Assessment of Myometrial Invasion in Premenopausal Grade 1 Endometrial Carcinoma: Is Magnetic Resonance Imaging a Reliable Tool in Selecting Patients for Fertility-Preserving Therapy?

J Comput Assist Tomogr. May/Jun 2018;42(3):412-417. doi: 10.1097/RCT.0000000000000689.

Abstract

Objectives: The aim of this study was to evaluate the diagnostic ability of magnetic resonance imaging (MRI) in premenopausal women with G1 endometrial carcinoma.

Methods: Twenty-six patients underwent T2W, diffusion weighted, and dynamic contrast-enhanced 3-T MRI. The degree of myometrial invasion was pathologically classified into no invasion, shallow (3 mm or less), and more. Two radiologists assessed myometrial invasion on MRI. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values, AUC, and interobserver agreement were analyzed.

Results: For assessing myometrial invasion, mean accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and AUC, respectively, were as follows: 63%, 42%, 85%, 79%, 47%, and 0.75. Mean interobserver agreement was fair (k = 0.36). Shallow invasions were underestimated as no invasion on MRI in all 6 cases.

Conclusions: Magnetic resonance imaging produced false-negative result on half of patients. The misjudgments tended to happen in patients with shallow invasion.

MeSH terms

  • Adult
  • Endometrial Neoplasms / diagnostic imaging*
  • Endometrial Neoplasms / pathology
  • Female
  • Fertility Preservation*
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • Myometrium / diagnostic imaging*
  • Myometrium / pathology
  • Neoplasm Invasiveness
  • Patient Selection*
  • Premenopause*
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity