- Wan-Ju Wu: Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
OBJECTIVE: To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) to detect deep myometrial invasion in patients with endometrial cancer.
MATERIALS AND METHODS: We retrospectively reviewed 66 cases of women with endometrial cancer, who underwent preoperative MRI assessment and surgical staging between January 2006 and October 2010. The MRI findings were then compared with the pathology results. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI in detecting deep myometrium invasion were evaluated.
RESULTS: The sensitivity, specificity, accuracy, PPV, and NPV results of MRI for the detection of deep myometrium invasion were 92.52%, 74.35%, 81.81%,71.42%, and 93.54%, respectively, with a kappa of 0.64. In the postmenopausal group, the values were 100%, 55.5%, 74.19%, 61.9%, and 100%. In the premenopausal women, they improved to 85.7%, 90.47%, 88.57%, 88.71%, and 90.47%. The sensitivity (100%) was better than the specificity (55.56%) in the postmenopausal women. The predictive value was markedly higher in the premenopausal women than the postmenopausal women (85.7% vs. 61.9%).
CONCLUSION: In patients with endometrial cancer, a preoperative MRI contributes to accurate staging, allowing planning for the scale of surgery and preoperative counseling. In our study, the pretreatment identification of myometrium invasion provided the opportunity for small-scale surgery in the premenopausal women with early endometrial cancer. However, for the postmenopausal patients, the standard surgical procedure is indicated even if the degree of myometrium invasion is low.