MRI of endometrium cancer - how we do it.
Meissnitzer Matthias,Forstner Rosemarie
Cancer imaging : the official publication of the International Cancer Imaging Society
Endometrial cancer is the most common malignancy of the female pelvis. New concepts in endometrial cancer treatment emphasize the value of MRI as a major predictor of lymph node metastasis and tumour recurrence. MRI findings aid in triaging patients for a more tailored therapeutic regimen.This review discusses the value of MRI in the preoperative assessment of endometrial cancer and provides a practical approach how to image and report endometrial cancer. Practical tips are provided how to increase the diagnostic accuracy in staging of endometrial cancer and how to avoid pitfalls.
Preoperative Prediction of Lymph Nodal Metastases in Endometrial Carcinoma: Is it Possible?: A Literature Review.
Fares Rami,Kehoe Sean,Shams Nazem
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
BACKGROUND:Lymph node status is one of the most important prognostic factors in endometrial cancer and crucial for deciding adjuvant therapy. OBJECTIVE:The aim of the study was to assess the different models used to predict lymphatic nodal disease. SEARCH STRATEGY:A literature search was conducted to detect the relevant studies. INCLUSION CRITERIA:Relevant papers comparing the preoperative modality with the final histopathological results including randomized clinical trials, case-control studies, and any publications with a minimum of 50 patients in the report. RESULTS:Molecular-based predictors are still far from a practical application. Preoperative radiological scans (positron emission tomography, computed tomography, magnetic resonance imaging, and ultrasound) have shown the best predictor of lymphatic dissemination. However, there is currently no ideal model available, which can be used within standard clinical care. CONCLUSIONS:Surgical staging still remains the criterion standard in the determination of lymph node status in endometrial cancer.
Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology.
Nougaret Stephanie,Horta Mariana,Sala Evis,Lakhman Yulia,Thomassin-Naggara Isabelle,Kido Aki,Masselli Gabriele,Bharwani Nishat,Sadowski Elizabeth,Ertmer Andrea,Otero-Garcia Milagros,Kubik-Huch Rahel A,Cunha Teresa M,Rockall Andrea,Forstner Rosemarie
OBJECTIVES:To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI. METHODS:The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS:Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended. CONCLUSIONS:These consensus recommendations should be used as a guide for endometrial cancer staging with MRI. KEY POINTS:• MRI is recommended for initial staging of endometrial cancer. • MR imaging protocol should be tailored based on the risk of lymph node metastases. • Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging. • The mnemonic "Clinical and MRI Critical TEAM" summarizes key elements of the standardized report.
Endometrial cancer: an overview of novelties in treatment and related imaging keypoints for local staging.
Rizzo Stefania,Femia Marco,Buscarino Valentina,Franchi Dorella,Garbi Annalisa,Zanagnolo Vanna,Del Grande Maria,Manganaro Lucia,Alessi Sarah,Giannitto Caterina,Ruju Francesca,Bellomi Massimo
Cancer imaging : the official publication of the International Cancer Imaging Society
Endometrial cancer is the most common gynaecologic malignancy in developed countries and its incidence is increasing. First-level treatment, if no contraindicated, is based on surgery. Pre-operative imaging is needed for evaluation of local extent and detection of distant metastases in order to guide treatment planning. Radiological evaluation, based on transvaginal ultrasound, MR and CT, can make the difference in disease management, paying special attention to assessment of entity of myometrial invasion, cervical stromal extension, and assessment of lymph nodal involvement and distant metastases.
Current Status of Magnetic Resonance Imaging in Patients with Malignant Uterine Neoplasms: A Review.
Huang Yu-Ting,Huang Yen-Ling,Ng Koon-Kwan,Lin Gigin
Korean journal of radiology
In this study, we summarize the clinical role of magnetic resonance imaging (MRI) in the diagnosis of patients with malignant uterine neoplasms, including leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, uterine carcinosarcoma, and endometrial cancer, with emphasis on the challenges and disadvantages. MRI plays an essential role in patients with uterine malignancy, for the purpose of tumor detection, primary staging, and treatment planning. MRI has advanced in scope beyond the visualization of the many aspects of anatomical structures, including diffusion-weighted imaging, dynamic contrast enhancement-MRI, and magnetic resonance spectroscopy. Emerging technologies coupled with the use of artificial intelligence in MRI are expected to lead to progressive improvement in case management of malignant uterine neoplasms.
Radiomics in cervical and endometrial cancer.
The British journal of radiology
Radiomics is an emerging field of research that aims to find associations between quantitative information extracted from imaging examinations and clinical data to support the best clinical decision. In the last few years, some papers have been evaluating the role of radiomics in gynecological malignancies, mainly focusing on ovarian cancer. Nonetheless, cervical cancer is the most frequent gynecological malignancy in developing countries and endometrial cancer is the most common in western countries. The purpose of this narrative review is to give an overview of the latest published papers evaluating the role of radiomics in cervical and endometrial cancer, mostly evaluating association with tumor prognostic factors, with response to therapy and with prediction of recurrence and distant metastasis.
HE4 as a Biomarker for Endometrial Cancer.
Behrouzi Roya,Barr Chloe E,Crosbie Emma J
There are currently no blood biomarkers in routine clinical use in endometrial carcinoma (EC). Human epididymis protein 4 (HE4) is a glycoprotein that is overexpressed in the serum of patients with EC, making it a good candidate for use as a diagnostic and/or prognostic biomarker. HE4 is correlated with poor prognostic factors, including stage, myometrial invasion and lymph node metastases, which means it could be used to guide decisions regarding the extent of surgery and need for adjuvant therapy. Serum HE4 has also shown promise for predicting responses to progestin therapy in early-stage EC. The use of algorithms and indices incorporating serum HE4 and other biomarkers, including clinical and imaging variables, is an area of increasing interest. Serum HE4 levels rise with age and renal dysfunction, which may affect the interpretation of results. This review covers the evidence supporting the use of HE4 as an EC biomarker for diagnosis, prognosis, recurrence monitoring, and prediction of therapy response. The evidence for combining serum HE4 with other biomarkers, including clinical and imaging variables, its value as a biomarker in other biofluids and potential challenges of its clinical use are also discussed.
Clinical Impact of Preoperative Magnetic Resonance Imaging in the Evaluation of Myometrial Infiltration and Lymph-Node Metastases in Stage I Endometrial Cancer.
Bús Dorottya,Nagy Gyöngyi,Póka Róbert,Vajda György
Pathology oncology research : POR
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.
Role of MRI in diagnosing the primary site of origin in indeterminate cases of uterocervical carcinomas: a systematic review and meta-analysis.
The British journal of radiology
OBJECTIVE:To perform a literature review assessing role of MRI in predicting origin of indeterminate uterocervical carcinomas with emphasis on sequences and imaging parameters. METHODS:Electronic literature search of PubMed was performed from its inception until May 2020 and PICO model used for study selection; population was female patients with known/clinical suspicion of uterocervical cancer, intervention was MRI, comparison was by histopathology and outcome was differentiation between primary endometrial and cervical cancers. RESULTS:Eight out of nine reviewed articles reinforced role of MRI in uterocervical primary determination. T2 and Dynamic contrast were the most popular sequences determining tumor location, morphology, enhancement, and invasion patterns. Role of DWI and MR spectroscopy has been evaluated by even fewer studies with significant differences found in both apparent diffusion coefficient values and metabolite spectra. The four studies eligible for meta-analysis showed a pooled sensitivity of 88.4% (95% confidence interval 70.6 to 96.1%) and a pooled specificity of 39.5% (95% confidence interval 4.2 to 90.6%). CONCLUSIONS:MRI plays a pivotal role in uterocervical primary determination with both conventional and newer sequences assessing important morphometric and functional parameters. Socioeconomic impact of both primaries, different management guidelines and paucity of existing studies warrants further research. Prospective multicenter trials will help bridge this gap. Meanwhile, individual patient database meta-analysis can help corroborate existing data. ADVANCES IN KNOWLEDGE:MRI with its classical and functional sequences helps in differentiation of the uterine 'cancer gray zone' which is imperative as both primary endometrial and cervical tumors have different management protocols.
Menstruation: science and society.
American journal of obstetrics and gynecology
Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.
Risk-reducing hysterectomy and bilateral salpingo-oophorectomy in female heterozygotes of pathogenic mismatch repair variants: a Prospective Lynch Syndrome Database report.
Dominguez-Valentin Mev,Crosbie Emma J,Engel Christoph,Aretz Stefan,Macrae Finlay,Winship Ingrid,Capella Gabriel,Thomas Huw,Nakken Sigve,Hovig Eivind,Nielsen Maartje,Sijmons Rolf H,Bertario Lucio,Bonanni Bernardo,Tibiletti Maria Grazia,Cavestro Giulia Martina,Mints Miriam,Gluck Nathan,Katz Lior,Heinimann Karl,Vaccaro Carlos A,Green Kate,Lalloo Fiona,Hill James,Schmiegel Wolff,Vangala Deepak,Perne Claudia,Strauß Hans-Georg,Tecklenburg Johanna,Holinski-Feder Elke,Steinke-Lange Verena,Mecklin Jukka-Pekka,Plazzer John-Paul,Pineda Marta,Navarro Matilde,Vidal Joan Brunet,Kariv Revital,Rosner Guy,Piñero Tamara Alejandra,Gonzalez María Laura,Kalfayan Pablo,Ryan Neil,Ten Broeke Sanne W,Jenkins Mark A,Sunde Lone,Bernstein Inge,Burn John,Greenblatt Marc,de Vos Tot Nederveen Cappel Wouter H,Della Valle Adriana,Lopez-Koestner Francisco,Alvarez Karin,Büttner Reinhard,Görgens Heike,Morak Monika,Holzapfel Stefanie,Hüneburg Robert,von Knebel Doeberitz Magnus,Loeffler Markus,Rahner Nils,Weitz Jürgen,Pylvänäinen Kirsi,Renkonen-Sinisalo Laura,Lepistö Anna,Auranen Annika,Hopper John L,Win Aung Ko,Haile Robert W,Lindor Noralane M,Gallinger Steven,Le Marchand Loïc,Newcomb Polly A,Figueiredo Jane C,Thibodeau Stephen N,Therkildsen Christina,Okkels Henrik,Ketabi Zohreh,Denton Oliver G,Rødland Einar Andreas,Vasen Hans,Neffa Florencia,Esperon Patricia,Tjandra Douglas,Möslein Gabriela,Sampson Julian R,Evans D Gareth,Seppälä Toni T,Møller Pål
Genetics in medicine : official journal of the American College of Medical Genetics
PURPOSE:To determine impact of risk-reducing hysterectomy and bilateral salpingo-oophorectomy (BSO) on gynecological cancer incidence and death in heterozygotes of pathogenic MMR (path_MMR) variants. METHODS:The Prospective Lynch Syndrome Database was used to investigate the effects of gynecological risk-reducing surgery (RRS) at different ages. RESULTS:Risk-reducing hysterectomy at 25 years of age prevents endometrial cancer before 50 years in 15%, 18%, 13%, and 0% of path_MLH1, path_MSH2, path_MSH6, and path_PMS2 heterozygotes and death in 2%, 2%, 1%, and 0%, respectively. Risk-reducing BSO at 25 years of age prevents ovarian cancer before 50 years in 6%, 11%, 2%, and 0% and death in 1%, 2%, 0%, and 0%, respectively. Risk-reducing hysterectomy at 40 years prevents endometrial cancer by 50 years in 13%, 16%, 11%, and 0% and death in 1%, 2%, 1%, and 0%, respectively. BSO at 40 years prevents ovarian cancer before 50 years in 4%, 8%, 0%, and 0%, and death in 1%, 1%, 0%, and 0%, respectively. CONCLUSION:Little benefit is gained by performing RRS before 40 years of age and premenopausal BSO in path_MSH6 and path_PMS2 heterozygotes has no measurable benefit for mortality. These findings may aid decision making for women with LS who are considering RRS.
Adiposity and cancer: a Mendelian randomization analysis in the UK biobank.
Ahmed Muktar,Mulugeta Anwar,Lee S Hong,Mäkinen Ville-Petteri,Boyle Terry,Hyppönen Elina
International journal of obesity (2005)
BACKGROUND:Observational and Mendelian randomization (MR) studies link obesity and cancer, but it remains unclear whether these depend upon related metabolic abnormalities. METHODS:We used information from 321,472 participants in the UK biobank, including 30,561 cases of obesity-related cancer. We constructed three genetic instruments reflecting higher adiposity together with either "unfavourable" (82 SNPs), "favourable" (24 SNPs) or "neutral" metabolic profile (25 SNPs). We looked at associations with 14 types of cancer, previously suggested to be associated with obesity. RESULTS:All genetic instruments had a strong association with BMI (p < 1 × 10 for all). The instrument reflecting unfavourable adiposity was also associated with higher CRP, HbA1c and adverse lipid profile, while instrument reflecting metabolically favourable adiposity was associated with lower HbA1c and a favourable lipid profile. In MR-inverse-variance weighted analysis unfavourable adiposity was associated with an increased risk of non-hormonal cancers (OR = 1.22, 95% confidence interval [CI]:1.08, 1.38), but a lower risk of hormonal cancers (OR = 0.80, 95%CI: 0.72, 0.89). From individual cancers, MR analyses suggested causal increases in the risk of multiple myeloma (OR = 1.36, 95%CI: 1.09, 1.70) and endometrial cancer (OR = 1.77, 95%CI: 1.16, 2.68) by greater genetically instrumented unfavourable adiposity but lower risks of breast and prostate cancer (OR = 0.72, 95%CI: 0.61, 0.83 and OR = 0.81, 95%CI: 0.68, 0.97, respectively). Favourable or neutral adiposity were not associated with the odds of any individual cancer. CONCLUSIONS:Higher adiposity associated with a higher risk of non-hormonal cancer but a lower risk of some hormone related cancers. Presence of metabolic abnormalities might aggravate the adverse effects of higher adiposity on cancer. Further studies are warranted to investigate whether interventions on adverse metabolic health may help to alleviate obesity-related cancer risk.
Systematic review of Mendelian randomization studies on risk of cancer.
BACKGROUND:We aimed to map and describe the current state of Mendelian randomization (MR) literature on cancer risk and to identify associations supported by robust evidence. METHODS:We searched PubMed and Scopus up to 06/10/2020 for MR studies investigating the association of any genetically predicted risk factor with cancer risk. We categorized the reported associations based on a priori designed levels of evidence supporting a causal association into four categories, namely robust, probable, suggestive, and insufficient, based on the significance and concordance of the main MR analysis results and at least one of the MR-Egger, weighed median, MRPRESSO, and multivariable MR analyses. Associations not presenting any of the aforementioned sensitivity analyses were not graded. RESULTS:We included 190 publications reporting on 4667 MR analyses. Most analyses (3200; 68.6%) were not accompanied by any of the assessed sensitivity analyses. Of the 1467 evaluable analyses, 87 (5.9%) were supported by robust, 275 (18.7%) by probable, and 89 (6.1%) by suggestive evidence. The most prominent robust associations were observed for anthropometric indices with risk of breast, kidney, and endometrial cancers; circulating telomere length with risk of kidney, lung, osteosarcoma, skin, thyroid, and hematological cancers; sex steroid hormones and risk of breast and endometrial cancer; and lipids with risk of breast, endometrial, and ovarian cancer. CONCLUSIONS:Despite the large amount of research on genetically predicted risk factors for cancer risk, limited associations are supported by robust evidence for causality. Most associations did not present a MR sensitivity analysis and were thus non-evaluable. Future research should focus on more thorough assessment of sensitivity MR analyses and on more transparent reporting.
MR imaging findings differentiating uterine submucosal polypoid adenomyomas from endometrial polyps.
Kawaguchi Masaya,Kato Hiroki,Suzui Natsuko,Furui Tatsuro,Morishige Ken-Ichirou,Goshima Satoshi,Matsuo Masayuki
The British journal of radiology
OBJECTIVE::This study aimed to assess the efficacy of MRI for differentiating between uterine submucosal polypoid adenomyomas (PAs) and endometrial polyps (EPs). METHODS::MRI was used to examine 40 histopathologically confirmed benign polypoid endometrial tumors (8submucosal PAs and 32 EPs). Atypical PAs were excluded from this study. Quantitative measurements (maximum tumor diameter, maximum cyst diameter, number of cysts, and apparent diffusion coefficient values) and qualitative imaging findings (predominance of cystic or solid components as well as presence of cysts, hemorrhage, myometrial invasion, fluid-fluid level, and fibrous core) were correlated with the two pathologies. RESULTS::The predominance of cystic components (37% vs 6%; p < 0.05) was more frequently observed in PAs than in EPs. The frequency of cysts (88% vs 25%; p < 0.01), hemorrhage (50% vs 9%; p < 0.05), and myometrial invasion (25% vs 0%; p < 0.05) were significantly higher in PAs than in EPs. No significant differences were observed in terms of the maximum tumor diameter, maximum cyst diameter, number of cysts, apparent diffusion coefficient values, and presence of fluid-fluid level and fibrous core between PAs and EPs. CONCLUSION::The differences of MR findings with emphasis on cystic components and hemorrhage may be useful for differentiating between PAs and EPs. ADVANCES IN KNOWLEDGE::The predominance of cystic or solid components and the presence of cysts, hemorrhage, and myometrial invasion were useful MR findings for differentiating between PAs and EPs.
Multiple mathematical models of diffusion-weighted imaging for endometrial cancer characterization: Correlation with prognosis-related risk factors.
Zhang Qi,Ouyang Han,Ye Feng,Chen Shuang,Xie Lizhi,Zhao Xinming,Yu Xiaoduo
European journal of radiology
PURPOSE:To investigate mono-exponential, bi-exponential, and stretched-exponential models of diffusion-weighted imaging (DWI) for evaluation of prognosis-related risk factors of endometrial cancer (EC). METHOD:Sixty-one consecutive patients with EC who preoperatively underwent pelvic MRI with multiple b value DWI between September 2016 and May 2018 were enrolled. The apparent-diffusion-coefficient (ADC), bi-exponential model parameters (D, D* and f) and stretched-exponential model parameters (DDC and α) were measured and compared to analyze the following prognosis-related risk factors confirmed by pathology: histological grade, depth of myometrial invasion, cervical stromal infiltration (CSI) and lymphovascular invasion (LVSI). A stepwise multilvariate logistic regression and the receiver operating characteristic (ROC) curves were performed for further statistical analysis. RESULTS:Lower ADC, D, f, and DDC were observed in tumor with high grade compared with a low-grade group, and the largest area under curve (AUC) was obtained when combining f and DDC values. ADC, D, f, DDC, and α were significantly different in patients with deep myometrial invasion (DMI) compared to those without DMI; the combination of f, DDC and α showed the highest AUC. Significantly different ADC and f were found between patients' presence and absence CSI; the f values showed the highest diagnostic performance with an AUC of 0.825. Regarding the LVSI, ADC, D*, f, and DDC were significantly lower in tumors with LVSI compared to those without LVSI; the combination of f and DDC showed the largest AUC. CONCLUSION:Multiple mathematical DWI models are a useful approach for the prediction of prognosis-related risk factors in EC.
Interventions for weight reduction in obesity to improve survival in women with endometrial cancer.
The Cochrane database of systematic reviews
BACKGROUND:Diagnoses of endometrial cancer are increasing secondary to the rising prevalence of obesity. Obesity plays an important role in promoting the development of endometrial cancer, by inducing a state of unopposed oestrogen excess, insulin resistance and inflammation. It also affects treatment, increasing the risk of surgical complications and the complexity of radiotherapy planning, and may additionally impact on subsequent survival. Weight-loss interventions have been associated with improvements in breast and colorectal cancer-specific survival as well as a reduction in the risk of cardiovascular disease, a frequent cause of death in endometrial cancer survivors. OBJECTIVES:To determine the impact of weight-loss interventions, in addition to standard management of endometrial cancer, on overall survival and the frequency of adverse events.Secondary objectives include an assessment of weight-loss interventions on endometrial cancer-specific survival, weight loss achieved, cardiovascular event frequency and quality of life both overall and stratified according to patient body mass index (BMI), where possible. SEARCH METHODS:This review searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase and reference lists of articles, trial registries, and international gynaecological oncology conference abstracts from inception to January 2018. SELECTION CRITERIA:Randomised controlled trials (RCTs) of interventions to facilitate weight loss in overweight or obese women undergoing treatment for, or previously treated for, endometrial cancer were selected. DATA COLLECTION AND ANALYSIS:Two review authors independently selected studies, assessed trial quality, and extracted data with disagreements resolved by a third review author. Study authors were contacted to obtain missing data, including details of any adverse events. MAIN RESULTS:We included three RCTs in the review, randomising a total of 161 overweight and obese women with endometrial cancer. All studies compared combined behavioural and lifestyle interventions to facilitate weight loss through dietary modification and increased physical activity. The included RCTs were of low or very low quality, due to high risk of bias by failing to blind participants, personnel and outcome assessors, and significant loss to follow-up (attrition rate up to 29%).Combined behaviour and lifestyle interventions were not associated with improved overall survival (risk ratio (RR mortality), 0.23 95% confidence interval (CI) 0.01 to 4.55, P = 0.34, one RCT, 37 participants; very low-certainty evidence) compared with usual care at 24 months. There was no evidence that such interventions were associated with improvements in cancer-specific survival or cardiovascular event frequency as no cancer-related deaths, myocardial infarctions or strokes were reported in the included studies. None of the included RCTs reported data for the outcome of recurrence-free survival. Combined behaviour and lifestyle interventions were not associated with significant weight loss at either six months (mean difference (MD) -1.88 kg, 95% CI -5.98 to 2.21 kg, P = 0.37, three RCTs, 131 participants, I= 0%; low-certainty evidenc e)or 12 months (MD -8.98 kg, 95% CI -19.88 to 1.92 kg, P = 0.11, two RCTs, 91 participants, I= 0%; very low-certainty evidence) when compared with usual care. Combined behaviour and lifestyle interventions were not associated with increased quality of life, when measured using either the SF-12 Physical Health questionnaire or FACT-G at six months (FACT-G MD 2.51, 95% CI -5.61 to 10.64, P = 0.54, two RCTs, 95 participants, I= 83%; very low-certainty evidence), or by FACT-G alone at 12 months (MD 2.77, 95% CI -0.65 to 6.20, P = 0.11, two RCTs, 89 participants, I= 0%; very low-certainty evidence) when compared with usual care. No serious adverse events, for example hospitalisation or deaths, were reported in included trials. Lifestyle and behavioural interventions were associated with a higher risk of musculoskeletal symptoms (RR 19.03, 95% CI 1.17, 310.52, P = 0.04, two RCTs, 91 participants; low-certainty evidence). AUTHORS' CONCLUSIONS:There is currently insufficient high-quality evidence to determine the effect of combined lifestyle and behavioural interventions on survival, quality of life, or significant weight loss in women with a history of endometrial cancer compared to those receiving usual care. The limited evidence suggests that there is little or no serious or life-threatening adverse effects due to these interventions, although musculoskeletal problems were increased, presumably due to increased activity levels. Our conclusion is based on low- and very low-quality evidence from a small number of trials and very few patients. We therefore have very little confidence in the evidence: the true effect of weight-loss interventions in obese women with endometrial cancer is currently not known.Further methodologically-rigorous, adequately-powered RCTs are required with follow-up of 5 to 10 years duration. These should focus on the effects of varying dietary modification regimens, pharmacological treatments associated with weight loss and bariatric surgery on survival, quality of life, weight loss and adverse events.
Multi-b-value diffusion weighted imaging for preoperative evaluation of risk stratification in early-stage endometrial cancer.
Zhang Qi,Yu Xiaoduo,Lin Meng,Xie Lizhi,Zhang Miaomiao,Ouyang Han,Zhao Xinming
European journal of radiology
PURPOSE:To investigate the application of multi-b-value DWI parameters for the assessment of risk stratification in early-stage endometrial cancer (EC). MATERIAL AND METHODS:Fifty-three patients with early-stage EC who preoperatively underwent multi-b-value DWI with 13 b values (from 0 to 2000s/mm²) were included in this study. Multi-b-value DWI derived parameters, including apparent diffusion coefficient (ADC), true diffusivity (D), perfusion-related diffusivity (D*) and perfusion fraction (f) were measured independently by two radiologists. In addition, binary logical regression model was used to calculate predicative probability of combined parameters indicating statistical significance in differentiating risk stratification of early-stage endometrial cancer. Receiver operating characteristic analysis was performed for all single and combined parameters. RESULTS:The ADC and D values were significantly lower in intermedium-risk compared with low-risk (P = 0.000 and 0.011), as well as high-risk compared with low-risk of early-stage EC (P = 0.001 and 0.013), while f values only showed significant differences between low-risk and intermedium-risk groups (P = 0.011). Among the single parameters, the ADC values had the highest area under the ROC curve (AUC) in the identification of the low-risk of early-stage EC (AUC=0.892). Moreover, the combination of ADC and f value had the best diagnostic performance with the AUC of 0.912, the sensitivity of 81.1% and the specificity of 87.5%. CONCLUSION:The multi-b-value DWI parameters provide valuable imaging biomarkers for the assessment of risk stratification in early-stage endometrial cancer. This approach might facilitate the selection of the optimal therapeutic approach and lead to the greater personalization of cancer care.
Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging.
Beddy Peter,Moyle Penelope,Kataoka Masako,Yamamoto Adam K,Joubert Ilse,Lomas David,Crawford Robin,Sala Evis
PURPOSE:To compare the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging with that of dynamic contrast material-enhanced (DCE) MR imaging in evaluating the depth of myometrial invasion and overall stage in patients with endometrial cancer. MATERIALS AND METHODS:The institutional review board approved this retrospective study; patient consent was not required. From May 2008 to February 2010, 48 women with endometrial cancer underwent preoperative MR imaging, including T1- and T2-weighted imaging, DW MR imaging (b=0 and 800 sec/mm2) and DCE MR imaging. Two radiologists independently interpreted the depth of myometrial invasion, overall stage, and presence of pitfalls associated with inaccurate assessment of myometrial invasion at T1- and T2-weighted imaging, DW MR imaging, and DCE MR imaging. Myometrial invasion and overall stage were compared by using the McNemar test, and κ statistics were used for reader agreement. RESULTS:For assessing the depth of myometrial invasion, diagnostic accuracy, sensitivity, and specificity, respectively, were as follows: DW MR imaging-reader 1, 90%, 84%, and 100%; reader 2, 85%, 84%, and 88%; DCE MR imaging-reader 1, 71%, 61%, and 88%; reader 2, 79%, 77%, and 82%. The improvement in diagnostic accuracy for reader 1 was significant (P=.035). For myometrial invasion, κ values were 0.75 with DW MR imaging and 0.26 with DCE MR imaging. There was no association between inaccurate assessment of myometrial invasion and standard pitfalls with DW MR imaging. Readers 1 and 2 correctly staged more patients by using DW MR imaging (39 and 38 patients, respectively) than by using DCE MR imaging (29 and 30 patients, respectively) (P<.05). For overall stage, κ values were 0.74 with DW MR imaging and 0.22 with DCE MR imaging. CONCLUSION:DW MR imaging has superior diagnostic accuracy in the assessment of myometrial invasion and significantly higher staging accuracy compared with DCE MR imaging.
Evidence of a Causal Association Between Insulinemia and Endometrial Cancer: A Mendelian Randomization Analysis.
Journal of the National Cancer Institute
BACKGROUND:Insulinemia and type 2 diabetes (T2D) have been associated with endometrial cancer risk in numerous observational studies. However, the causality of these associations is uncertain. Here we use a Mendelian randomization (MR) approach to assess whether insulinemia and T2D are causally associated with endometrial cancer. METHODS:We used single nucleotide polymorphisms (SNPs) associated with T2D (49 variants), fasting glucose (36 variants), fasting insulin (18 variants), early insulin secretion (17 variants), and body mass index (BMI) (32 variants) as instrumental variables in MR analyses. We calculated MR estimates for each risk factor with endometrial cancer using an inverse-variance weighted method with SNP-endometrial cancer associations from 1287 case patients and 8273 control participants. RESULTS:Genetically predicted higher fasting insulin levels were associated with greater risk of endometrial cancer (odds ratio [OR] per standard deviation = 2.34, 95% confidence internal [CI] = 1.06 to 5.14, P = .03). Consistently, genetically predicted higher 30-minute postchallenge insulin levels were also associated with endometrial cancer risk (OR = 1.40, 95% CI = 1.12 to 1.76, P = .003). We observed no associations between genetic risk of type 2 diabetes (OR = 0.91, 95% CI = 0.79 to 1.04, P = .16) or higher fasting glucose (OR = 1.00, 95% CI = 0.67 to 1.50, P = .99) and endometrial cancer. In contrast, endometrial cancer risk was higher in individuals with genetically predicted higher BMI (OR = 3.86, 95% CI = 2.24 to 6.64, P = 1.2x10(-6)). CONCLUSION:This study provides evidence to support a causal association of higher insulin levels, independently of BMI, with endometrial cancer risk.
Premenopausal abnormal uterine bleeding and risk of endometrial cancer.
Pennant M E,Mehta R,Moody P,Hackett G,Prentice A,Sharp S J,Lakshman R
BJOG : an international journal of obstetrics and gynaecology
BACKGROUND:Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. OBJECTIVES:To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. SEARCH STRATEGY:Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. SELECTION CRITERIA:Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. DATA COLLECTION AND ANALYSIS:Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. MAIN RESULTS:Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. CONCLUSIONS:The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. TWEETABLE ABSTRACT:Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy.
Body size, body composition and endometrial cancer risk among postmenopausal women in UK Biobank.
Omiyale Wemimo,Allen Naomi E,Sweetland Siân
International journal of cancer
Previous studies on the association of adiposity with endometrial cancer risk have mostly used body mass index (BMI) as the main exposure of interest. Whether more precise measures of body fat, such as body fat percentage and fat mass estimated by bioimpedance analyses, are better indicators of risk than BMI is unknown. The role of central adiposity and fat-free mass in endometrial cancer development remains unclear. We used Cox regression models to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI) for the associations of various measures of body size/composition with the risk of endometrial cancer among 135 110 postmenopausal women enrolled in UK Biobank. During a mean follow up of 6.8 years, 706 endometrial cancers were diagnosed, with a mean age at diagnosis of 65.5 years. The HRs (95% CIs) for endometrial cancer per 1 SD increase in BMI, body fat percentage and fat mass were broadly comparable, being 1.71 (1.61-1.82), 1.92 (1.75-2.11) and 1.73 (1.63-1.85), respectively. There was an indication of positive association between central adiposity, as reflected by waist circumference (HR = 1.08, 95% CI: 1.00-1.17) and waist to hip ratio (HR = 1.13, 95% CI: 1.01-1.26), and endometrial cancer risk after accounting for BMI. Fat-free mass was not an independent predictor of risk in this cohort. These findings suggest that body fat percentage and fat mass are not better indicators of endometrial cancer risk than BMI. Further studies are needed to establish whether central adiposity contributes to risk beyond overall adiposity.
Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade.
Nougaret Stephanie,Reinhold Caroline,Alsharif Shaza S,Addley Helen,Arceneau Jocelyne,Molinari Nicolas,Guiu Boris,Sala Evis
PURPOSE:To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. MATERIALS AND METHODS:The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. RESULTS:No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P < .0001). There was no significant difference in the ADCs between grades 1 and 2 tumors (P > .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P < .02). CONCLUSION:The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.
Amide Proton Transfer MR Imaging of Endometrioid Endometrial Adenocarcinoma: Association with Histologic Grade.
Takayama Yukihisa,Nishie Akihiro,Togao Osamu,Asayama Yoshiki,Ishigami Kousei,Ushijima Yasuhiro,Okamoto Daisuke,Fujita Nobuhiro,Sonoda Kenzo,Hida Tomoyuki,Ohishi Yoshihiro,Keupp Jochen,Honda Hiroshi
Purpose To evaluate the utility of amide proton transfer (APT) imaging in estimating histologic grades of endometrioid endometrial adenocarcinoma (EEA). Materials and Methods The institutional review board approved this prospective study. Between June 2012 and March 2016, 32 patients with EEA underwent magnetic resonance (MR) imaging. After their surgical procedures, their EEAs were confirmed pathologically and classified into histologic grades: grade 1 (n = 11), grade 2 (n = 11), and grade 3 (n = 10). The APT signal intensities (SIs) and the mean and minimum apparent diffusion coefficients (ADCs) of the three grades were calculated and compared. Spearman rank correlation coefficient was also calculated between the APT SIs and histologic grades, and between the ADCs and histologic grades. Results The Spearman correlation coefficient with histologic grade of the APT SIs, the mean ADC, and the minimum ADC were 0.55 (P = .001), 0.03 (P = .84), and -0.30 (P = .09), respectively. The average APT SIs and the mean and minimum ADCs were 2.2% ± 0.2 (standard deviation), 0.9 × 10 mm/sec ± 0.2, and 0.6 × 10 mm/sec ± 0.1 for grade 1; 3.2% ± 0.3, 0.8 × 10 mm/sec ± 0.1, and 0.5 × 10 mm/sec ± 0.1 for grade 2; and 3.7% ± 0.3, 0.9 × 10 mm/sec ± 0.1, and 0.5 × 10 mm/sec ± 0.1 for grade 3, respectively. The APT SIs of grade 3 EEA were significantly higher than those of grade 1 EEA (P = .01), but other pairwise comparisons did not reveal any significant differences (P = .06-.51). The mean and minimum ADCs showed no significant differences among the three histologic grades (P =.13-.51). Conclusion The APT SI was positively correlated with the histologic grades of EEA. RSNA, 2017 Online supplemental material is available for this article.
Detection of deep myometrial invasion in endometrial cancer MR imaging based on multi-feature fusion and probabilistic support vector machine ensemble.
Zhu Xueliang,Ying Jie,Yang Haima,Fu Le,Li Boyang,Jiang Bin
Computers in biology and medicine
The depth of myometrial invasion affects the treatment and prognosis of patients with endometrial cancer (EC), conventionally evaluated using MR imaging (MRI). However, only a few computer-aided diagnosis methods have been reported for identifying deep myometrial invasion (DMI) using MRI. Moreover, these existing methods exhibit relatively unsatisfactory sensitivity and specificity. This study proposes a novel computerized method to facilitate the accurate detection of DMI on MRI. This method requires only the corpus uteri region provided by humans or computers instead of the tumor region. We also propose a geometric feature called LS to describe the irregularity of the tissue structure inside the corpus uteri triggered by EC, which has not been leveraged for the DMI prediction model in other studies. Texture features are extracted and then automatically selected by recursive feature elimination. Utilizing a feature fusion strategy of strong and weak features devised in this study, multiple probabilistic support vector machines incorporate LS and texture features, which are then merged to form the ensemble model EPSVM. The model performance is evaluated via leave-one-out cross-validation. We make the following comparisons, EPSVM versus the commonly used classifiers such as random forest, logistic regression, and naive Bayes; EPSVM versus the models using LS or texture features alone. The results show that EPSVM attains an accuracy, sensitivity, specificity, and F1 score of 93.7%, 94.7%, 93.3%, and 87.8%, all of which are higher than those of the commonly used classifiers and the models using LS or texture features alone. Compared with the methods in existing studies, EPSVM exhibits high performance in terms of both sensitivity and specificity. Moreover, LS can achieve an accuracy, sensitivity, and specificity of 89.9%, 89.5%, and 90.0%. Thus, the devised geometric feature LS is significant for DMI detection. The fusion of LS and texture features in the proposed EPSVM can provide more reliable prediction. The computer-aided classification based on the proposed method can assist radiologists in accurately identifying DMI on MRI.
Review of Mendelian Randomization Studies on Endometrial Cancer.
Frontiers in endocrinology
Endometrial cancer (EC) is a common gynecological cancer. In some parts of the world, the incidence and mortality of EC are on the rise. Understanding the risk factors of EC is necessary to prevent the occurrence of this disease. Observational studies have revealed the association between certain modifiable environmental risk factors and EC risk. However, due to unmeasured confounding, measurement errors, and reverse causality, observational studies sometimes have limited ability to judge robust causal inferences. In recent years, Mendelian randomization (MR) analysis has received extensive attention, providing valuable insights for cancer-related research, and is expected to identify potential therapeutic interventions. In MR analysis, genetic variation (alleles are randomly assigned during meiosis and are usually independent of environmental or lifestyle factors) is used instead of modifiable exposure to study the relationship between risk factors and disease. Therefore, MR analysis can make causal inference about exposure and disease risk. This review briefly describes the key principles and assumptions of MR analysis; summarizes published MR studies on EC; focuses on the correlation between different risk factors and EC risks; and discusses the application of MR methods in EC research. The results of MR studies on EC showed that type 2 diabetes, uterine fibroids, higher body mass index, higher plasminogen activator inhibitor-1 (PAI-1), higher fasting insulin, early insulin secretion, longer telomere length, higher testosterone and higher plasma cortisol levels are associated with increased risk of EC. In contrast, later age of menarche, higher circulatory tumor necrosis factor, higher low-density lipoprotein cholesterol, and higher sex hormone-binding globulin levels are associated with reduced risk of EC. In general, despite some limitations, MR analysis still provides an effective way to explore the causal relationship between different risk factors and EC.
Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T.
Lin Gigin,Huang Yu-Ting,Chao Angel,Lin Yu-Chun,Yang Lan-Yan,Wu Ren-Chin,Lu Hsin-Ying,Ng Shu-Hang,Ng Koon-Kwan,Lai Chyong-Huey
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/mm), 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.
A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation.
Tanaka Yumiko Oishi,Nishida Masato,Tsunoda Hajime,Ichikawa Yoshihito,Saida Yukihisa,Itai Yuji
Thickened or indistinct junctional zone (JZ) is a problematic finding in staging endometrial carcinoma. We studied the incidence, pathological cause of this condition correlated to microcirculation, and the utility of dynamic contrast MRI for differential diagnosis. T2-weighted images were analyzed in 119 cases with endometrial carcinoma. The enhancement of the JZ during the dynamic contrast MRI, histopathological causes, and the density of arterioles in the JZ were retrospectively analyzed in cases with thickened or indistinct JZ. The MRI histopathological correlation of all 31 patients with a thickened or indistinct JZ were analyzed, in which it was corresponded to myometrial cancer invasion only in 22%. The sensitivity of a poor early enhancement pattern on dynamic study for detecting myometrial invasion was 71.4%, the specificity was 100%, and the overall accuracy was 92.5%. Although only weak relationship between the contrast enhancement and the arteriole density was revealed, the arteriole density within the JZ with cancer invasion was significantly decreased. Poor enhancement of JZ in early dynamic phase was correlated with the decreased density of arterioles within the myometrium which was invaded by endometrial carcinoma. Dynamic contrast study should be performed in staging endometrial carcinoma especially when JZ was thickened or indistinct.
Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning.
Manfredi Riccardo,Mirk Paoletta,Maresca Giulia,Margariti Pasquale A,Testa Antonia,Zannoni Gian Franco,Giordano Deborah,Scambia Giovanni,Marano Pasquale
PURPOSE:To assess magnetic resonance (MR) imaging in depicting the depth of myometrial infiltration, cervical invasion, and presence of enlarged lymph nodes in patients with endometrial adenocarcinoma compared with surgicopathologic findings. MATERIALS AND METHODS:Thirty-seven consecutive patients with endometrial carcinoma were included in this prospective study. All patients underwent MR imaging and surgery. Qualitative image analysis included the depth of myometrial infiltration, infiltration of the uterine cervix, and presence of enlarged lymph nodes. Quantitative image analysis included tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging. MR imaging findings were compared with surgicopathologic findings. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration and in lymph node assessment were calculated. RESULTS:Respective sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values in assessing myometrial infiltration were 87%, 91%, 89%, 87%, and 91%; those for cervical infiltration, 80%, 96%, 92%, 89%, and 93%; and those for lymph node assessment, 50%, 95%, 90%, 50%, and 95%. There was significant agreement between MR imaging and surgicopathologic findings in assessment of myometrial invasion (P <.001). Myometrial and cervical invasion and lymph node enlargement were correctly assessed with MR imaging in 28 (76%) of 37 patients. Quantitative analysis showed a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and precontrast phases (P <.001). CONCLUSION:MR imaging coupled with contrast material-enhanced dynamic MR imaging is highly accurate in local-regional staging of endometrial carcinoma; more challenging is the assessment of pelvic and lumboaortic lymph nodes.
Efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis and staging of endometrial tumors.
Kececi I S,Nural M S,Aslan K,Danacı M,Kefeli M,Tosun M
Diagnostic and interventional imaging
PURPOSE:The goal of this study was to evaluate the efficacy of diffusion-weighted imaging (DWI) in differentiating between benign and malignant endometrial lesions and determinining tumor grade. It also aimed to determine the contribution of the DWI to the diagnosis by detection of the myometrial invasion depth in malignant lesions. MATERIALS AND METHODS:The lesions were classified as benign (n=14) or malignant (n=42) according to the histopathological results and, the mean apparent diffusion coefficent (ADC) values were compared. For determining the myometrial invasion depth of malignant lesions, T2W, DWI and dynamic contrast-enhanced T1-weighted images (DCET1WI) were evaluated individually. RESULTS:The sensitivity, specificity and area under the curve for discriminating between malignant and benign lesions by using cutoff ADC value of 1.10×10(-3)s/mm(2) were 85.7%, 92.8% and 0.95, respectively. According to the histopathological grading, there was no difference for the mean ADC values. For both observers the diagnostic accuracy of MRI in determining the depth of myometrial invasion in malignant lesions was found to be 87.1%, 89.7% and 76.9%, 76.9% for T2WI-DWI and DCET1WI, respectively. CONCLUSION:DWI and ADC measurements can accurately discriminate endometrial cavity lesions as benign or malignant. T2WI-DWI is highly effective in determining the depth of myometrial invasion.
Peritumoral Enhancement for the Evaluation of Myometrial Invasion in Low-Risk Endometrial Carcinoma on Dynamic Contrast-Enhanced MRI.
Frontiers in oncology
OBJECTIVES:To explore the clinical value of subendometrial enhancement (SEE), irregular thin-layered peritumoral early enhancement (ITLPE) and focal irregular peritumoral early enhancement (FIPE) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for myometrial invasion in patients with low-risk endometrial carcinoma. METHODS:Seventy-seven patients with low-risk endometrial carcinoma who preoperatively underwent DCE-MRI were included. Two radiologists independently evaluated and recorded the occurrences of SEE, ITLPE and FIPE on DCE-MRI in all patients. Interobserver agreement was calculated between the two radiologists, and the relationships between SEE, ITLPE, FIPE, and myometrial invasion were analyzed based on histologic findings. For statistically significant findings, the sensitivity and specificity were calculated, and the differences in myometrial invasion evaluations were analyzed. For those with no statistical significance, images were compared with the histopathologic sections. RESULTS:Inter-observer agreement was good ( = 0.80; 95%CI, 0.577-0.955) for SEE, and very good ( = 0.88; 95%CI, 0.761-0.972) ( = 0.86; 95%CI, 0.739-0.973) for ITLPE and FIPE. After consensus, SEE was identified in 12/77 (15.6%) patients; ITLPE and FIPE were found in 53/77 (68.8%) and 30/77 (39.0%) patients, respectively. SEE and ITLPE were significantly correlated with myometrial infiltration ( = 0.000), but FIPE were not ( = 0.725).The sensitivity and specificity of SEE and ITLPE for myometrial invasion in patients with low-risk endometrial carcinoma were 95.0 and 52.9%, and 85.0 and 88.0%, respectively. The area under the curve (AUC) of SEE and ITLPE for myometrial invasion were 0.740 (95%CI, 0.584-0.896), and 0.866 (95%CI, 0.763-0.970), respectively. The sensitivity and specificity were statistically different between SEE and ITLPE for the detection of myometrial invasion ( = 0.031, 0.016). According to the comparison between FIPE and histopathologic findings, the irregular endomyometrial junction was found in 30/77 (38.9%) cases, 24/30 (80.0%) with myometrial infiltration and 6/30 (20.0%) cases without myometrial infiltration. CONCLUSIONS:FIPE was the irregular endomyometrial junction. It can be found in patients with or without myometrial infiltration and may lead to the overestimation of myometrial invasion by SEE on DCE-MRI. ITLPE presented high diagnostic performance and specificity for myometrial invasion in patients with low-risk endometrial carcinoma.
MRI-based traditional radiomics and computer-vision nomogram for predicting lymphovascular space invasion in endometrial carcinoma.
Long Ling,Sun Jianqing,Jiang Liling,Hu Yixin,Li Lan,Tan Yong,Cao Meimei,Lan Xiaosong,Zhang Jiuquan
Diagnostic and interventional imaging
PURPOSE:To determine the capabilities of MRI-based traditional radiomics and computer-vision (CV) nomogram for predicting lymphovascular space invasion (LVSI) in patients with endometrial carcinoma (EC). MATERIALS AND METHODS:A total of 184 women (mean age, 52.9±9.0 [SD] years; range, 28-82 years) with EC were retrospectively included. Traditional radiomics features and CV features were extracted from preoperative T2-weighted and dynamic contrast-enhanced MR images. Two models (Model 1, the radiomics model; Model 2, adding CV radiomics signature into the Model 1) were built. The performance of the models was evaluated by the area under the curve (AUC) of the receiver operator characteristic (ROC) in the training and test cohorts. A nomogram based on clinicopathological metrics and radiomics signatures was developed. The predictive performance of the nomogram was assessed by AUC of the ROC in the training and test cohorts. RESULTS:For predicting LVSI, the AUC values of Model 1 in the training and test cohorts were 0.79 (95% confidence interval [CI]: 0.702-0.889; accuracy: 65.9%; sensitivity: 88.8%; specificity: 57.8%) and 0.75 (95% CI: 0.585-0.914; accuracy: 69.5%; sensitivity: 85.7%; specificity: 62.5%), respectively. The AUC values of Model 2 in the training and test cohorts were 0.93 (95% CI: 0.875-0.991; accuracy: 94.9%; sensitivity: 91.6%; specificity: 96.0%) and 0.81 (95% CI: 0.666-0.962; accuracy: 71.7%; sensitivity: 92.8%; specificity: 62.5%), respectively. The discriminative ability of Model 2 was significantly improved compared to Model 1 (Net Reclassification Improvement [NRI]=0.21; P=0.04). Based on histologic grade, FIGO stage, Rad-score and CV-score, AUC values of the nomogram to predict LVSI in the training and test cohorts were 0.98 (95% CI: 0.955-1; accuracy: 91.6%; sensitivity: 91.6%; specificity: 96.0%) and 0.92 (95% CI: 0.823-1; accuracy: 91.3%; sensitivity: 78.5%; specificity: 96.8%), respectively. CONCLUSIONS:MRI-based traditional radiomics and computer-vision nomogram are useful for preoperative risk stratification in patients with EC and may facilitate better clinical decision-making.
Multimodal MRI-Based Radiomics-Clinical Model for Preoperatively Differentiating Concurrent Endometrial Carcinoma From Atypical Endometrial Hyperplasia.
Frontiers in oncology
Objectives:To develop and validate a radiomics model based on multimodal MRI combining clinical information for preoperative distinguishing concurrent endometrial carcinoma (CEC) from atypical endometrial hyperplasia (AEH). Materials and Methods:A total of 122 patients (78 AEH and 44 CEC) who underwent preoperative MRI were enrolled in this retrospective study. Radiomics features were extracted based on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. After feature reduction by minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithm, single-modal and multimodal radiomics signatures, clinical model, and radiomics-clinical model were constructed using logistic regression. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis were used to assess the models. Results:The combined radiomics signature of T2WI, DWI, and ADC maps showed better discrimination ability than either alone. The radiomics-clinical model consisting of multimodal radiomics features, endometrial thickness >11mm, and nulliparity status achieved the highest area under the ROC curve (AUC) of 0.932 (95% confidential interval [CI]: 0.880-0.984), bootstrap corrected AUC of 0.922 in the training set, and AUC of 0.942 (95% CI: 0.852-1.000) in the validation set. Subgroup analysis further revealed that this model performed well for patients with preoperative endometrial biopsy consistent and inconsistent with postoperative pathologic data (consistent group, F1-score = 0.865; inconsistent group, F1-score = 0.900). Conclusions:The radiomics model, which incorporates multimodal MRI and clinical information, might be used to preoperatively differentiate CEC from AEH, especially for patients with under- or over-estimated preoperative endometrial biopsy.
Endometrial Carcinoma: MR Imaging-based Texture Model for Preoperative Risk Stratification-A Preliminary Analysis.
Ueno Yoshiko,Forghani Behzad,Forghani Reza,Dohan Anthony,Zeng Xing Ziggy,Chamming's Foucauld,Arseneau Jocelyne,Fu Lili,Gilbert Lucy,Gallix Benoit,Reinhold Caroline
Purpose To evaluate the associations among mathematical modeling with the use of magnetic resonance (MR) imaging-based texture features and deep myometrial invasion (DMI), lymphovascular space invasion (LVSI), and histologic high-grade endometrial carcinoma. Materials and Methods Institutional review board approval was obtained for this retrospective study. This study included 137 women with endometrial carcinomas measuring greater than 1 cm in maximal diameter who underwent 1.5-T MR imaging before hysterectomy between January 2011 and December 2015. Texture analysis was performed with commercial research software with manual delineation of a region of interest around the tumor on MR images (T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced images and apparent diffusion coefficient maps). Areas under the receiver operating characteristic curve and diagnostic performance of random forest models determined by using a subset of the most relevant texture features were estimated and compared with those of independent and blinded visual assessments by three subspecialty radiologists. Results A total of 180 texture features were extracted and ultimately limited to 11 features for DMI, 12 for LVSI, and 16 for high-grade tumor for random forest modeling. With random forest models, areas under the receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were estimated at 0.84, 79.3%, 82.3%, 81.0%, 76.7%, and 84.4% for DMI; 0.80, 80.9%, 72.5%, 76.6%, 74.3%, and 79.4% for LVSI; and 0.83, 81.0%, 76.8%, 78.1%, 60.7%, and 90.1% for high-grade tumor, respectively. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of visual assessment for DMI were 84.5%, 82.3%, 83.2%, 77.7%, and 87.8% (reader 3). Conclusion The mathematical models that incorporated MR imaging-based texture features were associated with the presence of DMI, LVSI, and high-grade tumor and achieved equivalent accuracy to that of subspecialty radiologists for assessment of DMI in endometrial cancers larger than 1 cm. However, these preliminary results must be interpreted with caution until they are validated with an independent data set, because the small sample size relative to the number of features extracted may have resulted in overfitting of the models. RSNA, 2017 Online supplemental material is available for this article.