Peritumoral Enhancement for the Evaluation of Myometrial Invasion in Low-Risk Endometrial Carcinoma on Dynamic Contrast-Enhanced MRI

Tingting Cui; Feng Shi; Bei Gu; Yanfang Jin; Jinsong Guo; Chao Zhang; Jie Ren; Yunlong Yue

doi:10.3389/fonc.2021.793709

Peritumoral Enhancement for the Evaluation of Myometrial Invasion in Low-Risk Endometrial Carcinoma on Dynamic Contrast-Enhanced MRI

Front Oncol. 2022 Jan 17:11:793709. doi: 10.3389/fonc.2021.793709. eCollection 2021.

Authors

Tingting Cui¹, Feng Shi², Bei Gu³, Yanfang Jin¹, Jinsong Guo¹, Chao Zhang¹, Jie Ren¹, Yunlong Yue¹

Affiliations

¹ Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
² Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³ Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.

Abstract

Objectives: To explore the clinical value of subendometrial enhancement (SEE), irregular thin-layered peritumoral early enhancement (ITLPE) and focal irregular peritumoral early enhancement (FIPE) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for myometrial invasion in patients with low-risk endometrial carcinoma.

Methods: Seventy-seven patients with low-risk endometrial carcinoma who preoperatively underwent DCE-MRI were included. Two radiologists independently evaluated and recorded the occurrences of SEE, ITLPE and FIPE on DCE-MRI in all patients. Interobserver agreement was calculated between the two radiologists, and the relationships between SEE, ITLPE, FIPE, and myometrial invasion were analyzed based on histologic findings. For statistically significant findings, the sensitivity and specificity were calculated, and the differences in myometrial invasion evaluations were analyzed. For those with no statistical significance, images were compared with the histopathologic sections.

Results: Inter-observer agreement was good (k = 0.80; 95%CI, 0.577-0.955) for SEE, and very good (k = 0.88; 95%CI, 0.761-0.972) (k = 0.86; 95%CI, 0.739-0.973) for ITLPE and FIPE. After consensus, SEE was identified in 12/77 (15.6%) patients; ITLPE and FIPE were found in 53/77 (68.8%) and 30/77 (39.0%) patients, respectively. SEE and ITLPE were significantly correlated with myometrial infiltration (P = 0.000), but FIPE were not (P = 0.725).The sensitivity and specificity of SEE and ITLPE for myometrial invasion in patients with low-risk endometrial carcinoma were 95.0 and 52.9%, and 85.0 and 88.0%, respectively. The area under the curve (AUC) of SEE and ITLPE for myometrial invasion were 0.740 (95%CI, 0.584-0.896), and 0.866 (95%CI, 0.763-0.970), respectively. The sensitivity and specificity were statistically different between SEE and ITLPE for the detection of myometrial invasion (P = 0.031, 0.016). According to the comparison between FIPE and histopathologic findings, the irregular endomyometrial junction was found in 30/77 (38.9%) cases, 24/30 (80.0%) with myometrial infiltration and 6/30 (20.0%) cases without myometrial infiltration.

Conclusions: FIPE was the irregular endomyometrial junction. It can be found in patients with or without myometrial infiltration and may lead to the overestimation of myometrial invasion by SEE on DCE-MRI. ITLPE presented high diagnostic performance and specificity for myometrial invasion in patients with low-risk endometrial carcinoma.

Keywords: dynamic contrast-enhanced imaging; endometrial carcinoma; magnetic resonance imaging; risk classification; uterus.