Proposed MRI sequences for local staging of endometrial cancer: a single center experience

Charis Bourgioti, Konstantinos Chatoupis, Aristeidis Antoniou, Evangelia Panourgias, Chara Tzavara, Lia Angela Moulopoulos

Abstract


Purpose: To present our experience with preoperative staging of endometrial cancer (EC) using dedicated MRI protocol at a tertiary referral center for female pelvic imaging.

Material and Methods: Between April 2013 and June 2018, 117 women (mean age: 59.9 years ± SD: 12.7) with newly diagnosed, biopsy-confirmed EC, underwent pelvic MRI for staging. In all patients, T2-weighted (T2W), T1- weighted (T1W), dynamic T1W gradient echo contrast-enhanced images (DCE) and diffusion weighted (DWI) images were  obtained. Two expert radiologists prospectively recorded the following tumour prognostic factors: size, depth (< or ≥50%) of myometrial involvement, cervical extension, extrauterine spread and metastatic nodes; MRI predictive ability for each of the above characteristics was statistically tested with ROC curve analysis, using surgicopathological results as the standard of reference. Chi square and Student’s t-test were used for possible association of maximal tumour/myometrial contrast on DCE with prognostic tumour histological features including type, grade, size and depth of myometrial invasion. Qualitative assessment regarding usefulness of applied MRI sequences for tumour local staging was also addressed.

Results: MRI exhibited high diagnostic accuracy for prediction of myometrial invasion (AUC=0.86, 95% CI: 0.78-0.93, p<0.001), cervical invasion (AUC=0.86, 95% CI: 0.70-1.00, p<0.001) and pelvic nodal involvement (AUC=0.90, 95% CI: 0.69-1.00, p=0.003). No association was found between maximal tumour/myometrial contrast on DCE and known histologic prognostic factors. For evaluation of myometrial invasion, DCE received significantly better rating compared to T2W or DWI alone; the combination of T2W and DCE (T2W+DCE) exhibited significantly better results for assessment of myometrial invasion compared to T2W+DWI and it was equally effective compared to T2W+DWI+DCE. For tumour cervical extension, DCE received significantly better rating compared to T2W or DWI alone; T2W+DCE and T2W+DCE+DWI significantly improved diagnosis of cervical invasion. For evaluation of metastatic lymphadenopathy, T2W was significantly more helpful than DWI; T2W+DWI were not superior to T2W alone for the evaluation of nodal metastases.

Conclusions: MRI is accurate for preoperative local staging of EC. DCE-MRI optimises assessment of myometrial and cervical invasion.


Keywords


Endometrial cancer/Staging; MR imaging/diagnosis; MR imaging/Dynamic Contrast Enhanced; MR imaging/Diffusion Weighted Imaging

Full Text:

PDF

References


Amant F, Mirza MR, Koskas M, et al. Cancer of the corpus uteri. Int J Gynecol Obstet 2018; 143(Suppl. 2): 37-50.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1): 7-30.

Nevadunsky NS, Van Arsdale A, Strickler HD, et al. Obesity and age at diagnosis of endometrial cancer. Obstet Gynecol 2014; 124(2 Pt 1): 300-306.

Edmondson RJ, Crosbie EJ, Nickkho-Amiry M, et al. Markers of the p53 pathway further refine molecular profiling in high-risk endometrial cancer: A TransPORTEC initiative. Gynecol Oncol 2017; 146(2): 327-333.

Lin MY, Dobrotwir A, McNally O, et al. Role of imaging in the routine management of endometrial cancer. Int J Gynecol Obstet 2018; 143(Suppl. 2): 109-117.

Haldorsen IS, Salvesen HB. Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol 2012; 67(1): 2-12.

Bonatti M. Stuefer J, Oberhofer N, et al. MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed? Eur J Radiol 2015; 84(2): 208-214.

Nougaret S, Horta M, Sala E, et al. Endometrial cancer MRI staging: Updated guidelines of the European society of urogenital radiology. Eur Radiol 2019; 29(2): 792-805.

Hori M, Kim T, Onishi H, et al. Endometrial cancer: preoperative staging using three-dimensional T2-weighted turbo spin-echo and diffusion-weighted MR imaging at 3.0 T: a prospective comparative study. Eur Radiol 2013; 23(8): 2296-2305.

Beddy P, Moyle P, Kataoka M, et al. Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 2012; 262(2): 530-537.

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 2014; 24(6): 1327-1338.

Chi DS, Barakat RR, Palayekar MJ, et al. The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology. Int J Gynecol Cancer 2008; 18(2): 269-273.

Lewandowski G, Torrisi J, Potkul RK, et al. Hysterectomy with extended surgical staging and radiotherapy versus hysterectomy alone and radiotherapy in stage I endometrial cancer: a comparison of complication rates. Gynecol Oncol 1990; 36(3): 401-404.

Xu G, Wang D, Ling X, et al. Diagnostic value of assessment of cervical involvement in early-stage endometrial adenocarcinoma: Comparison of magnetic resonance imaging (MRI) versus hysteroscopy. Med Sci Monit 2018; 24: 7952-7957.

Ugaki H, Kimura T, Miyatake T, et al. Intraoperative frozen section assessment of myometrial invasion and histology of endometrial cancer using the revised FIGO staging system. Int J Gynecol Cancer 2011; 21(7): 1180-1184.

Cade TJ, Quinn MA, McNally OM, et al. Predictive value of magnetic resonance imaging in assessing myometrial invasion in endometrial cancer: is radiological staging sufficient for planning conservative treatment? Int J Gynecol Cancer 2010; 20(7): 1166-1169.

Ozturk E, Dikensoy E, Balat O, et al. Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience. Arch Gynecol Obstet 2012; 285(5): 1415-1419.

Wu LM, Xu JR, Gu HY, et al. 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 2013; 23(2): 435-449.

Rechichi G, Galimberti S, Signorelli M, et al. Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 2010; 20(3): 754-762.

Sala E, Rockall A, Rangarajan D, et al. The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis. Eur J Radiol 2010; 76(3): 367-385.

Seo JM, Kim CK, Choi D, et al. Endometrial cancer: utility of diffusion-weighted magnetic resonance imaging with background body signal suppression at 3T. J Magn Reson Imaging 2013; 37(5): 1151-1159.

Deng L, Wang QP, Chen X, et al. The combination of Diffusion- and T2-Weighted Imaging in predicting deep myometrial invasion of endometrial cancer: A systematic review and meta-analysis. J Comput Assist Tomogr 2015; 39(5): 661-673.

Lin G, Huang YT, Chao A, et al. Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T. Eur Radiol 2017; 27(5): 1867-1876.

Lin G, Ng KK, Chang CJ, et al. Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging--initial experience. Radiology 2009; 250(3): 784-792.

Rizzo S, Femia M, Buscarino V, et al. Endometrial cancer: an overview of novelties in treatment and related imaging keypoints for local staging. Cancer Imaging 2018; 18(1): 45.

Takeuchi M, Matsuzaki K, Harada M. Evaluating myometrial invasion in endometrial cancer: Comparison of reduced field-of-view diffusion-weighted Imaging and dynamic contrast-enhanced MR Imaging. Magn Reson Med Sci 2018; 17(1): 28-34.

Park SB, Moon MH, Sung CK, et al. Dynamic contrast-enhanced MR imaging of endometrial cancer: optimizing the imaging delay for tumour-myometrium contrast. Eur Radiol 2014; 24(11): 2795-2799.

Manfredi R, Mirk P, Maresca G, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 2004; 231(2): 372-378.

Bourgioti C, Chatoupis K, Panourgias E, et al. Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology. Abdom Imaging 2015; 40(7): 2529-2540.

Rauch GM, Kaur H, Choi H, et al. Optimization of MR imaging for pretreatment evaluation of patients with endometrial and cervical cancer. Radiographics 2014; 34(4): 1082-1098.

Nougaret S, Tirumani SH, Addley H, et al. Pearls and pitfalls in MRI of gynecologic malignancy with diffusion-weighted technique. AJR Am J Roentgenol 2013; 200(2): 261-276.

Lin G, Ho KC, Wang JJ, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging 2008; 28(1): 128-135.

Shen G, Zhou H, Jia Z, et al. Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: a systematic review and meta-analysis. Br J Radiol 2015; 88(1052): 20150063.




DOI: http://dx.doi.org/10.36162/hjr.v4i3.294

Refbacks

  • There are currently no refbacks.