Comparison of the determination of the local tumor extent of primary endometrial cancer using clinical examination and 3 Tesla magnetic resonance imaging compared to histopathology
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The aim of this study is to analyze the correct staging of primary endometrial cancer (EC) using clinical examination and 3 Tesla (T) magnetic resonance imaging (MRI) results compared to histopathology.
In this prospective, non-randomized, single-center study, 26 women with biopsy-proven EC were evaluated. All women underwent clinical examination including transvaginal ultrasound (CE/US) and 3T MRI (T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences) prior to surgery. Spearman’s correlation coefficient was employed to analyze the correlation between both staging methods and histopathology and generalized estimation equation analysis to compare their staging results. Main outcome measures are determinations of local tumor extent for EC on CE/US and 3T MRI compared to histopathology (gold standard).
Sixteen women had an early-stage pT1a tumor, 10 a locally advanced ≥ pT1b tumor. The early stage was correctly diagnosed at CE/US in 100%, by MRI in 81%. Spearman’s correlation coefficient was r = 1.0 (p < 0.001) for correlation of CE/US and histopathology, r = 0.93 (p < 0.001) for correlation of MRI and pathology. A locally advanced tumor stage was exactly diagnosed by MRI in 70% and at CE/US in 50%.
CE/US is sufficient for staging T1a endometrial cancer, while MRI provides higher sensitivity in detecting locally advanced tumors. Based on our results, combining CE/US and 3T MRI in patients with at least suspected deep myometrial invasion offers a more reliable workflow for individual treatment planning.
KeywordsEndometrial cancer staging Myometrial invasion Ultrasound 3 Tesla magnetic resonance imaging
KAB: project development, data collection, data analysis, and manuscript writing/editing. JPR: data analysis and manuscript editing. PH: protocol/project development and manuscript editing. CS: project development and manuscript editing. HPS: protocol/project development and manuscript editing. CDA: protocol/project development, data collection, and manuscript writing/editing.
The trial was self-funded.
Compliance with ethical standards
Conflict of interest
KA Brocker reports personal fees by Serag Wiessner, Naila, Germany, outside the submitted work. All the other authors declare that they have no conflict of interest.
All procedures performed in this trial involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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