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MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis

  • Magnetic Resonance
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Abstract

Objectives

To compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MR imaging in detecting deep myometrial invasion in endometrial cancer, using surgical-pathological staging as reference standard.

Methods

After searching a wide range of electronic databases and screening titles/abstracts, we obtained full papers for potentially eligible studies and evaluated according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. From each study, we extracted information on diagnostic performance of DW and DCE sequences. After exploring heterogeneity, we adopted a bivariate generalized linear mixed model to compare the effect of the two MR sequences jointly on sensitivity and specificity.

Results

Nine studies (442 patients) were considered. Significant evidence of heterogeneity was found only for specificity, both in DW and DCE imaging (I 2 = 70.8 % and 70.6 %). Pooled sensitivity of DW and DCE was 0.86 and specificity did not significantly differ (p = 0.16) between the two sequences (DW = 0.86 and DCE = 0.82). No difference was found between 3-T and 1.5-T MR. There was no evidence of publication bias.

Conclusions

MR diagnostic accuracy in presurgical detection of deep myometrial infiltration in endometrial cancer is high. DCE and DW imaging do not differ in sensitivity and specificity.

Key Points

• Myometrial invasion is the most important morphological prognostic feature of endometrial cancer

• MR diagnostic accuracy in presurgical detection of deep myometrial infiltration is high

• MR examination including T2 and DCE imaging is considered the reference standard

• DW imaging has been increasingly employed with heterogeneous results

• This meta-analysis shows that DCE and DW do not differ in diagnostic accuracy

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Abbreviations

ADC:

apparent diffusion coefficient

AIC:

Akaike information criterion

CI:

confidence interval

CT:

computed tomography

DCE:

dynamic contrast-enhanced

DOR:

diagnostic odds ratio

DW:

diffusion-weighted

ESS:

effective sample size

FIGO:

International Federation of Gynecology and Obstetrics

GLMM:

generalized linear mixed model

LR+ and LR−:

positive and negative likelihood ratio

MR:

magnetic resonance

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

ROC:

receiver operating characteristic

SNR:

signal to noise ratio

US:

ultrasound

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Acknowledgments

We thanks Laura Colombo for her thoughtful help during bibliographic research and Liu Xiaoqiu for her translation from Chinese.

The scientific guarantor of this publication is Maria Grazia Valsecchi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Three of the authors have significant statistical expertise. Institutional review board approval was not required because the manuscript is a meta-analysis of already published studies and there are no patient level data. Written informed consent was not required for this study because the manuscript is a meta-analysis and there are no patient level data. Methodology: meta-analysis, performed at one institution.

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Authors and Affiliations

  1. Center of Biostatistics for Clinical Epidemiology, Department of Health Sciences, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy

    Anita Andreano, Paola Rebora, Sandro Sironi, Maria Grazia Valsecchi & Stefania Galimberti

  2. Department of Radiology, S. Gerardo Hospital, Via Pergolesi 33, Monza, MB, 20900, Italy

    Gilda Rechichi & Sandro Sironi

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  1. Anita Andreano
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Correspondence to Maria Grazia Valsecchi.

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Andreano, A., Rechichi, G., Rebora, P. et al. MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Eur Radiol 24, 1327–1338 (2014). https://doi.org/10.1007/s00330-014-3139-4

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