Predictive value of T2-weighted imaging and contrast-enhanced MR imaging in assessing myometrial invasion in endometrial cancer: a pooled analysis of prospective studies

Abstract Introduction The sentinel lymph node (SLN) concept represents advancement in the management of the endometrial cancer (EC). We aim to assess the performance of the SLN procedure; its positive predictive value (PPV) and negative predictive value (NPV); in stage I of EC (FIGO2009). Method A prospective study is conducted in our institution. We perform a double detection of the SLN (radiolabel Tc 99 microsulfur colloid and a color method using patent blue) followed by pelvic lymphadenectomy with or without paraaortic lymphadenectomy. A pelvic MRI is performed to determine myometrial invasion and nodal status. The injection of Tc 99m colloid occurs the day prior to surgery. The injection into the stroma of the cervix at the 3 and 9 o'clock positions was performed by an oncologist surgeon with the assistance of a nuclear medicine physician. Preoperative lymphoscintigraphy was obtained after 90-120 minutes. We inject into the cervical stroma 2cc of patent blue similar to the Tc99 injection. A gamma detecting probe is used to locate radioactive lymph nodes. The SLNs identified then are labelled as radioactive and/or blue. No frozen-section analysis was performed. Results For the pathological analysis of the SLN, Haematoxylin Eosin is used. If there is no metastasis detected, an ultra staging protocol using different anti-cytokeratines is conducted. Studies have shown that this approach is possible having satisfactory results when conducted by dedicated surgical, radiology and pathology team. We look forward to our outcomes to illustrate those results. Take-home message Sentinel lymph node is a good alternative for gynecological cancer

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Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging

European Radiology ◽

10.1007/s003300050365 ◽

1998 ◽

Vol 8 (2) ◽

pp. 218-223 ◽

Cited By ~ 32

Author(s):

G. Savci ◽

T. Ozyaman ◽

M. Tutar ◽

T. Bilgin ◽

O. Erol ◽

...

Keyword(s):

Mr Imaging ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Contrast Enhanced

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Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T

European Radiology ◽

10.1007/s00330-016-4583-0 ◽

2016 ◽

Vol 27 (5) ◽

pp. 1867-1876 ◽

Cited By ~ 19

Author(s):

Gigin Lin ◽

Yu-Ting Huang ◽

Angel Chao ◽

Yu-Chun Lin ◽

Lan-Yan Yang ◽

...

Keyword(s):

Endometrial Cancer ◽

Mr Imaging ◽

Diagnostic Accuracy ◽

Stromal Invasion ◽

Dynamic Contrast Enhanced ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Cervical Stromal Invasion

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Diagnostic Accuracy of Magnetic Resonance Imaging in Endometrial Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182571490 ◽

2012 ◽

Vol 22 (6) ◽

pp. 1020-1025 ◽

Cited By ~ 11

Author(s):

Mark H. McComiskey ◽

W. Glenn McCluggage ◽

Arthur Grey ◽

Ian Harley ◽

Stephen Dobbs ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Endometrial Cancer ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Myometrial Invasion ◽

Preoperative Assessment ◽

Tumor Board ◽

Resonance Imaging ◽

Outer Half

ObjectivesThe objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging.MethodsThis was a diagnostic accuracy study of prospective cases in conjunction with STARD guidelines using collected data from a tumor board within a cancer network. Consecutive series of all endometrial cancers in Northern Ireland over a 21-month period was discussed at the Gynaecological Oncology Multidisciplinary Team/tumor board meeting. This study concerns 183 women who met all the inclusion criteria. Main outcome measure was the correlation between the depth of myometrial invasion suggested by preoperative MRI study and the subsequent histopathological findings following examination of the hysterectomy specimen. Secondary end point was how MRI changed management of women who required surgery to be performed at a central cancer center.ResultsFor the detection of outer-half myometrial invasion, overall sensitivity of MRI was 0.73 (95% confidence interval [CI], 0.59–0.83), and specificity was 0.83 (95% CI, 0.76–0.89). The positive predictive value was 0.63 (95% CI, 0.50–0.74), and negative predictive value was 0.89 (95% CI, 0.82–0.93). Positive likelihood ratio was 4.35 (95% CI, 2.87–6.61), and negative likelihood ratio was 0.33 (95% CI, 0.21–0.52). Magnetic resonance imaging improved the sensitivity and negative predictive value of endometrial biopsy alone in predicting women with endometrial cancer who require full surgical staging (0.73 vs 0.65 and 0.80 vs 0.78, respectively).ConclusionsPreoperative pelvic MRI is a moderately sensitive and specific method of identifying invasion to the outer half of myometrium in endometrial cancer. Addition of MRI to preoperative assessment leads to improved preoperative assessment, triage, and treatment.

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Intraoperative Ex Vivo High-Resolution Sonography: A Novel Technique for the Assessment of Myometrial Invasion in Endometrial Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000531 ◽

2015 ◽

Vol 25 (9) ◽

pp. 1639-1644

Author(s):

Derman Basaran ◽

Mehmet Coskun Salman ◽

Gokhan Boyraz ◽

Deniz Akata ◽

Mustafa Ozmen ◽

...

Keyword(s):

Endometrial Cancer ◽

High Resolution ◽

Predictive Value ◽

Ex Vivo ◽

Frozen Section ◽

Myometrial Invasion ◽

University Hospital ◽

Type I ◽

Novel Technique ◽

Linear Probe

ObjectiveThis study aims to assess the diagnostic performance of a novel intraoperative ex vivo ultrasonography technique in determining deep myometrial invasion (MI) in patients with apparently low-risk endometrial cancer (EC).MethodsThis prospective study included patients with type I EC who underwent staging laparotomy at Hacettepe University Hospital from December 2011 to September 2014. After hysterectomy, a radiologist with special training in gynecology examined the uterus ex vivo using a 12-MHz superficial linear probe. The specimen was sent for intraoperative frozen section (FS) analysis. The results were compared with permanent section reports.ResultsIn total, 45 female patients were eligible for analysis. Intraoperative ex vivo high-resolution sonography (IEVHS) correctly assessed depth of MI in 39 of 45 cases (86.6%) and overestimated it in 5 cases (11.1%). Only 1 case with deep infiltration was underestimated by IEVHS as invasion of less than one half of the myometrium. Frozen section correctly identified depth of MI in 41 of 46 cases (91.1%), overestimated it in 1 case (2.2%), and underestimated it in 3 cases (6.6%). The sensitivity, specificity, positive predictive value, and negative predictive value of IEVHS and FS for assessment of deep MI were 87.5%, 86.4%, 58.3%, and 96.9%, and 62.5%, 97.3%, 83.3%, and 92.3%, respectively.ConclusionsIntraoperative ex vivo high-resolution sonography is a novel technique for assessing MI in EC. Its high sensitivity for deep MI could be useful as an adjunct to FS (enabling pathologists to obtain targeted FS slices) and could improve the accuracy of FS.

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