The value of MRI in management of endometrial hyperplasia with atypia
Abstract Background The value of the magnetic resonance imaging (MRI) in the assessment of women with endometrial hyperplasia and its role in diagnosis of myometrial invasion or coexistence of cancer is not known. This study aimed to evaluate the accuracy and usefulness of MRI in the management of p...
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doaj-0b98d94020a94567ada6cc1b677244632021-02-14T12:23:36ZengBMCWorld Journal of Surgical Oncology1477-78192020-02-011811810.1186/s12957-020-1811-5The value of MRI in management of endometrial hyperplasia with atypiaPurushothaman Natarajan0Angela Vinturache1Richard Hutson2David Nugent3Timothy Broadhead4Department of Obstetrics & Gynaecology, Liverpool Women’s HospitalDepartment of Obstetrics & Gynaecology, St George’s Hospital, St George’s University Hospitals NHS Foundation TrustDepartment of Gynaecologic Oncology, Leeds Teaching HospitalsDepartment of Gynaecologic Oncology, Leeds Teaching HospitalsDepartment of Gynaecologic Oncology, Leeds Teaching HospitalsAbstract Background The value of the magnetic resonance imaging (MRI) in the assessment of women with endometrial hyperplasia and its role in diagnosis of myometrial invasion or coexistence of cancer is not known. This study aimed to evaluate the accuracy and usefulness of MRI in the management of patients diagnosed on endometrial biopsy with complex endometrial hyperplasia with atypia (CEHA). Methods A retrospective study of 86 cases diagnosed with endometrial hyperplasia with atypia on the initial endometrial biopsy in a tertiary university teaching hospital between 2010 and 2015 was carried out. The MRI accuracy in predicting malignant changes and influence the clinical management was compared among women who had either pelvic MRI, transvaginal ultrasound (TVUS), or no additional imagistic studies. Results MRI was performed in 24 (28%) and TVUS in 11 (13%)cases, while 51 (59%) women had no additional imagistic studies. In the group of women with no imaging studies, 26/51 (51%) were surgically treated and 8/26 (31%) were diagnosed with endometrial cancer (EEC) stage 1a. In the group of women who had TVUS, 5/11 (45%) were surgically treated and none was diagnosed with EEC. In the group of women who underwent an MRI examination, 20/24 (83%) were surgically treated. Among these, 11/20 (55%) were diagnosed with EEC, 7 had EEC stage 1a, and 4 had EEC stage 1b. Although MRI was able to identify malignant changes with a good sensitivity (91.7%), it had a low specificity in characterisation of malignant transformation (8%). MRI correctly identified 31% of the stage 1a and 33% of the stage 1b endometrial cancer. Conclusion In this study, we found a potential diagnostic value of MRI for identifying malignant transformation in patients with CEHA. However, pelvic MRI has a rather weak predictive value of myometrial invasion in women with CEHA and concurrent EEC. The diagnostic and therapeutic benefits of MRI assessment in patients with CEHA need further validation.https://doi.org/10.1186/s12957-020-1811-5Endometrial hyperplasiaMyometrial invasionEndometrial cancerMagnetic resonance imagingUltrasonographySensitivity and specificity |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Purushothaman Natarajan Angela Vinturache Richard Hutson David Nugent Timothy Broadhead |
spellingShingle |
Purushothaman Natarajan Angela Vinturache Richard Hutson David Nugent Timothy Broadhead The value of MRI in management of endometrial hyperplasia with atypia World Journal of Surgical Oncology Endometrial hyperplasia Myometrial invasion Endometrial cancer Magnetic resonance imaging Ultrasonography Sensitivity and specificity |
author_facet |
Purushothaman Natarajan Angela Vinturache Richard Hutson David Nugent Timothy Broadhead |
author_sort |
Purushothaman Natarajan |
title |
The value of MRI in management of endometrial hyperplasia with atypia |
title_short |
The value of MRI in management of endometrial hyperplasia with atypia |
title_full |
The value of MRI in management of endometrial hyperplasia with atypia |
title_fullStr |
The value of MRI in management of endometrial hyperplasia with atypia |
title_full_unstemmed |
The value of MRI in management of endometrial hyperplasia with atypia |
title_sort |
value of mri in management of endometrial hyperplasia with atypia |
publisher |
BMC |
series |
World Journal of Surgical Oncology |
issn |
1477-7819 |
publishDate |
2020-02-01 |
description |
Abstract Background The value of the magnetic resonance imaging (MRI) in the assessment of women with endometrial hyperplasia and its role in diagnosis of myometrial invasion or coexistence of cancer is not known. This study aimed to evaluate the accuracy and usefulness of MRI in the management of patients diagnosed on endometrial biopsy with complex endometrial hyperplasia with atypia (CEHA). Methods A retrospective study of 86 cases diagnosed with endometrial hyperplasia with atypia on the initial endometrial biopsy in a tertiary university teaching hospital between 2010 and 2015 was carried out. The MRI accuracy in predicting malignant changes and influence the clinical management was compared among women who had either pelvic MRI, transvaginal ultrasound (TVUS), or no additional imagistic studies. Results MRI was performed in 24 (28%) and TVUS in 11 (13%)cases, while 51 (59%) women had no additional imagistic studies. In the group of women with no imaging studies, 26/51 (51%) were surgically treated and 8/26 (31%) were diagnosed with endometrial cancer (EEC) stage 1a. In the group of women who had TVUS, 5/11 (45%) were surgically treated and none was diagnosed with EEC. In the group of women who underwent an MRI examination, 20/24 (83%) were surgically treated. Among these, 11/20 (55%) were diagnosed with EEC, 7 had EEC stage 1a, and 4 had EEC stage 1b. Although MRI was able to identify malignant changes with a good sensitivity (91.7%), it had a low specificity in characterisation of malignant transformation (8%). MRI correctly identified 31% of the stage 1a and 33% of the stage 1b endometrial cancer. Conclusion In this study, we found a potential diagnostic value of MRI for identifying malignant transformation in patients with CEHA. However, pelvic MRI has a rather weak predictive value of myometrial invasion in women with CEHA and concurrent EEC. The diagnostic and therapeutic benefits of MRI assessment in patients with CEHA need further validation. |
topic |
Endometrial hyperplasia Myometrial invasion Endometrial cancer Magnetic resonance imaging Ultrasonography Sensitivity and specificity |
url |
https://doi.org/10.1186/s12957-020-1811-5 |
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