The Value Of Magnetic Resonance Imaging In The Individualized Treatment Of Endometrial Carcinoma

[Objective]:Through retrospective analysis,to investigate the diagnostic value of preoperative Magnetic Resonance Imaging in myometrial invasion,cervical invasion,ovarian metastasis,and lymph node metastasis in patients with endometrial carcinoma;to evaluate the value of MRI for individualized treatment[Materials and Methods]:From January 2016 to December 2017,316 patients with pathologically confirmed endometrial carcinoma were included.All patients received preoperative Magnetic Resonance Imaging examination and surgery at QiluHospital of Shandong University.Clinical data of patients,including age,menstrual and reproductive history,comorbidities,family history of tumors,MRI findings,preoperative histopathological diagnosis,postoperative histopathological diagnosis,surgical-pathological stage,histologic grade,etc.,were collect.The preoperative MRI results were compared with the postoperative pathological findings.The value of MRI for the diagnosis of myometrial invasion,cervical invasion,ovarian metastasis and lymph node status in endometrial carcinoma was evaluated.Investigate the value of preoperative MRI for conservative,non-surgical management,ovarian conservation,and avoiding lymphadenectomy.All statistical data were input into an Excel sheet,and software SPSS 20 was used for statistical analysis of the data.Kappa test was used to verify the consistency between the MRI results and the pathological results.The chi-square test and Fisher exact test were used to compare the correlations between groups and the ROC curves were plotted.Calculate the area under the ROC curve of myometrial invasion depth by MRI and analyze the value of MRI in the individualized treatment of endometrial cancer.[Results]1.The accuracy rate of MRI staging was 74.68%,decreased with the stage or grade rising,(85.25%in stage la,57.89%in stage Ⅰb,46.67%in stage Ⅱ,36.67%in stage Ⅲ,0 in stage Ⅳ),and upstage rate was 11.7%.2.The sensitivity and specificity for tumor confined to the endometrium was 48.00%、89.85%,respectively.3.The diagnostic sensitivity for superficial myometrial invasion on MRI was 83.6%,specificity was 75.0%,the positive predictive value was 93.4%,and the AUC=0.793.And the sensitivity for DMI>50%was 75.0%.4.The sensitivity for cervical involvement was 56.1%and the specificity was 96.7%.5.In this study,the ovarian metastasis rate was 2.11%.No patients with synchronous ovarian primary cancer were found.Only one case of occult metastases occurred with an incidence of 0.35%.The ovarian metastasis rate was 0.8%in patients with type Ⅰ EC(0.47%in endometrioid cancer,DMI<50%)and 18.2%in patients with type Ⅱ EC.The rate of ovarian metastasis was closely correlated to pathological types.6.The sensitivity for ovarian involvement on MRI was 66.7%,the specificity was 100.0%,the positive predictive value was 100.0%,the negative predictive value was 98.9%,and the overall coincidence rate was 99.3%.That consisted with postoperative pathology well.7.Fallopian tube involvement,present in 17 patients(5.99%,17/284),is a predictive factor for ovarian metastasis,which can’t be shown on MRI.8.In MRI diagnosed 14 cases with low-risk of ovarian metastases,no ovarian or fallopian tube involvement were found.9.In this study,the overall rate of positive lymph node in EC patients was 3.77%,in which the rate of pelvic lymph node metastasis alone was 2.36%,and the rate of both pelvic and para-aortic lymph node metastasis was 1.42%.Among them,the lymph node metastasis rate of type I EC was 3.05%,while 13.33%in type II.The lymph node metastasis rate was related to LVSI(P=0.034),but there was no statistical significance with cervical involvement(P=0.346),deep muscle involvement(P=0.685),and pathological grade(P=0.349).The lymph node metastasis rate was 4.35%in the patients with deep myometrial infiltration and the rate of para-aortic lymph node metastasis was 2.17%;and 3.61%、1.20%in patients with DMI<50%.10.Sensitivity for lymph node metastasis of MRI was 25.0%,κ = 0.262,which means poor consistency,and the rate of missed diagnosis was 75.0%,misdiagnosis rate was 1.96%.11.One of the 58 low-risk patients(G1,MRI superficial muscle infiltration)had lymph node metastasis on MRI,which confirmed by pathology.Thus,lymph node metastasis rate in low-risk patients is very low(1.72%),while MRI diagnostic accuracy is higher.[Conclusions]1.Preoperative MRI can accurately diagnose the depth of myometrial infiltration and cervical involvement in EC patients.2.In this study,the ovarian metastasis rate in EC patients was 2.11%,of which the rate in patients with endometrioid adenocarcinoma whose DMI<l/2 was 0.47%.Though MRI has a high specificity in diagnosing ovarian metastases,it may miss the occult metastasis.And there is no evidence of tubal involvement on MRI.3.The lymph node metastasis rate of EC patients was 3.77%.The overall accuracy of MRI on the diagnosis of lymph node metastasis was poor,but the accuracy in patients with low-risk was higher.It can be used for preoperative reference for lymph node resection.