Magnetic Resonance Imaging for the Pre-Surgical Assessment of Endometrial Cancer: Results in a Routine Clinical Setting, Outside Dedicated Trials; a Cross-sectional Study.

AIM: To assess the efficacy of magnetic resonance imaging (MRI) in predicting the surgical stage of endometrial carcinoma as a diagnostic tool, in a routine clinical setting, and not just in dedicated pilot studies or trials.

MATERIALS AND METHODS: The stage prediction made on MRI, as stated in the Radiology report, was compared with the effective surgical stage registered in the Pathology report. The 2009 International Federation of Gynecology and Obstetrics (FIGO) staging was used.

RESULTS: MRI and surgical stage correlated significantly (p<0.0001, r=0.43). However, there was only full concordance between predicted and true stage in 47.2% (43/91) of cases. Conversely, 11% (10/91) of cases were overstaged by MRI, whereas 41.8% (38/91) were understaged. For type-I tumors, where the decision to perform lymphadenectomy or not is crucial, there was full concordance in 63.9% of cases. What is more important, neither understaging (eight cases), nor overstaging (five cases) by MRI would have resulted in modification of the global treatment schedule, and thus potentially of prognosis. However, five patients would have undergone unnecessary surgery. On the other hand, half of the patients would have been correctly spared extended surgery.

CONCLUSION: If restricted to type-I tumors, pre-surgical MRI appears useful under routine clinical conditions, and helps avoid unnecessary surgery in 50% of selected cases.