Luomaranta Anna, Leminen Arto, Loukovaara Mikko
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Int J Gynecol Cancer. 2015 Jun;25(5):837-42. doi: 10.1097/IGC.0000000000000194.
The aim of this study was to review the available literature on the reliability of contemporary magnetic resonance imaging (MRI) techniques in the assessment of high-risk features of endometrial carcinoma, that is, deep myometrial invasion, cervical stromal involvement, and lymph node metastasis.
The PubMed and Scopus databases were searched for studies published before March 2014. Studies on plain MRI were excluded.
Fifty-two eligible studies were identified. For the assessment of deep (≥ 50%) myometrial invasion (50 studies, 3720 patients), the pooled sensitivity, specificity, positive predictive value, and negative predictive value were 80.7%, 88.5%, 77.6%, and 89.5%, respectively, by random-effects analysis. For predicting cervical stromal involvement (12 studies, 1153 patients), the pooled values were 57.0%, 94.8%, 68.7%, and 90.5%, respectively. For lymph node metastasis on a per-patient basis (10 studies, 862 patients), they were 43.5%, 95.9%, 66.3%, and 92.2%, respectively. In a meta-regression analysis, dynamic imaging was associated with a higher sensitivity in detecting deep myometrial invasion, as compared with contrast-enhanced imaging (P = 0.021). The improvement by diffusion-weighted imaging was of a borderline significance (P = 0.057). Significant small-study effects were found for the sensitivity of MRI in detecting deep myometrial invasion (P < 0.0001) and cervical stromal involvement (P = 0.049).
Considering the poor-to-moderate sensitivity of MRI in detecting high-risk features of endometrial carcinoma, patients with negative findings on MRI may not safely forgo surgical staging unless the findings are confirmed by a backup method. The high specificities allow the targeting of staging procedures by MRI alone in patients with positive findings. Compared with contrast-enhanced imaging, dynamic and diffusion-weighted imaging may be more reliable in the radiological staging of endometrial carcinoma.
本研究旨在回顾当代磁共振成像（MRI）技术在评估子宫内膜癌高危特征（即肌层深部浸润、宫颈间质受累及淋巴结转移）方面的可靠性的现有文献。
检索PubMed和Scopus数据库中2014年3月之前发表的研究。排除普通MRI研究。
共纳入52项符合条件的研究。对于评估肌层深部（≥50%）浸润（50项研究，3720例患者），随机效应分析得出的合并敏感度、特异度、阳性预测值和阴性预测值分别为80.7%、88.5%、77.6%和89.5%。对于预测宫颈间质受累（12项研究，1153例患者），合并值分别为57.0%、94.8%、68.7%和90.5%。对于基于患者的淋巴结转移情况（10项研究，862例患者），分别为43.5%、95.9%、66.3%和92.2%。在一项Meta回归分析中，与对比增强成像相比，动态成像在检测肌层深部浸润方面具有更高的敏感度（P = 0.021）。弥散加权成像的改善具有临界显著性（P = 0.057）。发现MRI检测肌层深部浸润（P < 0.0001）和宫颈间质受累（P = 0.049）的敏感度存在显著的小研究效应。
考虑到MRI检测子宫内膜癌高危特征的敏感度为低到中度，MRI检查结果为阴性的患者可能无法安全地放弃手术分期，除非通过备用方法证实该结果。高特异度使得仅通过MRI对检查结果为阳性的患者进行分期手术成为可能。与对比增强成像相比，动态成像和弥散加权成像在子宫内膜癌的影像学分期中可能更可靠。
