Assessment of Intrauterine Invasion of Endometrial Cancer by Magnetic Resonance Imaging

To assess intrauterine invasion by endometrial cancer through the use of magnetic resonance imaging (MRI), 26 patients with histologically-proven endometrial carcinoma underwent pre-operative pelvic MR staging. Twenty-five patients received primary treatment of abdominal hysterectomy or radical hysterectomy. The surgical specimens and MR findings were compared. The remaining one without surgery was considered to be a true stage Ia disease because repeated dilatation and curettage showed no residual tumor, and the patient was disease-free during two years follow-up. The presence of myometrial invasion was determined with an accuracy rate of 92%, and with a sensitivity of 95% plus a specificity of 83%. Accuracy in showing deep myometrial invasion was 90%, with a sensitivity of 100% and specificity of 82%. In evaluation of cervical invasion, the accuracy was 96%. The overall accuracy of staging endometrial carcinoma was 80%. This experience showed that MRI can be used to distinguish between superficial and deep myometrial invasion. It can alert the surgeon to make a thorough search for pelvic and paraaortic lymph node metastasis instead of limited nodal sampling, if deep myometrial invasion was depicted by MR.