invasion in MRI and the final pathology report, 29 out of 46 patients (63%) without cervical involvement in MRI did not have any cervical invasion in the surgicopthological report, 13 patients (28.3%) had only mucosal and four patients (8.7%) had stromal involvement. One out of two patients (50%) with mucosal involvement in MRI had mucosal and another one had stromal involvement (Figure 2). In case of cervical stromal involvement in the MRI report, all of them had stromal invasion in the pathology report (100% correlation between MRI and pathology). For cervical stromal involvement, the sensitivity, specificity, diagnostic accuracy, positive and negative predictive values and positive and negative likelihood ratios of MRI were 54.54%, 100%, 90.74%, 100%, 89.58%, 2.85 and 0.95, respectively (calculated with 95% confidence intervals). In the case of mucosal involvement, the positive predictive value was only 50% and the accuracy decreased to 74.07%. For agreement between MRI report and pathology of cervix, the Kappa was 0.347. According to old and new FIGO staging classifications, among the patients with stage Ia in MRI based on the old FIGO staging system, eight patients (57.1%) had the same pathological stage, two patients (14.3%) had Ib, one (7.1%) had IIa, one patient (7.1%) had IIb and two patients (14.3%) had IIIa. Six (85.7%) of the patients with Ic,had the same stage and one patient had stage IIa. Two (66.7 %) of the patients with stage IIb in MRI, had the same report and one (33.3%) had IIIa. The Kappa for agreement of old staging between MRI and pathology results was 0.628.

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