European Radiology

, Volume 27, Issue 5, pp 1877–1882 | Cite as

Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology

  • Sungmin Woo
  • Sang Youn Kim
  • Jeong Yeon Cho
  • Seung Hyup Kim



To investigate the added value of secondary reports issued by radiologists subspecializing in gynaecologic imaging for determining deep myometrial invasion of endometrial cancer on MRI.


Initial (from referring institutions) and secondary (by subspecialized radiologists) interpretations of MRI of 55 patients with endometrial cancer were retrospectively reviewed. A radiologist blinded to clinicopathological information assessed both reports for the presence of deep myometrial invasion. Reference standard was based on hysterectomy specimens. Kappa coefficients (k) were used to measure their concordance. McNemar testing and receiver operating characteristic (ROC) analysis was used to compare sensitivities, specificities and areas under the curves (AUCs).


Deep myometrial invasion was present in 25 (45.5 %) patients. Among 27.3 % (15/55; k = 0.458) patients with discrepant results, secondary interpretations were correct in 10 (66.7 %) cases. Sensitivity was higher in secondary than in initial reports (76.0 % vs. 48.0 %, p = 0.039) while no significant difference was seen in specificity (70.0 % vs. 76.7 %, p = 0.668). At ROC analysis, there was a tendency for higher AUCs in secondary reports (0.785 vs 0.669, p = 0.096).


Secondary readings of MRI by subspecialized gynaecologic oncologic radiologists may provide incremental value in determining deep myometrial invasion of endometrial cancer.

Key Points

Deep myometrial invasion is an important prognostic factor in endometrial cancer.

Assessment of deep myometrial invasion is often discrepant between initial and secondary reports.

Secondary reports showed higher sensitivity and accuracy.

Secondary review of MRI may provide incremental value in endometrial cancer patients.


Endometrial cancer Deep myometrial invasion Magnetic resonance imaging Subspecialty Gynaecologic oncologic imaging 



Area under the curve


Computed tomography


International Federation of Gynaecology and Obstetrics


Magnetic resonance imaging


Receiver operating curve


T2-weighted imaging



The scientific guarantor of this publication is Sang Youn Kim. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. None of the study subjects or cohorts have been previously reported in any studies. Methodology: retrospective, cross-sectional study, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Sungmin Woo
    • 1
  • Sang Youn Kim
    • 1
    • 2
  • Jeong Yeon Cho
    • 1
    • 3
  • Seung Hyup Kim
    • 1
    • 3
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulKorea
  2. 2.Department of RadiologySeoul National University HospitalSeoulKorea
  3. 3.Institute of Radiation Medicine and Kidney Research InstituteSeoul National University Medical Research CenterSeoulKorea

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