RM de los tumores malignos de endometrio y cérvix

Structured reports of pelvic magnetic resonance imaging in primary endometrial cancer: Potential benefits for clinical decision-making

BACKGROUND

Although evidence is increasing that the implementation of structured reports (SRs) may increase the standardization of reports and improve communication between radiologists and end-users, it is unclear whether these alternative formats of Chinese radiological narratives are appealing or even acceptable to radiologists and clinicians.

OBJECTIVE

To compare the effect of SRs and non-structured reports (NSRs) of pelvic magnetic resonance imaging (MRI) in patients with primary endometrial cancer on referring gynecologists' satisfaction, further decision-making and efficiency.

METHODS

Forty-one patients with histologically proven endometrial cancer were included in this study. SRs and NSRs for local MRI staging of endometrial cancer were generated for all subjects. NSRs were generated during clinical routine practice. The same 41 uterine studies were reviewed by the same radiologist using structured reporting system after a period of time. Two radiologists compared SRs on the number of key features related to cancer staging and writing efficiency with NSRs together. Five gynecologists filled in questionnaires regarding satisfaction with content, clinical usefulness, report' quality and time consumption. Statistical analysis included Kendall's W test, paired-sample t test and Wilcoxon signed rank test.

RESULTS

There was no significant difference in the number of key features in NSRs comparison to SRs (p = 0.055). A statistically significant difference was observed in the satisfaction with linguistic quality for NSRs versus SRs by three gynaecologists (reader 1: 4.02 vs. 4.63, p = 0.002; reader 3: 3.86 vs. 4.02, p = 0.035; reader 4: 4.05 vs. 4.27, p = 0.024). The radiologist spent less time finishing SRs compared with NSRs (727.22 ± 38.42 sec vs. 616.44 ± 60.00 sec, p = 0.037).

CONCLUSIONS

The application of SRs significantly increased the value of female pelvic MRI reports by increasing radiologists' work efficiency and gynaecologists' satisfaction.

MRI is highly specific in determining primary cervical versus endometrial cancer when biopsy results are inconclusive

AIM

To evaluate utility of magnetic resonance imaging (MRI) in determining the primary site of endometrial versus cervical tumours when the biopsy results are inconclusive.

MATERIAL AND METHODS

Forty-eight patients who underwent a total hysterectomy for unknown primary adenocarcinoma of the uterus after endometrial and/or endocervical biopsies were included in the study. The 48 available pelvic MRI images were reviewed by two body radiologists independently and jointly to resolve discordance, blinded to any clinical and pathological information. The clinical information and histopathology were reviewed by a radiology fellow and a pathologist specializing is gynaecological oncology. The final surgical pathology was used as the reference standard to confirm the origin of the primary tumour.

RESULTS

The radiologists correctly identified the primary sites in 85% of the cases (41/48). There was substantial agreement between the two readers (kappa statistics = 0.79). Both radiologists found that T2 and dynamic T1-weighted images (WI) were most helpful in making the diagnosis, and dynamic T1WI helped resolve problematic cases. The sensitivity and specificity for detecting endometrial and cervical cancer on MRI were 88% and 88% and 75% and 93%, respectively.

CONCLUSION

MRI has high sensitivity and specificity in determining the origin of the primary endometrial versus cervical tumours when endometrial/endocervical curettage is inconclusive.