Department of Obstetrics and Gynecology, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary.
Department of Radiology, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary.
Pathol Oncol Res. 2021 Apr 1;27:611088. doi: 10.3389/pore.2021.611088. eCollection 2021.
Purpose: In the developed world, endometrial cancer is one of the most common malignant gynecological cancer types. Due to the highly available diagnostic modalities and patient education, the early detection of the tumor leads to high overall survival. In this study we analyzed the reliability of preoperative MRI findings in the staging of early stage endometrial cancer, as well as the clinical characteristics of patients underwent radical hysterectomy and the histopathologic evaluation of their tumor, with the retrospective data of radical hysterectomies performed in our hospital between 2010 and 2019. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI regarding stage were 94.7, 63.3, 94.8, 83.8, and 83.8%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of the myometrial invasion were 69.8, 80.0, 60.8, 64.3, and 77.5%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of lymph node metastases were 78.1, 28.6, 82, 11.1, and 93.6%, respectively. Based on our results, MRI is the method of choice in terms of evaluating overall staging, as well as myometrial invasion, as its specificity and negative predictive value are relatively high. However, systematic lymphadenectomy showed improved cancer-related survival and recurrence-free survival. Our studies showed that the diagnosis of lymph node metastases is difficult with MRI modality since hyperplastic and metastatic nodes cannot easily differentiate, leading to a high percentage of false-positive results. Therefore, other imaging modalities may be used for more accurate evaluation. New findings of our study were that the role of the radiologist's expertise in the evaluation of MR imaging plays an essential role in lowering false-negative and false-positive results. Therefore, findings evaluated by a radiologist with high-level expertise in gynecological imaging can complement the clinical findings and help substantially define the needed treatment.
在发达国家，子宫内膜癌是最常见的恶性妇科癌症之一。由于诊断方法和患者教育高度普及，肿瘤的早期发现导致总体生存率很高。本研究分析了术前 MRI 检查在早期子宫内膜癌分期中的可靠性，以及在我院 2010 年至 2019 年间行根治性子宫切除术的患者的临床特征和肿瘤的组织病理学评估。MRI 对分期的准确性、敏感度、特异度、阴性预测值和阳性预测值分别为 94.7%、63.3%、94.8%、83.8%和 83.8%。MRI 检测肌层浸润的准确性、敏感度、特异度、阴性预测值和阳性预测值分别为 69.8%、80.0%、60.8%、64.3%和 77.5%。MRI 检测淋巴结转移的准确性、敏感度、特异度、阴性预测值和阳性预测值分别为 78.1%、28.6%、82%、11.1%和 93.6%。基于我们的结果，MRI 是评估整体分期以及肌层浸润的首选方法，因为其特异性和阴性预测值相对较高。然而，系统淋巴结切除术显示出改善的癌症相关生存率和无复发生存率。我们的研究表明，MRI 诊断淋巴结转移较为困难，因为增生和转移的淋巴结不易区分，导致假阳性结果比例较高。因此，可能需要使用其他成像方式进行更准确的评估。本研究的新发现是，放射科医生在评估 MRI 成像方面的专业知识在降低假阴性和假阳性结果方面发挥着重要作用。因此，由具有高水平妇科成像专业知识的放射科医生评估的结果可以补充临床发现，并在很大程度上帮助确定所需的治疗方法。
