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 preoperative 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