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01.10.2015

Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology

verfasst von: Charis Bourgioti, Konstantinos Chatoupis, Evangelia Panourgias, Chara Tzavara, Kyrillos Sarris, Alexandros Rodolakis, Lia Angela Moulopoulos

Erschienen in: Abdominal Radiology | Ausgabe 7/2015

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Abstract

Purpose

To report discriminant MRI features between cervical and endometrial carcinomas and to design an MRI- scoring system, with the potential to predict the origin of uterine cancer (cervix or endometrium) in histologically indeterminate cases.

Materials and methods

Dedicated pelvic MRIs of 77 patients with uterine tumors involving both cervix and corpus were retrospectively analyzed by two experts in female imaging. Seven MRI tumor characteristics were statistically tested for their discriminant ability for tumor origin compared to final histology: tumor location, perfusion pattern, rim enhancement, depth of myometrial invasion, cervical stromal integrity, intracavitary mass, and retained endometrial secretions. Kappa values were estimated to assess the levels of inter-rater reliability. On the basis of positive likelihood ratio values, an MRI-score was assigned.

Results

K value was excellent for most of the imaging criteria. Using ROC curve analysis, the estimated optimal cut-off for the MRI-scoring system was 4 with 96.6% sensitivity and 100% specificity. Using a ≥4 cut-off for cervical cancers and <4 for endometrial cancers, 97.4% of the patients were correctly classified. 2/58 patients with cervical cancer had MRI score <4 and none of the patients with endometrial cancer had MRI score >4. The area under curve of the MRI-scoring system was 0.99 (95% CI 0.98–1.00). When the MRI-score was applied to 20/77 patients with indeterminate initial biopsy and to 5/26 surgically treated patients with erroneous pre-op histology, all cases were correctly classified.

Conclusion

The produced MRI-scoring system may be a reliable problem-solving tool for the differential diagnosis of cervical vs. endometrial cancer in cases of equivocal histology.

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Titel: Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology
verfasst von: Charis Bourgioti
Konstantinos Chatoupis
Evangelia Panourgias
Chara Tzavara
Kyrillos Sarris
Alexandros Rodolakis
Lia Angela Moulopoulos
Publikationsdatum: 01.10.2015
Verlag: Springer US
Erschienen in: Abdominal Radiology / Ausgabe 7/2015
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-015-0399-7

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Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology