Abstract
Purpose
The aim of this study is to analyze the correct staging of primary endometrial cancer (EC) using clinical examination and 3 Tesla (T) magnetic resonance imaging (MRI) results compared to histopathology.
Methods
In this prospective, non-randomized, single-center study, 26 women with biopsy-proven EC were evaluated. All women underwent clinical examination including transvaginal ultrasound (CE/US) and 3T MRI (T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences) prior to surgery. Spearman’s correlation coefficient was employed to analyze the correlation between both staging methods and histopathology and generalized estimation equation analysis to compare their staging results. Main outcome measures are determinations of local tumor extent for EC on CE/US and 3T MRI compared to histopathology (gold standard).
Results
Sixteen women had an early-stage pT1a tumor, 10 a locally advanced ≥ pT1b tumor. The early stage was correctly diagnosed at CE/US in 100%, by MRI in 81%. Spearman’s correlation coefficient was r = 1.0 (p < 0.001) for correlation of CE/US and histopathology, r = 0.93 (p < 0.001) for correlation of MRI and pathology. A locally advanced tumor stage was exactly diagnosed by MRI in 70% and at CE/US in 50%.
Conclusions
CE/US is sufficient for staging T1a endometrial cancer, while MRI provides higher sensitivity in detecting locally advanced tumors. Based on our results, combining CE/US and 3T MRI in patients with at least suspected deep myometrial invasion offers a more reliable workflow for individual treatment planning.
Similar content being viewed by others
References
Howlader N, Noone A, Krapcho M, et al. (2016) Cancer Statistics Review, 1975-2014 - SEER Statistics, National Cancer Institute. SEER Cancer Stat Rev 1975-2014 https://seer.cancer.gov/csr/1975_2014/.
Baekelandt MM, Castiglione M (2009) Endometrial carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):29–31. https://doi.org/10.1093/annonc/mdp120
Chaudhry S, Reinhold C, Guermazi A et al (2003) Benign and malignant diseases of the endometrium. Top Magn Reson Imaging 14:339–357
Colombo N, Preti E, Landoni F et al. (2013) Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi33–8. 10.1093/annonc/mdt353
Savelli L, Ceccarini M, Ludovisi M et al (2008) Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obs Gynecol 31:560–566. https://doi.org/10.1002/uog.5295
Brocker KA, Alt CD, Breyer U et al (2014) Endometrial cancer: results of clinical and histopathological staging compared to magnetic resonance imaging using an endorectal surface coil. Arch Gynecol Obstet 289:851–858. https://doi.org/10.1007/s00404-013-3061-z
Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN et al (2008) Current issues in the management of endometrial cancer. Mayo Clin Proc 83:97–112. https://doi.org/10.4065/83.1.97
Vasconcelos C, Felix A, Cunha TM (2007) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and histopathologic evaluation. J Obs Gynaecol 27:65–70. https://doi.org/10.1080/01443610601056418
Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obs 105:103–104
Rockall AG, Meroni R, Sohaib SA et al (2007) Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer 17:188–196. https://doi.org/10.1111/j.1525-1438.2007.00805.x
Sala E, Rockall AG, Freeman SJ et al (2013) The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 266:717–740. https://doi.org/10.1148/radiol.12120315
Manfredi R, Mirk P, Maresca G et al (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378. https://doi.org/10.1148/radiol.23120211842312021184
Ortashi O, Jain S, Emannuel O et al (2008) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obs Gynecol Reprod Biol 137:232–235. https://doi.org/10.1016/j.ejogrb.2007.02.029
Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718
Leone FPG, Timmerman D, Bourne T et al (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: A consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35:103–112. https://doi.org/10.1002/uog.7487
Kinkel K, Forstner R, Danza FM et al (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574. https://doi.org/10.1007/s00330-009-1309-6
Alt CD, Brocker KA, Eichbaum M et al (2012) Accuracy of MRI with an endorectal coil for staging endometrial cancer. Acta Radiol 53:580–585. https://doi.org/10.1258/ar.2012.110617
Koyama T, Tamai K, Togashi K (2007) Staging of carcinoma of the uterine cervix and endometrium. Eur Radiol 17:2009–2019. https://doi.org/10.1007/s00330-006-0555-0
Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours 8th edition. Acad Leg Writ. 10.1002/ejoc.201200111
Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130. https://doi.org/10.2307/2531248
Bossuyt PM, Reitsma JB, Bruns DE et al (2007) Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Vet Clin Pathol 36:8–12. https://doi.org/10.1111/j.1939-165X.2007.tb00175.x
Wu LM, Xu JR, Gu HY et al (2013) Predictive value of T2-weighted imaging and contrast-enhanced MR imaging in assessing myometrial invasion in endometrial cancer: a pooled analysis of prospective studies. Eur Radiol 23:435–449. https://doi.org/10.1007/s00330-012-2609-9
Zuurendonk LD, Smit R, a, Mol BWJ, et al (2006) Routine pelvic lymphadenectomy in apparently early stage endometrial cancer. Eur J Surg Oncol 32:450–454. https://doi.org/10.1016/j.ejso.2006.02.008
Sala E, Rockall A, Kubik-Huch RA (2011) Advances in magnetic resonance imaging of endometrial cancer. Eur Radiol 21:468–473. https://doi.org/10.1007/s00330-010-2010-5
Beddy P, Moyle P, Kataoka M et al (2012) Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 262:530–537. https://doi.org/10.1148/radiol.11110984
Beddy P, O’Neill AC, Yamamoto AK et al (2012) FIGO staging system for endometrial cancer: added benefits of MR imaging. Radiographics 32:241–254. https://doi.org/10.1148/rg.321115045
NCCN (2015) NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms. Nccn
Haldorsen IS, Husby JA, Werner HMJ et al (2012) Standard 1.5-T MRI of endometrial carcinomas: Modest agreement between radiologists. Eur Radiol 22:1601–1611. https://doi.org/10.1007/s00330-012-2400-y
Emlik D, Kiresi D, Özdemir S et al (2010) Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: Comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging. J Med Imaging Radiat Oncol 54:202–210. https://doi.org/10.1111/j.1754-9485.2010.02160.x
Lin G, Ng K-K, Chang C-J et al (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging–initial experience. Radiology 250:784–792. https://doi.org/10.1148/radiol.2503080874
Teng F, Zhang YF, Wang YM et al (2015) Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: diagnostic value and error analysis in endometrial carcinoma. Acta Obstet Gynecol Scand 94:266–273. https://doi.org/10.1111/aogs.12570
Manfredi R, Gui B, Maresca G et al (2005) Endometrial cancer: magnetic resonance imaging. Abdom Imaging 30:626–636. https://doi.org/10.1007/s00261-004-0298-9
Piver MS, Lele SB, Barlow JJ, Blumenson L (1982) Paraaortic lymph node evaluation in stage I endometrial carcinoma. Obstet Gynecol 59:97–100
Hardesty LA, Sumkin JH, Nath ME et al (2000) Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology 215:45–49. https://doi.org/10.1148/radiology.215.1.r00ap3945
Yamashita Y, Harada M, Sawada T et al (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501. https://doi.org/10.1148/radiology.186.2.8421757
Chan JK, Cheung MK, Huh WK et al (2006) Therapeutic role of lymph node resection in endometrioid corpus cancer: A study of 12,333 patients. Cancer 107:1823–1830. https://doi.org/10.1002/cncr.22185
Funding
The trial was self-funded.
Author information
Authors and Affiliations
Contributions
KAB: project development, data collection, data analysis, and manuscript writing/editing. JPR: data analysis and manuscript editing. PH: protocol/project development and manuscript editing. CS: project development and manuscript editing. HPS: protocol/project development and manuscript editing. CDA: protocol/project development, data collection, and manuscript writing/editing.
Corresponding author
Ethics declarations
Conflict of interest
KA Brocker reports personal fees by Serag Wiessner, Naila, Germany, outside the submitted work. All the other authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this trial involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Brocker, K.A., Radtke, J.P., Hallscheidt, P. et al. Comparison of the determination of the local tumor extent of primary endometrial cancer using clinical examination and 3 Tesla magnetic resonance imaging compared to histopathology. Arch Gynecol Obstet 299, 1391–1398 (2019). https://doi.org/10.1007/s00404-019-05072-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-019-05072-5