Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging in Staging Endometrial Cancer: a Five-year Experience
CYH Chan, SKW Shek, SKY Kwok, WK Wong, THN Wong, DHS Fung, WL Poon
Hong Kong J Radiol 2016;19:249-55
DOI: 10.12809/hkjr1615345
Objectives: To evaluate the accuracy of magnetic resonance imaging (MRI) in predicting deep myometrial invasion, cervical stromal invasion, and pelvic lymph node involvement in the preoperative assessment of women with endometrial cancer.
Methods: Patients with endometrial cancer, having preoperative MRI available, and hysterectomy performed in a regional hospital in Hong Kong between 1 January 2010 and 31 December 2014 were included. Those treated with neoadjuvant therapy or without staging MRI were excluded. Primary outcome measure was the correlation between deep myometrial invasion suggested by preoperative MRI and subsequent histopathology of the hysterectomy specimen. Imaging-pathological correlation of cervical stromal invasion and pelvic node involvement was also assessed.
Results: Overall 90 women met the criteria and were included in this study. Sensitivity, specificity, and accuracy of preoperative MRI was respectively 83.3%, 88.9%, and 87.8% for predicting deep myometrial invasion; 22.2%, 98.6%, and 83.3% for predicting cervical stromal invasion; and 60.0%, 96.6%, and 91.2% for predicting pelvic node disease.
Conclusions: Preoperative MRI is highly accurate in the detection of deep myometrial invasion, which is the single most important prognostic factor. It is moderately accurate and highly specific in the diagnosis of cervical stromal invasion and pelvic node metastasis. The favourable performance of preoperative MRI allows better surgical planning that may then translate into better patient outcome. Although not formally included in the FIGO staging system, it is a highly valuable adjunct in preoperative assessment of women with endometrial cancer.
Authors’ affiliation:
Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
中文摘要
術前磁共振成像用於子宮內膜癌分期的診斷準確率：五年經驗
陳彥豪、石家偉、郭啟欣、王旺根、王馨藝、馮漢盛、潘偉麟
目的：評估磁共振成像（MRI）在預測子宮內膜癌患者深肌層浸潤、宮頸間質浸潤和盆腔淋巴結累及的準確性。
方法：研究對象為2010年1月1日至2014年12月31日期間於香港一所分區醫院接受子宮切除術及術前MRI檢查的子宮內膜癌患者。曾接受新輔助療法或無分期MRI的患者不納入本研究。主要評估術前MRI顯示的深部子宮肌層浸潤狀況與子宮切除術標本的組織病理學之間的相關性。此外，對子宮頸間質浸潤和盆腔淋巴結的影像－病理學相關性進行了評估。
結果：共90名女性符合標準並納入本研究。術前MRI在預測以下三種病症的靈敏度、特異性和準確度的結果如下：深肌層浸潤為83.3%、88.9%和87.8%；宮頸間質浸潤為22.2%、98.6%和83.3%；盆腔淋巴結疾病為60.0%、96.6%和91.2%。
結論：術前MRI檢測深肌層浸潤狀況具有高度準確性，而深肌層浸潤正是一個最重要的預後因素。此外，術前MRI在宮頸間質浸潤和盆腔淋巴結轉移的診斷準確性屬中適度，特異性屬高度。術前MRI的準確性和特異性讓醫生能更好的作手術計劃，繼而轉化為更佳的病人預後。雖然術前MRI並未正式納入FIGO分期系統，但可作為一個具相當價值的子宮內膜癌患者術前評估工具。