Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer

Yuki Himoto; Yulia Lakhman; Shinya Fujii; Satoshi Morita; Jennifer J Mueller; Mario M Leitao Jr; Aki Kido

doi:10.1007/s00261-021-03050-7

Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer

Abdom Radiol (NY). 2021 Sep;46(9):4410-4419. doi: 10.1007/s00261-021-03050-7. Epub 2021 Apr 7.

Authors

Yuki Himoto¹, Yulia Lakhman², Shinya Fujii³, Satoshi Morita⁴, Jennifer J Mueller⁵, Mario M Leitao Jr⁵, Aki Kido⁶

Affiliations

¹ Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan.
² Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
³ Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Faculty of Medicine, Tottori University, Tottori, Japan.
⁴ Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁵ Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁶ Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan. akikido@kuhp.kyoto-u.ac.jp.

Abstract

Purpose: To compare the diagnostic performance of biparametric magnetic resonance imaging (bpMRI) versus multiparametric MRI (mpMRI) for the staging of well-differentiated endometrioid endometrial cancer (EC) in potential candidates for fertility-sparing management.

Methods: This multi-center retrospective study included 48 potential candidates for fertility-sparing management (age <46 years, grade 1 endometroid EC) who did not wish to undergo fertility-sparing management and thus underwent definitive surgery. Two readers (R1, R2) independently reviewed bpMRI (T1, T2, and diffusion-weighted imaging) and mpMRI (bpMRI and dynamic contrast-enhanced imaging, DCE) during two separate sessions spaced one month apart for the presence of myometrial invasion (MI), cervical stromal involvement (CSI), malignant adnexal disease (mAD), and pelvic lymphadenopathy (pLNM). Each reader also recorded maximum tumor diameter, tumor volume, and tumor-to-uterine volume ratio (TVR) on T2-weighted imaging. The diagnostic performance of bpMRI and mpMRI was determined for each reader with surgical pathology serving as a gold standard.

Results: The area under the receiver operating curve (AUC) for bpMRI versus mpMRI was 0.76/0.78 (R1/R2) versus 0.84/0.83 for MI, 0.79/0.76 versus 0.99/0.80 for CSI, 0.84/0.84 versus 0.84/0.80 for mAD, and 0.82/0.82 for pLMN. The sensitivity and specificity of MRI for detecting tumor spread beyond the endometrium were 71%/77% and 71%/65% for bpMRI (R1/R2) vs. 84%/90% and 71%/65% for mpMRI (R1/R2), respectively. The AUC of maximum tumor diameter, tumor volume, and TVR for MI was 0.71/0.61, 0.73/0.75, and 0.75/0.77 for R1/R2, respectively.

Conclusion: MRI had moderate diagnostic performance across potential candidates for fertility-sparing treatment of EC. mpMRI outperformed bpMRI for detecting EC spreading beyond the endometrium.

Keywords: Endometrial cancer; Fertility preservation; Magnetic resonance imaging; Patient selection.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diffusion Magnetic Resonance Imaging
Endometrial Neoplasms* / diagnostic imaging
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Multiparametric Magnetic Resonance Imaging*
Patient Selection
Retrospective Studies
Sensitivity and Specificity

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States