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Baijnath P, Pelissier M, Sahki N, Henrot P. Evaluation of pre-therapeutic imaging work-up in the staging of endometrial cancer: Interest in a systematic second opinion in a cancer center. J Gynecol Obstet Hum Reprod 2024; 53:102716. [PMID: 38142752 DOI: 10.1016/j.jogoh.2023.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/26/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the interest of a systematic second opinion in quality assessment and FIGO staging in the pretherapeutic imaging work-up. MATERIALS AND METHODS A retrospective observational study was conducted on 156 patients who underwent surgery for endometrioid cancer in our institution. 42 % had their initial MRI scans performed in expert centers (University Hospital and Cancer center) and 58 % in non-expert centers. Quality assessment, concordances between initial reports, and second opinions by a junior and a senior ICL radiologist versus histopathological data were analyzed. RESULTS MRI scans performed in expert centers were more complete and more likely to be rated as higher quality. The overall accuracy of T staging from initial reports vs gold standard was 0.59 (95 % CI, 0.46-0.71) in expert centers and 0.49 (95 % CI, 0.38-0.60) in non-expert centers. The overall accuracy and Kappa of a second opinion for FIGO 2009 staging from expert center and non-expert center examinations were 0.61 (95 % CI, 0.48-0.72) vs 0.50 (95 % CI, 0.39-0.60) and 0.37 vs 0.27 for junior reader and 0.62 (95 % CI, 0.49-0.74) vs 0.48 (95 % CI, 0.37-0.58) and 0.39 vs 0.24 for senior reader, respectively. There was also a significant lower confidence level of the junior radiologist in MRI FIGO staging for non-expert center examinations (p 0.003). CONCLUSION Accuracy in the FIGO 2009 staging and quality assessment are higher for MR examinations performed from expert centers than in non-expert centers. A systematic second opinion by radiologists in expert centers should be proposed before pre-treatment multidisciplinary consultation.
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Affiliation(s)
- Pawan Baijnath
- Service d'imagerie médicale et de radiologie, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy F-54500, France.
| | - Margaux Pelissier
- Service d'imagerie médicale et de radiologie, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy F-54500, France
| | - Nassim Sahki
- Unité de biostatistique, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy, France
| | - Philippe Henrot
- Service d'imagerie médicale et de radiologie, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-les-Nancy F-54500, France
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López-González E, García-Jiménez R, Rodríguez-Jiménez A, Rojas-Luna JA, Daza-Manzano C, Gómez-Salgado J, Álvarez RM. Analysis of correlation of pre-therapeutic assessment and the final diagnosis in endometrial cancer: role of tumor volume in the magnetic resonance imaging. Front Oncol 2023; 13:1219818. [PMID: 37655105 PMCID: PMC10467420 DOI: 10.3389/fonc.2023.1219818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Objective To evaluate whether the introduction of tumor volume as new parameter in the MRI assessment could improve both concordance between preoperative and postoperative staging, and the identification of histological findings. Methods A retrospective observational study with 127 patients with endometrial cancer (EC) identified between 2016 and 2021 at the Juan Ramon Jimenez University Hospital, Huelva (Spain) was carried out. Tumor volume was measured in three ways. Analyses of Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) were performed. Results Although preoperative MRI had an 89.6% and 66.7% sensitivity for the detection of deep mucosal invasion and cervical stroma infiltration, preoperative assessment had an intraclass correlation coefficient of 0.517, underestimating tumor final stage in 12.6% of cases, with a poor agreement between preoperative MRI and postoperative staging (κ=0.082) and low sensitivity (14.3%) for serosa infiltration. The cut-off values for all three volume parameters had good/excellent AUC (0.73-0.85), with high sensitivity (70-83%) and specificity (64-84%) values for all histopathological variables. Excellent/good agreement was found all volume parameters for the identification of deep myometrial invasion (0.71), cervical stroma infiltration (0.80), serosa infiltration (0.81), and lymph node metastases (0.81). Conclusion Tumor volume measurements have good predictive capacity to detect histopathological findings that affect final tumor staging and might play a crucial role in the preoperative assessment of patients with endometrial cancer in the future.
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Affiliation(s)
- Elga López-González
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Rocío García-Jiménez
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - José Antonio Rojas-Luna
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Cinta Daza-Manzano
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labor Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Rosa María Álvarez
- Gynecological Oncology and Breast Cancer Unit, Department of Obstetrics and Gynecology, Hospital Universitario Santa Cristina, Madrid, Spain
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Moreira ASL, Ribeiro V, Aringhieri G, Fanni SC, Tumminello L, Faggioni L, Cioni D, Neri E. Endometrial Cancer Staging: Is There Value in ADC? J Pers Med 2023; 13:jpm13050728. [PMID: 37240898 DOI: 10.3390/jpm13050728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To assess the ability of apparent diffusion coefficient (ADC) measurements in predicting the histological grade of endometrial cancer. A secondary goal was to assess the agreement between MRI and surgical staging as an accurate measurement. METHODS Patients with endometrial cancers diagnosed between 2018-2020 and having received both MRI and surgical staging were retrospectively enrolled. Patients were characterized according to histology, tumor size, FIGO stage (MRI and surgical stage), and functional MRI parameters (DCE and DWI/ADC). Statistical analysis was performed to determine if an association could be identified between ADC variables and histology grade. Secondarily, we assessed the degree of agreement between the MRI and surgical stages according to the FIGO classification. RESULTS The cohort included 45 women with endometrial cancer. Quantitative analysis of ADC variables did not find a statistically significant association with histological tumor grades. DCE showed higher sensitivity than DWI/ADC in the assessment of myometrial invasion (85.00% versus 65.00%) with the same specificity (80.00%). A good agreement between MRI and histopathology for the FIGO stage was found (kappa of 0.72, p < 0.01). Differences in staging between MRI and surgery were detected in eight cases, which could not be justified by the interval between MRI and surgery. CONCLUSIONS ADC values were not useful for predicting endometrial cancer grade, despite the good agreement between MRI interpretation and histopathology of endometrial cancer staging at our center.
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Affiliation(s)
| | - Vera Ribeiro
- Gynaecology Department, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal
| | - Giacomo Aringhieri
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Salvatore Claudio Fanni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Tumminello
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Dania Cioni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
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Li X, Dessi M, Marcus D, Russell J, Aboagye EO, Ellis LB, Sheeka A, Park WHE, Bharwani N, Ghaem-Maghami S, Rockall AG. Prediction of Deep Myometrial Infiltration, Clinical Risk Category, Histological Type, and Lymphovascular Space Invasion in Women with Endometrial Cancer Based on Clinical and T2-Weighted MRI Radiomic Features. Cancers (Basel) 2023; 15:cancers15082209. [PMID: 37190137 DOI: 10.3390/cancers15082209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE To predict deep myometrial infiltration (DMI), clinical risk category, histological type, and lymphovascular space invasion (LVSI) in women with endometrial cancer using machine learning classification methods based on clinical and image signatures from T2-weighted MR images. METHODS A training dataset containing 413 patients and an independent testing dataset consisting of 82 cases were employed in this retrospective study. Manual segmentation of the whole tumor volume on sagittal T2-weighted MRI was performed. Clinical and radiomic features were extracted to predict: (i) DMI of endometrial cancer patients, (ii) endometrial cancer clinical high-risk level, (iii) histological subtype of tumor, and (iv) presence of LVSI. A classification model with different automatically selected hyperparameter values was created. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, F1 score, average recall, and average precision were calculated to evaluate different models. RESULTS Based on the independent external testing dataset, the AUCs for DMI, high-risk endometrial cancer, endometrial histological type, and LVSI classification were 0.79, 0.82, 0.91, and 0.85, respectively. The corresponding 95% confidence intervals (CI) of the AUCs were [0.69, 0.89], [0.75, 0.91], [0.83, 0.97], and [0.77, 0.93], respectively. CONCLUSION It is possible to classify endometrial cancer DMI, risk, histology type, and LVSI using different machine learning methods.
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Affiliation(s)
- Xingfeng Li
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Michele Dessi
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Diana Marcus
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- Chelsea and Westminster Hospital, 369 Fulham Rd., London SW10 9NH, UK
| | - James Russell
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Laura Burney Ellis
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Alexander Sheeka
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Won-Ho Edward Park
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Nishat Bharwani
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Andrea G Rockall
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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