Skip to main content
SpringerLink
Log in

Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T

  • Urogenital
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for detecting cervical stromal invasion in endometrial cancer.

Methods

Eighty-three consecutive women with endometrial cancer underwent preoperative evaluation in a 3-T unit, including T2-weighted, DW (b = 0 and 1000 s/mm2), and DCE MR imaging. Two radiologists independently assessed presence of cervical stromal invasion, with histopathological reference as gold standard.

Results

For assessing cervical stromal invasion, the diagnostic accuracy, sensitivity, and specificity, respectively for Reader 1/Reader 2, were as follows: DW MR imaging— 95.2 %/91.6 %, 91.7 %/100 %, and 95.8 %/90.1 %; DCE MR imaging— 91.6 %/88 %, 58.3 %/50 %, and 97.2 %/94.4 %. The diagnostic performance of DW MR imaging (Reader 1: areas under the receiver operating characteristic curve (AUC) = 0.98; Reader 2: AUC = 0.97) was significantly higher than that of DCE MR imaging (p = 0.009 for Reader 2) or T2-weighted MR imaging (Reader 1: p = 0.006; Reader 2: p = 0.013). Patients with cervical stromal invasion showed a significantly greater canal width (p < 0.0001) and myometrial invasion extent (p = 0.006).

Conclusions

DW MR imaging has superior diagnostic performance compared with DCE MR imaging in the detection of cervical stromal invasion.

Key Points

• DWI demonstrates a higher accuracy than DCE in detecting cervical stromal invasion.

• Tumour ADC values are similar between patients without or with cervical invasion.

• Canal widening causes false-negativity on DCE and T2W but not on DWI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Areas under the receiver operating characteristics curve

CA-125:

Cancer antigen 125

DCE:

Dynamic contrast-enhanced

DW:

Diffusion-weighted

FIGO:

International Federation of Gynecology and Obstetrics

FOV:

Field of view

MR:

Magnetic resonance

NCCN:

National Comprehensive Cancer Network

ROI:

Region of interest

TR:

Repetition time

TE:

Echo time

References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7–30

    Article  PubMed  Google Scholar 

  2. Turan T, Hizli D, Yilmaz SS et al (2012) What is the impact of cervical invasion on lymph node metastasis in patients with stage IIIC endometrial cancer? Arch Gynecol Obstet 285:1119–1124

    Article  PubMed  Google Scholar 

  3. Solmaz U, Mat E, Dereli M et al (2015) Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer. Aust N Z J Obstet Gynaecol 55:81–86

    Article  PubMed  Google Scholar 

  4. Taskin S, Ortac F, Kahraman K, Goc G, Oztuna D, Gungor M (2013) Cervical stromal involvement can predict survival in advanced endometrial carcinoma: a review of 67 patients. Int J Clin Oncol 18:105–109

    Article  PubMed  Google Scholar 

  5. Kwon JS, Qiu F, Saskin R, Carey MS (2009) Are uterine risk factors more important than nodal status in predicting survival in endometrial cancer? Obstet Gynecol 114:736–743

    Article  PubMed  Google Scholar 

  6. Ferriss JS, Brix W, Tambouret R, DeSimone CP, Stoler M, Modesitt SC (2010) Cervical stromal invasion predicting survival in endometrial cancer. Obstet Gynecol 116:1035–1041

    Article  PubMed  Google Scholar 

  7. Tewari KS, Filiaci VL, Spirtos NM et al (2012) Association of number of positive nodes and cervical stroma invasion with outcome of advanced endometrial cancer treated with chemotherapy or whole abdominal irradiation: a Gynecologic Oncology Group study. Gynecol Oncol 125:87–93

    Article  PubMed  Google Scholar 

  8. Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104

    Article  PubMed  Google Scholar 

  9. NCCN Clinical Practice Guidelines in Oncology: Uterine Cancers. National Comprehensive Cancer Network, USA. Available via http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed 23 May, 2016

  10. American College of O, Gynecologists (2005) ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 106:413–425

    Article  Google Scholar 

  11. Eskander RN, Randall LM, Berman ML, Tewari KS, Disaia PJ, Bristow RE (2011) Fertility preserving options in patients with gynecologic malignancies. Am J Obstet Gynecol 205:103–110

    Article  PubMed  PubMed Central  Google Scholar 

  12. Manfredi R, Mirk P, Maresca G et al (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378

    Article  PubMed  Google Scholar 

  13. Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718

    Article  CAS  PubMed  Google Scholar 

  14. Ortashi O, Jain S, Emannuel O, Henry R, Wood A, Evans J (2008) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obstet Gynecol Reprod Biol 137:232–235

    Article  PubMed  Google Scholar 

  15. Cicinelli E, Marinaccio M, Barba B et al (2008) Reliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: a comparative study with transvaginal sonography and MRI. Gynecol Oncol 111:55–61

    Article  PubMed  Google Scholar 

  16. Mascilini F, Testa AC, Van Holsbeke C, Ameye L, Timmerman D, Epstein E (2013) Evaluating myometrial and cervical invasion in women with endometrial cancer: comparing subjective assessment with objective measurement techniques. Ultrasound Obstet Gynecol 42:353–358

    Article  CAS  PubMed  Google Scholar 

  17. Haldorsen IS, Berg A, Werner HM et al (2012) Magnetic resonance imaging performs better than endocervical curettage for preoperative prediction of cervical stromal invasion in endometrial carcinomas. Gynecol Oncol 126:413–418

    Article  PubMed  Google Scholar 

  18. Luomaranta A, Leminen A, Loukovaara M (2015) Magnetic resonance imaging in the assessment of high-risk features of endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer 25:837–842

    Article  PubMed  Google Scholar 

  19. Rauch GM, Kaur H, Choi H et al (2014) Optimization of MR imaging for pretreatment evaluation of patients with endometrial and cervical cancer. Radiographics 34:1082–1098

    Article  PubMed  PubMed Central  Google Scholar 

  20. Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK (1996) Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol 88:394–398

    Article  CAS  PubMed  Google Scholar 

  21. Nagar H, Dobbs S, McClelland HR, Price J, McCluggage WG, Grey A (2006) The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer. Gynecol Oncol 103:431–434

    Article  PubMed  Google Scholar 

  22. Seki H, Takano T, Sakai K (2000) Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervix. AJR Am J Roentgenol 175:171–176

    Article  CAS  PubMed  Google Scholar 

  23. Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E (2012) The revised FIGO staging system for uterine malignancies: implications for MR imaging. Radiographics 32:1805–1827

    Article  PubMed  Google Scholar 

  24. Lin G, Ng KK, Chang CJ et al (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging--initial experience. Radiology 250:784–792

    Article  PubMed  Google Scholar 

  25. Beddy P, Moyle P, Kataoka M et al (2012) Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 262:530–537

    Article  PubMed  Google Scholar 

  26. Kinkel K, Forstner R, Danza FM et al (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574

    Article  CAS  PubMed  Google Scholar 

  27. Koplay M, Dogan NU, Erdogan H et al (2014) Diagnostic efficacy of diffusion-weighted MRI for pre-operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma. J Med Imaging Radiat Oncol 58:538–546

    Article  PubMed  Google Scholar 

  28. Hori M, Kim T, Onishi H et al (2013) Endometrial cancer: preoperative staging using three-dimensional T2-weighted turbo spin-echo and diffusion-weighted MR imaging at 3.0 T: a prospective comparative study. Eur Radiol 23:2296–2305

    Article  PubMed  Google Scholar 

  29. Bonatti M, Stuefer J, Oberhofer N et al (2015) MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed? Eur J Radiol 84:208–214

    Article  PubMed  Google Scholar 

  30. Lin G, Huang YT, Chao A et al (2015) Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: diffusion-weighted and dynamic contrast-enhanced MRI at 3 T. Clin Radiol 70:1260–1268

    Article  CAS  PubMed  Google Scholar 

  31. Sanjuan A, Escaramis G, Ayuso JR et al (2008) Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer. Arch Gynecol Obstet 278:535–539

    Article  CAS  PubMed  Google Scholar 

  32. Tamai K, Koyama T, Saga T et al (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687

    Article  PubMed  Google Scholar 

  33. Kurman RJ (2002) Blaustein’s pathology of the female genital tract, 5 edn. Springer, Berlin Heidelberg New York

  34. McCluggage WG, Hirschowitz L, Wilson GE, Oliva E, Soslow RA, Zaino RJ (2011) Significant variation in the assessment of cervical involvement in endometrial carcinoma: an interobserver variation study. Am J Surg Pathol 35:289–294

    Article  PubMed  Google Scholar 

  35. Fleiss JL (1981) Statistical methods for rates and proportions. Wiley, New York

    Google Scholar 

  36. Medina LS, Zurakowski D (2003) Measurement variability and confidence intervals in medicine: why should radiologists care? Radiology 226:297–301

    Article  PubMed  Google Scholar 

  37. Emlik D, Kiresi D, Ozdemir S, Celik C, Karakose S (2010) Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging. J Med Imaging Radiat Oncol 54:202–210

    Article  CAS  PubMed  Google Scholar 

  38. Antonsen SL, Jensen LN, Loft A et al (2013) MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer - a multicenter prospective comparative study. Gynecol Oncol 128:300–308

    Article  CAS  PubMed  Google Scholar 

  39. Duncan KA, Drinkwater KJ, Frost C, Remedios D, Barter S (2012) Staging cancer of the uterus: a national audit of MRI accuracy. Clin Radiol 67:523–530

    Article  CAS  PubMed  Google Scholar 

  40. Vasconcelos C, Felix A, Cunha TM (2007) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and histopathologic evaluation. J Obstet Gynaecol 27:65–70

    Article  CAS  PubMed  Google Scholar 

  41. Cabrita S, Rodrigues H, Abreu R et al (2008) Magnetic resonance imaging in the preoperative staging of endometrial carcinoma. Eur J Gynaecol Oncol 29:135–137

    CAS  PubMed  Google Scholar 

  42. Teng F, Zhang YF, Wang YM et al (2015) Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: diagnostic value and error analysis in endometrial carcinoma. Acta Obstet Gynecol Scand 94:266–273

    Article  PubMed  Google Scholar 

  43. Ascher SM, Reinhold C (2002) Imaging of cancer of the endometrium. Radiol Clin North Am 40:563–576

    Article  PubMed  Google Scholar 

  44. Cao K, Gao M, Sun YS et al (2012) Apparent diffusion coefficient of diffusion weighted MRI in endometrial carcinoma-relationship with local invasiveness. Eur J Radiol 81:1926–1930

    Article  PubMed  Google Scholar 

  45. Shih IL, Yen RF, Chen CA et al (2015) Standardized uptake value and apparent diffusion coefficient of endometrial cancer evaluated with integrated whole-body PET/MR: correlation with pathological prognostic factors. J Magn Reson Imaging 42:1723–1732

    Article  PubMed  Google Scholar 

  46. Nougaret S, Reinhold C, Alsharif SS et al (2015) Endometrial cancer: combined MR volumetry and diffusion-weighted imaging for assessment of myometrial and lymphovascular invasion and tumor grade. Radiology 276:797–808

    Article  PubMed  Google Scholar 

  47. Padhani AR, Koh DM, Collins DJ (2011) Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 261:700–771

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank all the members of the Cancer Center, Chang Gung Memorial Hospital, for their invaluable help. The scientific guarantor of this publication is Chyong-Huey Lai. 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. This study has received funding by Chang Gung Medical Foundation grant CMRPG-3B1923, CIRPG3E0021, National Science Council (Taiwan) 104-2314-B-182A-095-MY3. Dr Lan-Yan Yang kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Chang Gung IRB No. 101-2187B, 103-7316A3. The authors thank all the members of the Cancer Center, Chang Gung Memorial Hospital, for their invaluable help.

Some study subjects or cohorts had been previously reported to investigate the influence of menopausal status on diagnostic accuracy of MR imaging for evaluation of myometrial invasion: Lin G, Huang YT, Chao A, et al (2015) Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: diffusion-weighted and dynamic contrast-enhanced MRI at 3 T. Clin Radiol 70:1260-1268. In the current manuscript we selected the 83 patients who had completed hysterectomy and compared the accuracy of DW and DCE MR imaging in diagnosis of cervical stromal invasion in endometrial cancer.

Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Medical Imaging and Intervention, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Gigin Lin, Yu-Ting Huang, Yu-Chun Lin, Hsin-Ying Lu, Shu-Hang Ng & Koon-Kwan Ng

  2. Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Angel Chao & Chyong-Huey Lai

  3. Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Ren-Chin Wu

  4. Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Lan-Yan Yang

  5. Clinical Phenome Center, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Gigin Lin & Hsin-Ying Lu

Authors
  1. Gigin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu-Ting Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angel Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu-Chun Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lan-Yan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ren-Chin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hsin-Ying Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shu-Hang Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koon-Kwan Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chyong-Huey Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gigin Lin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, G., Huang, YT., Chao, A. et al. Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T. Eur Radiol 27, 1867–1876 (2017). https://doi.org/10.1007/s00330-016-4583-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4583-0

Keywords

Search

Navigation