Evaluation Of MRI In The Metastasis Of Endometrial Carcinoma And The Selection Of Surgical Method

Objective:To investigate the value of preoperative Magnetic Resonance Imaging examination in the diagnosis of myometrial invasion,cervical invasion and lymphatic metastasis in endometrial carcinoma,and the value of guiding surgical method,especially whether lymphadenectomy is needed.Method: Retrospectively analysed 215 patients’ data who diagnosed with endometrial carcinoma from June 2005 to March 2015 in Shenzhen People’s Hospital.All patients received Magnetic Resonance Imaging examination before operation and underwent surgical treatment in the hospital.All patients’ MRI images were blindly reviewed by a experienced radiological doctor according to FIGO 2014 standard in PACS system.All patients’ pathological section were reviewed by a experienced pathologists.As surgical pathology being the final diagnosis standard,the diagnostic evaluation of MRI was compared.Results: 1.The result of MRI for superficial myometrial invasion yielded a sensitivity of85.45%,specificity of 60.00%,positive predictive value of 87.58%,and negative predictive value of 55.55%,respectively.The values for deep myometrial invasion were 60.00%,85.45%,55.55%and 87.58,respectively,the kappa confidence was 0.44.2.The sensitivity,specificity,positive predictive value,negative predictive value and kappa confidence of MRI for cervical invasion were 33.33%,96%,38.46%,95.05%,0.31,respectively.3.The sensitivity,specificity,positive predictive value,negative predictive value and kappa confidence of MRI for lymphatic metastasis were 27.78%,98.88%,71.43%,93.16%,0.368,respectively.4.The sensitivity,specificity,positive predictive value,negative predictive value and kappa confidence of MRI for lymphatic metastasis of patients with grade 1 or 2 endometrioid adenocarcinoma were 62.5%,99.38%,83.33%,98.17,0.702,respectively.5.The sensitivity,specificity,positive predictive value,negative predictive value and kappa confidence of MRI for lymphatic metastasis of patients with grade 3 endometrioid adenocarcinoma were 42.86%,95.83,75%,85.16%,0.456,respectively.6.The accuracy and misdiagnosis rate of MRI for lymphatic metastasis of stage I endometrioid adenocarcinoma G1 or grade G2 patients were 99.22%,0.78%.7.The accuracy and misdiagnosis rate of MRI for lymph node negative of patients with stage Ⅰ~Ⅱ endometrial carcinoma were 98.88%,1.11%.8.The lymphatic metastasis rate of clinical stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 6.15%,0%,62.5%,and 0%,respectively,P =0.00.The lymphatic metastasis rate of G1,G2 and G3 were2.90%,8.60% and 22.86%,respectively,P = 0.004.The lymphatic metastasis rate in the mucosa or superficial myometrial invasion and deep myometrial invasion were 2.61% and 28.57%,respectively,P = 0.00.Conclusion:1.MRI has a high value in the diagnosis of myometrial invasion,cervical invasion.2.If the preoperative MRI diagnosis of pelvic and para-aortic lymph node is positive,the pathological stage of patient is likely to be III or IV.3.Preoperative MRI examination is helpful to guide the choice of surgical method and avoid blind enlargement of the scope of operation and reduce the trauma of patients4.Preoperative MRI has a high accuracy in the diagnosis of patients without pelvic and para-aortic lymphatic metastasis.For patients with stage Ⅰ and endometrioid adenocarcinoma with G1 or G2 and superficial myometrial invasion,there is no need for pelvic and para-aortic lymph node dissection.5.The lymphatic metastasis rate is proportional to clinical stage,histological grade and the deep of myometrial invasion.Pelvic and para-aortic lymph node dissection is necessary for patients with stage III,grade G2,or serous carcinoma,or deep myometrial invasion.