Skip to main content
SpringerLink
Log in

Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists

  • Urogenital
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate pelvic magnetic resonance imaging (MRI) interobserver agreement for the detection of deep myometrial invasion, cervical stroma invasion and lymph node metastases in endometrial carcinoma patients in relation to surgical staging.

Methods

Fifty-seven patients with histologically confirmed endometrial carcinoma were prospectively included in a study of preoperative 1.5-T MRI. Four radiologists, blinded to patient data, independently reviewed the images for the presence of deep myometrial invasion, cervical stroma invasion and lymph node metastases. Kappa coefficients for interobserver agreement and diagnostic performances for each observer were calculated using final surgical staging results (FIGO 09) as reference standard.

Results

Overall agreement among all observers was moderate for cervical stroma invasion (κ = 0.50 [95% CI 0.27–0.73]) and lymph node metastases (κ = 0.56 [0.09–0.80]) and fair for deep myometrial invasion (κ = 0.39 [0.26–0.55]). Sensitivity (specificity) values for the four observers were 72–92% (44–63%) for deep myometrial invasion, 38–63% (82–94%) for cervical stroma invasion and 25–38% (90–100%) for lymph node metastases.

Conclusions

Conventional MRI showed only modest interobserver agreement and diagnostic accuracy for detection of deep myometrial invasion, cervical stroma invasion and lymph node metastases. Improved methods are needed for preoperative imaging in the staging of endometrial carcinomas.

Key Points

• MRI is an important tool for preoperative endometrial cancer staging.

• Staging agreement based on pelvic MRI was modest among different observers.

• Preoperative MRI alone was suboptimal in identifying high-risk patients.

• Improved imaging and biomarkers may refine preoperative risk stratification in endometrial cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Amant F, Moerman P, Neven P, Timmerman D, Van LE, Vergote I (2005) Endometrial cancer. Lancet 366:491–505

    Article  PubMed  Google Scholar 

  2. Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL, Heintz AP, Ngan HY, Pecorelli S (2006) Carcinoma of the corpus uteri. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 95:S105–S143

    Article  PubMed  Google Scholar 

  3. Cohn DE, Woeste EM, Cacchio S, Zanagnolo VL, Havrilesky LJ, Mariani A, Podratz KC, Huh WK, Whitworth JM, McMeekin DS, Powell MA, Boyd E, Phillips GS, Fowler JM (2007) Clinical and pathologic correlates in surgical stage II endometrial carcinoma. Obstet Gynecol 109:1062–1067

    Article  PubMed  Google Scholar 

  4. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165–1172

    Article  PubMed  Google Scholar 

  5. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  PubMed  CAS  Google Scholar 

  6. Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718

    PubMed  CAS  Google Scholar 

  7. Sala E, Wakely S, Senior E, Lomas D (2007) MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol 188:1577–1587

    Article  PubMed  Google Scholar 

  8. Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855

    Article  PubMed  CAS  Google Scholar 

  9. Koyama T, Tamai K, Togashi K (2007) Staging of carcinoma of the uterine cervix and endometrium. Eur Radiol 17:2009–2019

    Article  PubMed  Google Scholar 

  10. Cabrita S, Rodrigues H, Abreu R, Martins M, Teixeira L, Marques C, Mota F, de Oliveira CF (2008) Magnetic resonance imaging in the preoperative staging of endometrial carcinoma. Eur J Gynaecol Oncol 29:135–137

    PubMed  CAS  Google Scholar 

  11. Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH (2007) Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer 17:188–196

    Article  PubMed  CAS  Google Scholar 

  12. Sala E, Crawford R, Senior E, Shaw A, Simcock B, Vrotsou K, Palmer C, Rajan P, Joubert I, Lomas D (2009) Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma. Int J Gynecol Cancer 19:141–146

    Article  PubMed  Google Scholar 

  13. Undurraga M, Petignat P, Pelte MF, Jacob S, Dubuisson JB, Loubeyre P (2009) Magnetic resonance imaging to identify risk of lymph node metastasis in patients with endometrial cancer. Int J Gynaecol Obstet 104:233–235

    Article  PubMed  Google Scholar 

  14. Haldorsen IS, Salvesen HB (2012) Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol 67:2–12

    Article  PubMed  CAS  Google Scholar 

  15. Kinkel K, Forstner R, Danza FM, Oleaga L, Cunha TM, Bergman A, Barentsz JO, Balleyguier C, Brkljacic B, Spencer JA (2009) Staging of endometrial cancer with MRI: Guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574

    Article  PubMed  CAS  Google Scholar 

  16. Hori M, Kim T, Murakami T, Imaoka I, Onishi H, Nakamoto A, Nakaya Y, Tomoda K, Tsutsui T, Enomoto T, Kimura T, Nakamura H (2009) MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: comparison with imaging at 1.5 T. J Magn Reson Imaging 30:621–630

    Article  PubMed  Google Scholar 

  17. Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, Wu TI, Wang CC, Chen YR, Huang YT, Ng SH, Jung SM, Chang TC, Lai CH (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging – initial experience. Radiology 250:784–792

    Article  PubMed  Google Scholar 

  18. Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S (2010) Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 20:754–762

    Article  PubMed  Google Scholar 

  19. Scoutt LM, McCarthy SM, Flynn SD, Lange RC, Long F, Smith RC, Chambers SK, Kohorn E, Schwartz P, Chambers JT (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology 194:567–572

    PubMed  CAS  Google Scholar 

  20. Seki H, Takano T, Sakai K (2000) Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervix. AJR Am J Roentgenol 175:171–176

    PubMed  CAS  Google Scholar 

  21. Torricelli P, Ferraresi S, Fiocchi F, Ligabue G, Jasonni VM, Di MI, Rivasi F (2008) 3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer. AJR Am J Roentgenol 190:489–495

    Article  PubMed  Google Scholar 

  22. Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104

    Article  PubMed  Google Scholar 

  23. Silverberg SG, Kurman RJ, Nogales F et al (2003) Tumors of the uterine corpus: epithelial tumors and related lesions. In: Tavassoli FA, Devilee P (eds) WHO Classification of Tumors: Pathology and Genetics of Tumors of the Breast and Female Genital Organs. IARC Press, Lyon, pp 221–232

    Google Scholar 

  24. Fleiss JL, Levin B, Paik MC (2004) The Measurement of Interrater Agreement. In: Statistical Methods for Rates and Proportions, 3 rdth edn. Wiley, New York

    Google Scholar 

  25. Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I (2008) Uterine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed Online 17:244–248

    Article  PubMed  Google Scholar 

  26. Bankier AA, Levine D, Halpern EF, Kressel HY (2010) Consensus interpretation in imaging research: is there a better way? Radiology 257:14–17

    Article  PubMed  Google Scholar 

  27. Mower WR (1999) Evaluating bias and variability in diagnostic test reports. Ann Emerg Med 33:85–91

    Article  PubMed  CAS  Google Scholar 

  28. Manfredi R, Gui B, Maresca G, Fanfani F, Bonomo L (2005) Endometrial cancer: magnetic resonance imaging. Abdom Imaging 30:626–636

    Article  PubMed  CAS  Google Scholar 

  29. Sala E, Rockall A, Kubik-Huch RA (2011) Advances in magnetic resonance imaging of endometrial cancer. Eur Radiol 21:468–473

    Article  PubMed  Google Scholar 

  30. Sanjuan A, Cobo T, Pahisa J, Escaramis G, Ordi J, Ayuso JR, Garcia S, Hernandez S, Torne A, Martinez RS, Lejarcegui JA, Vanrell JA (2006) Preoperative and intraoperative assessment of myometrial invasion and histologic grade in endometrial cancer: role of magnetic resonance imaging and frozen section. Int J Gynecol Cancer 16:385–390

    Article  PubMed  CAS  Google Scholar 

  31. Chung HH, Kang SB, Cho JY, Kim JW, Park NH, Song YS, Kim SH, Lee HP (2007) Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 104:654–659

    Article  PubMed  Google Scholar 

  32. Akaeda T, Isaka K, Takayama M, Kakizaki D, Abe K (2005) Myometrial invasion and cervical invasion by endometrial carcinoma: evaluation by CO2-volumetric interpolated breathhold examination (VIBE). J Magn Reson Imaging 21:166–171

    Article  PubMed  Google Scholar 

  33. Nakao Y, Yokoyama M, Hara K, Koyamatsu Y, Yasunaga M, Araki Y, Watanabe Y, Iwasaka T (2006) MR imaging in endometrial carcinoma as a diagnostic tool for the absence of myometrial invasion. Gynecol Oncol 102:343–347

    Article  PubMed  Google Scholar 

  34. Ortashi O, Jain S, Emannuel O, Henry R, Wood A, Evans J (2008) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obstet Gynecol Reprod Biol 137:232–235

    Article  PubMed  Google Scholar 

  35. Vasconcelos C, Felix A, Cunha TM (2007) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and histopathologic evaluation. J Obstet Gynaecol 27:65–70

    Article  PubMed  CAS  Google Scholar 

  36. Manfredi R, Mirk P, Maresca G, Margariti PA, Testa A, Zannoni GF, Giordano D, Scambia G, Marano P (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378

    Article  PubMed  Google Scholar 

  37. Sanjuan A, Escaramis G, Ayuso JR, Roman SM, Torne A, Ordi J, Lejarcegui JA, Pahisa J (2008) Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer. Arch Gynecol Obstet 278:535–539

    Article  PubMed  CAS  Google Scholar 

  38. Sironi S, Colombo E, Villa G, Taccagni G, Belloni C, Garancini P, DelMaschio A (1992) Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. Radiology 185:207–212

    PubMed  CAS  Google Scholar 

  39. Loubeyre P, Undurraga M, Bodmer A, Petignat P (2011) Non-invasive modalities for predicting lymph node spread in early stage endometrial cancer? Surg Oncol 20:e102–e108

    Article  PubMed  Google Scholar 

  40. Narayanan P, Iyngkaran T, Sohaib SA, Reznek RH, Rockall AG (2009) Pearls and pitfalls of MR lymphography in gynecologic malignancy. Radiographics 29:1057–1069

    Article  PubMed  Google Scholar 

  41. Shen SH, Chiou YY, Wang JH, Yen MS, Lee RC, Lai CR, Chang CY (2008) Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol 190:481–488

    Article  PubMed  Google Scholar 

  42. Takeuchi M, Matsuzaki K, Nishitani H (2009) Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion. Acta Radiol 50:947–953

    Article  PubMed  CAS  Google Scholar 

  43. Joja I, Asakawa M, Asakawa T, Nakagawa T, Kanazawa S, Kuroda M, Togami I, Hiraki Y, Akamatsu N, Kudo T (1996) Endometrial carcinoma: dynamic MRI with turbo-FLASH technique. J Comput Assist Tomogr 20:878–887

    Article  PubMed  CAS  Google Scholar 

  44. Trovik J, Wik E, Stefansson IM, Marcickiewicz J, Tingulstad S, Staff AC, Njolstad TS, Vandenput I, Amant F, Akslen LA, Salvesen HB (2011) Stathmin overexpression identifies high-risk patients and lymph node metastasis in endometrial cancer. Clin Cancer Res 17:3368–3377

    Article  PubMed  CAS  Google Scholar 

  45. Engelsen IB, Stefansson I, Akslen LA, Salvesen HB (2006) Pathologic expression of p53 or p16 in preoperative curettage specimens identifies high-risk endometrial carcinomas. Am J Obstet Gynecol 195:979–986

    Article  PubMed  CAS  Google Scholar 

  46. Engelsen IB, Stefansson IM, Akslen LA, Salvesen HB (2008) GATA3 expression in estrogen receptor alpha-negative endometrial carcinomas identifies aggressive tumors with high proliferation and poor patient survival. Am J Obstet Gynecol 199:543–547

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Supported by The Western Norway Regional Health Authority, Research Funds at the Department of Radiology, Haukeland University Hospital, Norwegian Research Council, The University of Bergen, The Meltzer Foundation, and The Norwegian Cancer Society (The Harald Andersen’s legacy). This study was supported by The Western Norway Regional Health Authority, Research Funds at Department of Radiology Haukeland University Hospital, Norwegian Research Council, The University of Bergen, The Meltzer Foundation, and The Norwegian Cancer Society (the Harald Andersen legacy).

Author information

Authors and Affiliations

  1. Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway

    Ingfrid S. Haldorsen, Jenny A. Husby, Inger J. Magnussen, Jarle Rørvik & Ansgar Espeland

  2. Section for Radiology, Department of Surgical Sciences, University of Bergen, Bergen, Norway

    Ingfrid S. Haldorsen, Jarle Rørvik & Ansgar Espeland

  3. Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway

    Henrica M. J. Werner, Harald Helland, Jone Trovik & Helga B. Salvesen

  4. Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway

    Henrica M. J. Werner, Jone Trovik & Helga B. Salvesen

  5. Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Øyvind O. Salvesen

Authors
  1. Ingfrid S. Haldorsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jenny A. Husby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henrica M. J. Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inger J. Magnussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jarle Rørvik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Harald Helland
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jone Trovik
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Øyvind O. Salvesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ansgar Espeland
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Helga B. Salvesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ingfrid S. Haldorsen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haldorsen, I.S., Husby, J.A., Werner, H.M.J. et al. Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists. Eur Radiol 22, 1601–1611 (2012). https://doi.org/10.1007/s00330-012-2400-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-012-2400-y

Keywords

Search

Navigation