Magnetic resonance imaging in the preoperative assessment of clinical stage I endometrial carcinoma

The ability of helical CT to preoperatively stage endometrial carcinoma

OBJECTIVE

This study evaluated helical CT as an imaging modality for preoperative staging of endometrial carcinoma.

MATERIALS AND METHODS

Three radiologists retrospectively and independently reviewed the preoperative helical CT scans of 25 consecutive patients with endometrial carcinoma. The presence or absence of deep myometrial invasion and the presence or absence of cervical involvement were evaluated on helical CT and compared with pathologic findings at hysterectomy.

RESULTS

Helical CT has a sensitivity of 83% and a specificity of 42% for the detection of deep myometrial invasion (stage IC). Helical CT has a sensitivity of 25% and a specificity of 70% for the detection of cervical involvement (state II). These results compare poorly with those of MR imaging (sensitivity 92%, specificity 90% for the detection of deep myometrial invasion; sensitivity 86%, specificity 97% for the detection of cervical involvement).

CONCLUSION

Helical CT is insensitive and nonspecific compared with MR imaging for the preoperative staging of endometrial carcinoma. MR imaging remains the imaging modality of choice.

Radiologic staging in patients with endometrial cancer: a meta-analysis

PURPOSE

To apply a meta-analysis to compare the utility of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging in staging endometrial cancer.

MATERIALS AND METHODS

Data were obtained from a MEDLINE literature search and from manual reviews of article bibliographies. Articles were selected that included results in patients with proved endometrial cancer and imaging-histopathologic correlation and that presented data that allowed calculation of contingency tables. Data for the imaging evaluation of myometrial and cervical invasion were abstracted independently by two authors. Data on year of publication, International Federation of Gynecology and Obstetrics (FIGO) stage distribution, and methodologic quality were also collected. A subgroup analysis was performed to compare contrast medium-enhanced MR imaging with nonenhanced MR imaging, US, and CT.

RESULTS

Six studies met the inclusion criteria for CT; 16, for US; and 25, for MR imaging. Summary receiver operating characteristic analysis showed no significant differences in the overall performance of CT, US, and MR imaging. In the assessment of myometrial invasion, however, contrast-enhanced MR imaging performed significantly better than did nonenhanced MR imaging or US (P < .002) and demonstrated a trend toward better results, as compared with CT. The lack of data on the assessment of cervical invasion at CT or US prevented meta-analytic comparison with data obtained at MR imaging. Results were not influenced by year of publication, FIGO stage distribution, or methodologic quality.

CONCLUSION

Although US, CT, or MR imaging can be used in the pretreatment evaluation of endometrial cancer, contrast-enhanced MR imaging offers "one-stop" examination with the highest efficacy.

Risk factors predictive of para-aortic lymph node metastasis in endometrial carcinomas

OBJECTIVE

To identify risk factors predictive of para-aortic lymph node (PAN) metastasis in endometrial carcinomas.

METHODS

Sixty patients with endometrial carcinomas Stage I to III (FIGO, 1988) who each underwent a complete pelvic and para-aortic lymphadenectomy with a semiradical or radical hysterectomy, bilateral salpingo-oophorectomy, between April 1988 and March 1996, were included in this study. The relationship between PAN metastasis and clinico-pathological factors such as histological type, grade, depth of myometrial invasion (MI), vascular space involvement (VSI), cervical invasion (CI), peritoneal cytology, tumor size, pelvic lymph node (PLN) metastasis, and glutathione S-transferase pi (GST-pi) expression was examined using univariate and multivariate analysis.

RESULTS

Seven variables--G3 grade, more than one-half MI, positive VSI, positive CI, tumor size of more than 2 cm in diameter, positive PLN metastasis, and positive GST-pi--were significantly correlated with PAN metastasis using univariate analysis. Multivariate analysis revealed that of the above 7 variables, 3 were significantly and independently correlated with PAN metastasis: more than one-half MI, positive PLN, and positive GST-pi. The relative risk of a patient with these 3 factors having PAN metastasis was 18.0 times greater than the risk for a patient without them.

CONCLUSION

These variables--More than one-half MI, positive PLN, and positive GST-pi--were significantly related to PAN metastasis.

Endometrial carcinoma: dynamic MRI with turbo-FLASH technique

PURPOSE

Our goal was to investigate the usefulness of dynamic MRI with the turbo-FLASH technique in estimating myometrial invasion by endometrial carcinoma.

METHOD

Forty-six patients with endometrial carcinomas were evaluated with pathologic correlation. Dynamic MRI was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique.

RESULTS

The inner muscle layer showed more rapid contrast enhancement effects than the outer muscle layer even after menopause. Contrast-to-noise ratio between the inner muscle layer and endometrial carcinoma was maximum at approximately 50 s after administration of Gd-DTPA. In postmenopausal women, the accuracy in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MRI was 66.7, 77.8, and 92.6%, respectively.

CONCLUSION

Dynamic MRI with the turbo-FLASH technique is considered to be a useful imaging method for the estimation of myometrial invasion by endometrial carcinoma, especially in postmenopausal patients.