Accuracy of MRI Staging in Endometrial Cancer: a 3 Year Longitudinal Study

Accuracy of MRI staging in endometrial cancer: a 3 year longitudinal study.

N. Folwell, AM. Paterson, AJ. Thomson, S. Evans, WM Hair.

Departments of Obstetrics and Gynaecology and Radiology, Royal Alexandra Hospital, Paisley.

Introduction

Magnetic resonance imaging (MRI) is an imaging modality used in the pre-operative staging of women with endometrial cancer. Information from MRI and pre-operative FIGO staging may assist in planning optimal patient management. However, studies investigating the performance of MRI have produced inconsistent results. The objective of this study was compare staging by MRI and final surgical staging in a cohort of women in Clyde with endometrial cancer.

Methods

Cases of endometrial cancer were ascertained using an electronic pathology database and through a manual check of paper records from January 2005 to August 2008. All cases had their notes reviewed. Pathology records were obtained for all those who underwent surgery. The estimated tumour stage of all those who underwent pre-operative MRI was compared to that from surgical staging. Cases were included in the final comparison only if they had both MRI and surgical staging.

Results

128 women were diagnosed with endometrial cancer. 20 patients did not undergo surgery but received radiotherapy and were excluded from the study. 51 patients had a pre-operative MRI scan, of which 10 did not have surgery and were excluded, leaving 41 cases for analysis.

With regard to accuracy of MRI staging, the results improved with time demonstrating a clear learning effect. There was agreement between surgical and radiological staging seen in 14.3% of patients in the 6 months beginning January 2005, rising to 60% in the period beginning July 2008 which is consistent with nationally published data.

There was also a clear effect of stage on accuracy of MRI staging with 83% of Stage 1a lesions being accurately staged falling to 33% for more advanced lesions.

Conclusions

MRI may be a valuable tool in the preoperative assessment of women with endometrial cancer. However, it is important to recognize the physical limitations of preoperative imaging and to appreciate that accurate interpretation requires considerable expertise and training.

The raw data:

128 patients with endometrial carcinoma

108 patients had a TAH/BSO (assumed because we have surgical staging available for them)

51 patients had an MRI scan

41 patients have had both an MRI scan and surgical staging