Endometrial carcinoma: merit of magnetic resonance in pre-surgical staging
ABSTRACT 115 Objetivo: Evaluar la capacidad de la RM para valorar la infiltración profunda del miometrio y cérvix en el carcinoma de endometrio. Pacientes y métodos: Se estudió una serie de 30 pacientes consecu-tivas diagnosticadas de cáncer de endometrio que fueron evaluadas pre-quirúrgicamente mediante resonancia magnética (RM). Se utilizaron se-cuencias TSE T2 con saturación de la grasa y secuencia dinámica FFE tras la administración de gadolinio. Se realizó una correlación con la estadificación posquirúrgica histológica. Se halló la sensibilidad (S), es-pecificidad (E), valor predictivo positivo (VPP) y valor predictivo ne-gativo (VPN) para la infiltración profunda miometrial y la invasión del cérvix. Se analizaron los casos de sobrestimación e infraestimación. Resultados: Para el miometrio y cérvix se obtuvo una S del 67% y 63%, E del 89% y 91%, VPP del 80% y 71% y VPN del 80% y 87%, respectivamente. Se sobrevaloraron dos casos para la infiltración miometrial y dos para el cérvix e infravaloraron cuatro y tres casos, respectivamente. Conclusión: La estadificación por RM del carcinoma de endometrio es una técnica de alta fiabilidad diagnóstica pero presenta sus limitaciones. Palabras clave: Tumores uterinos. Estadificación. Resonancia magné-tica. Miometrio. Cérvix. Endometrial carcinoma: merit of magnetic resonance in pre-surgical staging Aim: To evaluate MR capacity in assessing deep myometrial and cervical infiltrations in cases of endometrial carcinoma. Material and methods: A series of 30 consecutively diagnosed en-dometrial cancer patients was pre-surgically evaluated by means of magnetic resonance (MR). TSE-T2 sequences with fat saturation and dynamic FFE sequence were used after gadolinium administration. A correlation with post-surgical histological staging was made. There were then determined sensitivity (S), specificity (SP), positive predicti-ve value (PPV) and negative predictive value (NPV) for the deep myo-metrial infiltration and cervical invasion. Cases of overestimation and underestimation were analyzed. Results: Values obtained for myometrium and cervix were, respec-tively, S of 67% and 63%, SP of 89% and 91%, PPV of 80% and 71% and NPV of 80% and 87%. Two cases each were overvalued for myo-metrial infiltration and cervix; four cases and 3 cases, respectively, we-re undervalued.
British Journal of Obstetrics and Gynaecology 09/1989; 96(8):889-92.
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ABSTRACT: To apply a meta-analysis to compare the utility of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging in staging endometrial cancer. 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. 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. 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.Radiology 09/1999; 212(3):711-8. DOI:10.1148/radiology.212.3.r99au29711 · 6.21 Impact Factor
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ABSTRACT: To determine if, in a patient with an endometrial cancer, in addition to the knowledge of tumor grade, preoperative magnetic resonance (MR) imaging findings contribute to treatment stratification and specialist referral. By using a MEDLINE literature search and institutional pathology reports, pretest probabilities for myometrial invasion were correlated with tumor grade. Likelihood ratios (LRs) were obtained through summary receiver operating characteristics. The mean pretest probabilities of deep myometrial invasion were derived from seven articles (1,875 patients) and from 125 institutional pathology reports. LRs for the prediction of myometrial invasion with contrast-enhanced MR imaging were derived from nine studies (742 patients); positive and negative LRs were 10.11 and 0.1, respectively. The mean weighted pretest probabilities of deep myometrial invasion in patients with tumor grades 1, 2, or 3 were 13%, 35%, or 54%, respectively. Posttest probabilities of deep myometrial invasion for grades 1, 2, or 3 increased to 60%, 84%, or 92%, respectively, for positive and decreased to 1%, 5%, or 10%, respectively, for negative MR imaging findings. Use of contrast-enhanced MR imaging significantly affects the posttest probability of deep myometrial invasion in patients with all grades of endometrial cancer and could be used to select patients for specialist referral.Radiology 09/2000; 216(2):444-9. DOI:10.1148/radiology.216.2.r00au17444 · 6.21 Impact Factor