| 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7-34. |
Review/Other-Dx |
N/A |
To provide the estimated numbers of new cancer cases and deaths in 2019 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on the most current population-based data for cancer incidence through 2015 and for mortality through 2016; to estimate the total number of deaths averted because of the continuous decline in cancer death rates since the early 1990s and analyze cancer mortality rates by county-level poverty. |
Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. |
4 |
| 2. Murali R, Soslow RA, Weigelt B. Classification of endometrial carcinoma: more than two types. Lancet Oncol 2014;15:e268-78. |
Review/Other-Dx |
N/A |
To provide an overview of traditional and newer genomic classifications of endometrial cancer and discuss how a classification system that incorporates genomic and histopathological features to define biologically and clinically relevant subsets of the disease would be useful. |
No results stated in abstract. |
4 |
| 3. Kurman RJ, International Agency for Research on Cancer., World Health Organization. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: International Agency for Research on Cancer; 2014. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 4. Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol. 1989; 96(8):889-892. |
Review/Other-Tx |
N/A |
Revised FIGO staging for gynaecological cancer. |
N/A |
4 |
| 5. Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. Int J Gynaecol Obstet 2018;143 Suppl 2:37-50. |
Review/Other-Dx |
N/A |
To review cancer of the corpus uteri. |
No results stated in abstract. |
4 |
| 6. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103-104. |
Review/Other-Tx |
N/A |
A consensus document on revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. |
No results stated in abstract. |
4 |
| 7. Abu-Rustum NR, Zhou Q, Gomez JD, et al. A nomogram for predicting overall survival of women with endometrial cancer following primary therapy: toward improving individualized cancer care. Gynecol Oncol 2010;116:399-403. |
Review/Other-Dx |
1735 patients |
To develop a clinically useful nomogram in the hope of providing a more individualized and accurate estimation of overall survival (OS) following primary therapy. |
The median age was 62 years (range, 25–96). Final grade included: G1 (471), G2 (622), G3 (634), missing (8). Stage included: IA (501), IB (590), IC (141), IIA (36), IIB (75), IIIA (116), IIIB (6), IIIC (135), IVA (7), and IVB (128). Histology included: adenocarcinoma (1376), carcinosarcoma (100), clear cell (62), serous (197). Median follow-up for survivors was 29.2 months (0–162.2 months). Concordance probability estimator for the nomogram is 0.746 ± 0.011. |
4 |
| 8. Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355(9213):1404-1411. |
Experimental-Tx |
714 patients |
A multicenter prospective randomized trial to find whether postoperative pelvic RT improves locoregional control and survival for patients with stage-1 endometrial carcinoma. |
The median duration of follow-up was 52 months. 5-year actuarial locoregional recurrence rates were 4% in the RT group and 14% in the control group (P<0.001). Actuarial 5-year OS rates were similar in the two groups: 81% (RT) and 85% (controls), P=0.31. Endometrial-cancer-related death rates were 9% in the RT group and 6% in the control group (P=0.37). Treatment-related complications occurred in 25% of RT patients, and in 6% of the controls (P<0.0001). Two-thirds of the complications were grade 1. Grade 3-4 complications were seen in 8 patients, of which 7 were in the RT group (2%). 2-year survival after vaginal recurrence was 79%, in contrast to 21% after pelvic recurrence or distant metastases. Survival after relapse was significantly (P=0.02) better for patients in the control group. Multivariate analysis showed that for locoregional recurrence, RT and age below 60 years were significant favorable prognostic factors. |
1 |
| 9. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010;375:1165-72. |
Observational-Tx |
671 patients |
To establish whether complete, systematic lymphadenectomy, including the para-aortic lymph nodes, should be part of surgical therapy for endometrial cancer patients at intermediate and high risk of recurrence. |
Overall survival was significantly longer in the pelvic and para-aortic lymphadenectomy group than in the pelvic lymphadenectomy group (HR 0·53, 95% CI 0·38–0·76; p=0·0005). This association was also recorded in 407 patients at intermediate or high risk (p=0·0009), but overall survival was not related to lymphadenectomy type in low-risk patients. Multivariate analysis of prognostic factors showed that in patients with intermediate or high risk of recurrence, pelvic and para-aortic lymphadenectomy reduced the risk of death compared with pelvic lymphadenectomy (0·44, 0·30-0·64; p<0·0001). Analysis of 328 patients with intermediate or high risk who were treated with adjuvant radiotherapy or chemotherapy showed that patient survival improved with pelvic and para-aortic lymphadenectomy (0·48, 0·29–0·83; p=0·0049) and with adjuvant chemotherapy (0·59, 0·37–1·00; p=0·0465) independently of one another. |
1 |
| 10. Bendifallah S, Canlorbe G, Raimond E, et al. A clue towards improving the European Society of Medical Oncology risk group classification in apparent early stage endometrial cancer? Impact of lymphovascular space invasion. Br J Cancer 2014;110:2640-6. |
Observational-Dx |
496 patients |
To investigate whether lymphovascular space invasion (LVSI) may improve the accuracy of the European Society of Medical Oncology (ESMO) classification in predicting the recurrence risk. |
The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1–152)and 27 (range: 1–134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI-, intermediate risk/LVSI+, high risk/LVSI-, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI:0.68–0.74) and 0.74 (95% CI: 0.71–0.77), respectively. |
3 |
| 11. Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Canc Netw 2014;12:288-97. |
Review/Other-Dx |
N/A |
To review sentinel lymph node mapping for endometrial cancer. |
No results stated in abstract. |
4 |
| 12. Frati A, Ballester M, Dubernard G, et al. Contribution of Lymphoscintigraphy for Sentinel Lymph Node Biopsy in Women with Early Stage Endometrial Cancer: Results of the SENTI-ENDO Study. Ann Surg Oncol. 22(6):1980-6, 2015. |
Observational-Dx |
133 patients |
To evaluate detection rate and anatomical location of sentinel lymph node (SLN) at lymphoscintigraphy, to compare short and long lymphoscintigraphy protocols, and to correlate lymphoscintigraphic and surgical mapping of SLN in patients with early-stage endometrial cancer (EC). |
A total of 133 patients were enrolled in the study and 118 (94.5 %) underwent a lymphoscintigraphy. Of these 118 patients, 44 (37 %) underwent a short protocol and 66 (56 %) a long protocol (data on lymphoscintigraphy were not available in eight patients). Lymphoscintigraphic detection rate was 74.6 %(34 %for short protocol and 60.2 %for long protocol). No difference in the detection rate was observed according to lymphoscintigraphy protocol (p = 0.22), but a higher numberof SLN was noted for the long protocol (p = 0.02). Aberrant drainage was noted on lymphoscintigraphy in 30.5 % of the patients. Paraaortic SLNs were exclusively detected using the long protocol. A poor correlation was noted between short (j test = 0.24) or long lymphoscintigraphy (j test = 0.3) protocol and SLN surgical mapping. |
3 |
| 13. Holloway RW, Abu-Rustum NR, Backes FJ, et al. Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol 2017;146:405-15. |
Review/Other-Dx |
N/A |
To review the current literature regarding sentinel lymph node (SLN) assessment in endometrial cancer and to improve outcomes for women with this disease. |
No results stated in abstract. |
4 |
| 14. Khoury-Collado F, Murray MP, Hensley ML, et al. Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes. Gynecol Oncol 2011;122:251-4. |
Observational-Dx |
266 patients |
To compare the incidence of metastatic cancer cells in sentinel lymph nodes (SLN) vs. nonsentinel nodes in patients who had lymphatic mapping for endometrial cancer and to determine the contribution of metastases detected on ultrastaging to the overall nodal metastasis rate. |
Between 09/2005 and 03/2010, 266 patients with endometrial cancer underwent lymphatic mapping. Sentinel node identification was successful in 223 (84%) cases. Positive nodes were diagnosed in 32/ 266 (12%) patients. Of those, 8/266 patients (3%) had the metastasis detected only by additional section or IHCas part of SLN ultrastaging. Excluding the 8 cases with positive SLN on ultrastaging only, 24/801 (2.99%) SLN and 30/2698 (1.11%) non-SLN were positive for metastatic disease (p=0.0003). |
3 |
| 15. Rossi EC, Kowalski LD, Scalici J, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 2017;18:384-92. |
Experimental-Dx |
385 patients |
To measure the sensitivity and negative predictive value of sentinel-lymph-node mapping compared with the gold standard of complete lymphadenectomy in detecting metastatic disease for endometrial cancer. |
Between Aug 1, 2012, and Oct 20, 2015, 385 patients were enrolled. Sentinel-lymph-node mapping with complete pelvic lymphadenectomy was done in 340 patients and para-aortic lymphadenectomy was done in 196 (58%) of these patients. 293 (86%) patients had successful mapping of at least one sentinel lymph node. 41 (12%) patients had positive nodes, 36 of whom had at least one mapped sentinel lymph node. Nodal metastases were identified in the sentinel lymph nodes of 35 (97%) of these 36 patients, yielding a sensitivity to detect node-positive disease of 97·2% (95% CI 85·0-100), and a negative predictive value of 99·6% (97·9-100). The most common grade 3-4 adverse events or serious adverse events were postoperative neurological disorders (4 patients) and postoperative respiratory distress or failure (4 patients). 22 patients had serious adverse events, with one related to the study intervention: a ureteral injury incurred during sentinel-lymph-node dissection. |
3 |
| 16. Sohaib SA, Houghton SL, Meroni R, Rockall AG, Blake P, Reznek RH. Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clin Radiol. 62(1):28-34; discussion 35-6, 2007 Jan. |
Review/Other-Tx |
86 patients |
To evaluate patterns of disease and identify factors predicting outcome in patients presenting with recurrent endometrial adenocarcinoma following primary surgery. |
Following primary surgery recurrent disease occurred within 2 years in 64% and within 3 years in 87%. Relapse was seen within lymph nodes in 41 (46%), the vagina in 36 (42%) the peritoneum in 24 (28%) and the lung in 21 (24%). Unusual sites of disease included spleen, pancreas, rectum, muscle and brain. Univariate survival analysis showed the factors significant for poor outcome were: multiple sites of disease, liver and splenic disease, haematogenous, peritoneal and nodal spread, poorly differentiated tumor, and early relapse. The presence of disease within the vagina, bladder or lung was not associated with poor prognosis. Multivariate analysis identified multiple sites of disease, liver and splenic metastases to be independent predictors of poor outcome. |
4 |
| 17. Kurra V, Krajewski KM, Jagannathan J, Giardino A, Berlin S, Ramaiya N. Typical and atypical metastatic sites of recurrent endometrial carcinoma. Cancer Imaging 2013;13:113-22. |
Review/Other-Dx |
N/A |
To illustrate the imaging findings of typical and atypical metastatic sites of recurrent endometrial carcinoma. |
No results stated in abstract. |
4 |
| 18. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 2005;106:413-25. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 19. Gadducci A, Cosio S, Fanucchi A, Cristofani R, Genazzani AR. An intensive follow-up does not change survival of patients with clinical stage I endometrial cancer. Anticancer Res. 2000; 20(3B):1977-1984. |
Observational-Tx |
133 patients |
To determine whether there is a clinical benefit of an intensive follow-up protocol in endometrial cancer patients. Patients had initial abdominal surgery for clinical stage I endometrial cancer between 1988 and 1997 and were periodically followed-up until April 1999 or until death. After surgery, 89 patients received postoperative adjuvant treatment. |
Intensive surveillance protocol did not have any significant impact on the outcome of patients with clinical stage I endometrial cancer. Simplified follow-up programs tailored for patient subsets with different recurrence risk are required. |
2 |
| 20. Faubion SS, MacLaughlin KL, Long ME, Pruthi S, Casey PM. Surveillance and Care of the Gynecologic Cancer Survivor. J Womens Health (Larchmt) 2015;24:899-906. |
Review/Other-Dx |
N/A |
To present a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. |
Key messages include the limitations of laboratory studies, including CA-125, and imaging in thesetting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-relatedvasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general healthscreening, fertility preservation, and contraception. |
4 |
| 21. Sartori E, Pasinetti B, Carrara L, Gambino A, Odicino F, Pecorelli S. Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients. Gynecol Oncol 2007;107:S241-7. |
Observational-Tx |
84 patients |
To evaluate the outcome benefit of follow-up protocols for patients with recurrent endometrial and cervical cancer. |
The vast majority of recurrences occurred within the first 3 years after primary treatment (78% and 87% in endometrial and cervicalcancers, respectively). A better overall survival from relapse was observed when vaginal relapse was compared to other sites in endometrial cancerpatients and when pelvic recurrence was compared to distant sites in cervical cancer cases. Recurrent endometrial and cervical cancer patientswere symptomatic in 52% and 65% of cases, respectively. Among asymptomatic recurrent endometrial cancer cases, pelvic examination,abdominal or pelvic ultrasound and CT could detect 92% of relapses, while the vast majority of cervical cancer relapses could be diagnosed bypelvic examination and/or CT (85%). |
2 |
| 22. Testa AC, Di Legge A, Virgilio B, et al. Which imaging technique should we use in the follow up of gynaecological cancer?. [Review]. Best Practice & Research in Clinical Obstetrics & Gynaecology. 28(5):769-91, 2014 Jul. |
Review/Other-Dx |
N/A |
To summarise the diagnostic performance of ultrasound, computed tomography, and magnetic resonance imaging in the follow up of women treated for ovarian or uterine cancers. |
No results stated in abstract. |
4 |
| 23. NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms. Version 1.2010. Available at: https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. |
Review/Other-Dx |
N/A |
To provide clinical practice guidelines regarding head and neck cancers. |
No abstract available. |
4 |
| 24. Haldorsen IS, Salvesen HB. Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol. 2012; 67(1):2-12. |
Review/Other-Dx |
N/A |
To review the value of MRI and novel MRI techniques (diffusion, perfusion, spectroscopy, blood oxygen level-dependent -MRI, and MRI with new contrast agents) in endometrial carcinomas. |
CE-MRI is the imaging technique of choice, and DWI MRI may help to identify malignant lesions and assess myometrial invasion. Novel MRI techniques may potentially increase diagnostic accuracy, enabling a refined, tailored surgical procedure and better prediction of treatment outcomes. |
4 |
| 25. Narayanan P, Iyngkaran T, Sohaib SA, Reznek RH, Rockall AG. Pearls and pitfalls of MR lymphography in gynecologic malignancy. Radiographics 2009;29:1057-69; discussion 69-71. |
Review/Other-Dx |
N/A |
To review the advantages and disadvantages of MR lymphography in gynecologic malignancy. |
No results stated in abstract. |
4 |
| 26. Valenzano M, Podesta M, Giannesi A, Corticelli A, Nicoletti L, Costantini S. [The role of transvaginal ultrasound and sonohysterography in the diagnosis and staging of endometrial adenocarcinoma]. Radiol Med. 2001; 101(5):365-370. |
Observational-Dx |
19 patients |
To evaluate the accuracy of sonohysterography in early diagnosis of endometrial tumor lesions and in the detection of myometrial infiltration for staging. |
Depth of myometrial invasion accuracy assessed in 17/19 (89.4%) women. Sensitivity was 88%, specificity 100%, PPV 100% and NPV 33%. Sonohysterography allowed to evaluate exactly the depth of myometrial invasion in 15/16 cases (93.7%), in which a myometrial infiltration was suspected. For this, the sensitivity was 85.7%, the specificity was 100%, the PPV 100% and NPV 90.9%. |
3 |
| 27. Dessole S, Rubattu G, Farina M, et al. Risks and usefulness of sonohysterography in patients with endometrial carcinoma. Am J Obstet Gynecol. 2006; 194(2):362-368. |
Observational-Dx |
32 patients |
Prospective study to assess the risk of malignant cell dissemination into the peritoneal cavity through the fallopian tubes in patients with endometrial carcinoma undergoing sonohysterography and to evaluate the accuracy of sonohysterography in the estimation of myometrial invasion by the tumor and its role in the preoperative staging. |
Fluid spilled into peritoneal cavity containing malignant and suspicious cells in 2/32 (6.3%) and 6/32 (18.8%) cases. Sonohysterography was useful to assess the depth of myometrial invasion and may have a role in preoperative staging. |
2 |
| 28. Christensen JW, Dueholm M, Hansen ES, Marinovskij E, Lundorf E, Ortoft G. Assessment of myometrial invasion in endometrial cancer using three-dimensional ultrasound and magnetic resonance imaging. Acta Obstet Gynecol Scand 2016;95:55-64. |
Observational-Dx |
110 women |
To assess the diagnostic efficiency of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasonography (TVS) with and without saline infusion (SIS) and magnetic resonance imaging (MRI) for assessment of myometrial invasion in endometrial cancer. |
For myometrial involvement, MRI showed greater accuracy than 3D-TVS or 2D-TVS (83, 71 and 75%, respectively). The efficiency of 3D-TVS was not superior to 2D-TVS and did not improve with SIS. The sensitivities of 2D-TVS and 3D-TVS were similar to that of MRI, and the efficiency of 3D-TVS improved when volumes of inadequate quality (39%) were excluded. For evaluating cervical involvement, the accuracy of 3D-TVS was 85%, comparable to the results of 2D-TVS (80%) and MRI (85%). The results did not improve when saline was added. |
2 |
| 29. Guralp O, Kushner DM. Iatrogenic transtubal spill of endometrial cancer: risk or myth. Arch Gynecol Obstet 2011;284:1209-21. |
Review/Other-Dx |
N/A |
To study the the role of hysteroscopy (H/S), saline infusion sonography (SIS) and laparoscopy (L/S) in dissemination of EC cells and prognostic significance of positive peritoneal washings (PPW). |
PPW rates vary between 0-14% after dilatation and curettage (D&C), 0-83% after H/S, 0-10% after L/S and 12-52% after SIS. The majority of the studies about EC cell dissemination during H/S and SIS suggest that they increase the risk of spill. There is not enough evidence to support the association between tumor spill and pressure, type and volume of distension medium, duration of the procedure, stage, grade and interval between H/S or SIS and laparotomy. Investigation into the rate of spill of EC cells during laparoscopic surgery is in the early stages and not yet definitive. |
4 |
| 30. Stewart CJ, Doherty DA, Havlat M, et al. Transtubal spread of endometrial carcinoma: correlation of intra-luminal tumour cells with tumour grade, peritoneal fluid cytology, and extra-uterine metastasis. Pathology 2013;45:382-7. |
Observational-Dx |
262 patients |
To assess the significance of intra-luminal tumour cells (ILTC) within the fallopian tubes of patients with endometrial carcinoma, with emphasis on high grade histological subtypes. |
ILTC were identified in 26% and 3% of high and low grade carcinomas, respectively. The presence of ILTC correlated strongly with positive peritoneal fluid cytology and with peritoneal metastasis in high grade tumours (both p < 0.001), and there was also a correlation with lymph node metastasis (p = 0.049). ILTC were more common in serous and undifferentiated carcinomas (>30%) but the differences between the high grade tumour subtypes were not statistically significant. |
3 |
| 31. Liu ZZ, Jiang YX, Dai Q, et al. Imaging of endometrial carcinoma using contrast-enhanced sonography. Journal of Ultrasound in Medicine. 30(11):1519-27, 2011 Nov. |
Observational-Dx |
35 patients |
To evaluate the utility of contrast-enhanced US as an adjunct to conventional TVUS for detecting endometrial carcinoma and defining the depth of myometrial invasion. |
Of the 34 tumors identified by contrast-enhanced US, 28 (82.4%) showed early wash-in, and 6 (17.6%) showed late wash-in. Similar numbers of cases showed early and late wash-out. The enhancement phases did not differ significantly across groups with different average tumor diameters or histologic grades (P>.05). Contrast-enhanced US contributed the most to tumor imaging in patients with a thin endometrium after endometrial biopsy because it enhanced the contrast between the tumor and tissue. The diagnostic accuracy of contrast-enhanced US for determining the myometrium infiltration depth was 85.3%. |
3 |
| 32. Queiroz MA, Kubik-Huch RA, Hauser N, et al. PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison. European Radiology. 25(8):2222-30, 2015 Aug. |
Observational-Dx |
26 patients |
To compare the diagnostic accuracy of PET/MRI and PET/CT for staging and re-staging advanced gynaecological cancer patients as well as identify the potential benefits of each method in such a population. |
Eighteen (69.2 %) patients underwent PET/MRI for primary staging and eight patients (30.8 %) for re-staging their gynaecological malignancies. For primary tumour delineation, PET/MRI accuracy was statistically superior to PET/CT (p?<?0.001). Among the different types of cancer, PET/MRI presented better tumour delineation mainly for cervical (6/7) and endometrial (2/3) cancers. PET/MRI for local evaluation as well as PET/CT for extra-abdominal metastases had therapeutic consequences in three and one patients, respectively. PET/CT detected 12 extra-abdominal distant metastases in 26 patients. |
3 |
| 33. Nie J, Zhang J, Gao J, et al. Diagnostic role of 18F-FDG PET/MRI in patients with gynecological malignancies of the pelvis: A systematic review and meta-analysis. [Review]. PLoS ONE. 12(5):e0175401, 2017. |
Meta-analysis |
7 studies |
To assess the diagnostic performance of 18F-FDG Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) for gynecological cancers of the pelvis, based on a systematic review and meta-analysis of published data. |
Eventually, 7 studies fulfilled our predefined inclusion criteria were included in our research. On patient-based assessment, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of 18F-FDG PET/MRI for diagnosis of gynecological malignancies were 0.95 (95%CI 0.86-0.99), 0.95 (95% CI 0.74-1.00), 7.51 (95% CI 2.29-24.59), 0.12 (95% CI 0.05-0.29) and 116.27 (95% CI 17.07-791.74), respectively. On lesion-based assessment, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the summary DOR were 0.89 (95%CI 0.84-0.93), 0.87 (95%CI 0.74-0.95), 6.99 (95%CI 3.30-14.79), 0.12 (95%CI 0.06-0.25) and 55.82 (95%CI 20.91-149.05), respectively. |
Good |
| 34. Kirchner J, Sawicki LM, Suntharalingam S, et al. Whole-body staging of female patients with recurrent pelvic malignancies: Ultra-fast 18F-FDG PET/MRI compared to 18F-FDG PET/CT and CT. PLoS ONE [Electronic Resource]. 12(2):e0172553, 2017. |
Observational-Dx |
43 patients |
To evaluate the diagnostic feasibility of an ultra-fast 18F-FDG PET/MRI protocol, including T2-w and contrast-enhanced T1-w imaging as well as metabolic assessment (PET) in comparison to 18F-FDG PET/CT and CT for whole-body staging of female patients with suspected recurrence of pelvic malignancies. |
Tumor relapse was present in 38 of the 43 patients. Based on CT readings 25/38 tumor relapses were correctly identified. PET/CT enabled correct identification of 37/38 patients, PET/MRI correctly identified 36 of the 38 patients with recurrent cancer. On a lesion-based analysis PET/MRI enabled the correct detection of more lesions, comprising a lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 50%, 58%, 76%, 31%, and 53% for CT, 97%, 83%, 93%, 94%, and 92% for PET/CT and 98%, 83%, 94%, 94%, and 94% for PET/MRI, respectively. Mean scan duration of ultra-fast PET/MRI, PET/CT and whole-body CT amounted to 18.5 ± 1 minutes, 18.2 ± 1 minutes and 3.5 minutes, respectively. |
2 |
| 35. Zheng M, Xie D, Pan C, Xu Y, Yu W. Diagnostic value of 18F-FDG PET/MRI in recurrent pelvis malignancies of female patients: a systematic review and meta-analysis. [Review]. Nuclear Medicine Communications. 39(6):479-485, 2018 Jun. |
Meta-analysis |
7 studies; 256 patients |
To assess the diagnostic performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/MRI for suspected recurrence of pelvis malignancies of female patients using a meta-analysis. |
On patient-based analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of F-FDG PET/MRI in detecting recurrence of pelvis malignancies were 0.96 [95% confidence interval (CI): 0.93-0.99], 0.95 (95% CI: 0.87-0.99), 9.85 (95% CI: 4.62-21.00), 0.07 (95% CI: 0.04-0.13), and 201.41 (95% CI: 62.89-645.03), respectively. On lesion-based analysis, the corresponding estimates were 0.99 (95% CI: 0.97-1.00), 0.94 (95% CI: 0.89-0.97), 17.11 (95% CI: 4.46-65.60), 0.02 (95% CI: 0.01-0.05), and 1125.24 (95% CI: 211.46-5987.79), respectively. |
Good |
| 36. Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 2013;266:717-40. |
Review/Other-Dx |
N/A |
To highlight the added role of MR imaging in the treatment stratification and overall care of patients with endometrial, cervical, or ovarian cancer. |
No results stated in abstract. |
4 |
| 37. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 2016;26:2-30. |
Review/Other-Dx |
N/A |
To discuss the multidisciplinary evidence-based guidelines on selected clinically-relevant questions in order to complement the already-available EuropeanSociety for Medical Oncology (ESMO) Clinical Practice Guidelines (CPG) for the diagnosis, treatment and follow-up of patients with endometrial cancer. |
No results stated in abstract. |
4 |
| 38. Beddy P, Moyle P, Kataoka M, et al. Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology. 2012; 262(2):530-537. |
Observational-Dx |
48 women |
To compare the diagnostic performance of DWI MRI with that of dynamic contrast material-enhanced MRI in evaluating the depth of myometrial invasion and overall stage in patients with endometrial cancer. |
For assessing the depth of myometrial invasion, diagnostic accuracy, sensitivity, and specificity, respectively, were as follows: DWI MRI-reader 1, 90%, 84%, and 100%; reader 2, 85%, 84%, and 88%; dynamic contrast-enhanced MRI-reader 1, 71%, 61%, and 88%; reader 2, 79%, 77%, and 82%. The improvement in diagnostic accuracy for reader 1 was significant (P=.035). For myometrial invasion, kappa values were 0.75 with DWI MRI and 0.26 with dynamic contrast-enhanced MRI. There was no association between inaccurate assessment of myometrial invasion and standard pitfalls with DWI MRI. Readers 1 and 2 correctly staged more patients by using DWI MRI (39 and 38 patients, respectively) than by using dynamic contrast-enhanced MRI (29 and 30 patients, respectively) (P<.05). For overall stage, kappa values were 0.74 with DWI MRI and 0.22 with dynamic contrast-enhanced MRI. |
2 |
| 39. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl):2035-2041. |
Observational-Tx |
621 patients |
To report the surgical pathologic findings and their correlation in a group-wide prospective study. |
All patients were treated with primary surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and paraaortic lymphadenectomy and peritoneal cytology. An appreciable number of patients (144-22%) with Stage I cancers have disease outside of the uterus (lymph node metastasis, adnexal disease, intraperitoneal spread and/or malignant cells in peritoneal washings). Multiple prognostic factors particularly grade and depth of invasion are related to extrauterine disease. |
2 |
| 40. Grossman J, Ricci ZJ, Rozenblit A, Freeman K, Mazzariol F, Stein MW. Efficacy of contrast-enhanced CT in assessing the endometrium. AJR Am J Roentgenol 2008;191:664-9. |
Observational-Dx |
259 patients |
To determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. |
The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1% and 93.5%, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7% and 89.1%, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images. |
2 |
| 41. Lakhman Y, Katz SS, Goldman DA, et al. Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus. Ann Surg Oncol 2016;23:1271-8. |
Observational-Dx |
193 women |
To assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus. |
The respective sensitivities and specificities achieved by R1/R2 were 0.79/0.64 and 0.87/0.75 for detecting deep myometrial invasion (MI) on CT; 0.56/0.63 and 0.93/0.79 for detecting cervical stromal invasion; 0.52/0.45 and 0.95/0.93 for detecting pelvic nodal metastases; and 0.45/0.30 and 0.98/0.98 for detecting para-aortic nodal metastases. Although CT had suboptimal sensitivity for the detection of omental disease, it had high PPV for omental seeding at surgical exploration (1.00 for R1 and 0.92 for R2). Inter-observer agreement ranged from moderate in the detection of deep MI (? = 0.42 ± 0.06) to almost perfect in the detection of para-aortic nodal metastases (? = 0.88 ± 0.08). |
2 |
| 42. Kim SH, Kim HD, Song YS, Kang SB, Lee HP. Detection of deep myometrial invasion in endometrial carcinoma: comparison of transvaginal ultrasound, CT, and MRI. J Comput Assist Tomogr. 1995; 19(5):766-772. |
Observational-Dx |
26 patients |
To compare TVUS with MRI for use in detecting the depth of myometrial involvement by endometrial carcinoma. Histologic examination results of the surgical specimen were considered the gold standard. |
The accuracy, sensitivity, specificity of TVUS was 69%, 50%, 81% respectively. The accuracy, sensitivity, specificity of CT was 61%, 40%, 75% respectively. The accuracy, sensitivity, specificity of MRI was 89%, 90%, 88%, respectively. Study recommends MRI instead of CT or TVUS for the evaluation of the depth of myometrial invasion in endometrial carcinoma. |
3 |
| 43. Tsili AC, Tsampoulas C, Dalkalitsis N, Stefanou D, Paraskevaidis E, Efremidis SC. Local staging of endometrial carcinoma: role of multidetector CT. Eur Radiol. 2008; 18(5):1043-1048. |
Observational-Dx |
21 women |
To evaluate the accuracy of MDCT in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration. |
Sensitivity, specificity and accuracy of MDCT in evaluating myometrial invasion were 100%, 80% and 95%, respectively, and for assessing cervical infiltration were 78%, 83% and 81%, respectively. MDCT proved accurate in local staging of endometrial carcinoma. |
2 |
| 44. Rizzo S, Femia M, Radice D, et al. Evaluation of deep myometrial invasion in endometrial cancer patients: is dual-energy CT an option? Radiol Med 2018;123:13-19. |
Observational-Dx |
39 patients |
To assess deep (>50%) myometrial invasion by dual-energy CT (DECT) and Trans-Vaginal US (TVUS) in patients with endometrial cancer. |
Thirty-nine patients were included. Median time from CT and TVUS to surgery was 23 and 18 days, respectively. The best agreement between evaluation of myometrial infiltration and the gold standard was 0.88 (0.72, 1.00) for the 50 keV images; the worst agreement was 0.43 (0.00, 0.88) for the 70 keV images. CT iodine reconstructions and US agreement were comparable. Specificity, sensitivity and accuracy were 0.91, 1.00, 0.94; 0.57, 0.86, 0.71; 0.82, 1.00, 0.87; 0.91, 0.77, 0.86 for 50 keV, 70 keV, iodine reconstructions and ultrasound, respectively. |
3 |
| 45. Ahmed M, Al-Khafaji JF, Class CA, et al. Can MRI help assess aggressiveness of endometrial cancer?. Clin Radiol. 73(9):833.e11-833.e18, 2018 09. |
Observational-Dx |
71 patients |
To identify potential magnetic resonance imaging (MRI) biomarkers to predict the aggressiveness of endometrial cancer. |
Tumours with qualitative higher signal than that of normal myometrium on the late T1WI DCE image sequences were more likely to have lymphovascular space invasion (p<0.001). Tumours that had a higher SI tumour ratio (T1 post-contrast arterial/T1 precontrast) had a higher chance of being microsatellite stable (odds ratio 2.36). The SI ratio of the tumour to the myometrium showed that lower T2 tumour/T2 myometrial ratio correlated with =50% depth of myometrial invasion as determined by imaging (p=0.006). Endometrial tumours showing a SI of >209 on delayed T1WI sequences had longer recurrence-free survival than those with tumours showing a SI =209 (p=0.014). Tumour subtype and grade were not associated with MRI findings. |
3 |
| 46. Guo Y, Wang P, Wang P, et al. Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging. Onco Targets Ther 2017;10:5937-43. |
Observational-Dx |
58 patients |
To accurately assess invasion depth and preoperative staging of an endometrial carcinoma. |
Compared with the T2WI group, a significantly higher diagnostic accuracy was observed for myometrial invasion with fusion of T2WI and DWI (77.6% for T2WI; 94.8% for T2WI-DWI). For the identification of deep invasion, we calculated values for diagnostic sensitivity (69.2% for T2WI; 92.3% for T2WI-DWI), specificity (80% for T2WI; 95.6% for T2WI-DWI), positive predictive value (50% for T2WI; 85.7% for T2WI-DWI), and negative predictive value (90% for T2WI; 97.7% for T2WI-DWI). In summary, T2WI-DWI fusion exhibits higher diagnostic accuracy with respect to staging relative to T2WI only (81.0% for T2WI; 94.8% for T2WI-DWI). |
3 |
| 47. Nougaret S, Horta M, Sala E, et al. Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology. Eur Radiol 2019;29:792-805. |
Review/Other-Dx |
N/A |
To update the 2009 European Society of Urogenital Radiology (ESUR) endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI. |
Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended. |
4 |
| 48. Soneji ND, Bharwani N, Ferri A, Stewart V, Rockall A. Pre-operative MRI staging of endometrial cancer in a multicentre cancer network: can we match single centre study results? Eur Radiol 2018;28:4725-34. |
Observational-Dx |
270 studies |
To evaluate the staging accuracy of magnetic resonance imaging (MRI) for endometrial cancer in daily practice over a 3-year period at a tertiary referral centre receiving scans from a large number of hospitals with varying protocols. To compare these daily practice results to published data from single-centre studies. |
Published MRI staging accuracy from small single-centre studies were not replicated in a tertiary referral centre receiving scans with heterogeneous protocols over a 3-year period. These results highlight the challenges faced in daily practice and may reflect achievable and realistic MRI staging accuracies in large rapid throughput referral networks. Adherence to standardised high-quality protocols may help to improve future results. |
4 |
| 49. Ueno Y, Forghani B, Forghani R, et al. Endometrial Carcinoma: MR Imaging-based Texture Model for Preoperative Risk Stratification-A Preliminary Analysis. Radiology 2017;284:748-57. |
Observational-Dx |
137 patients |
To evaluate the associations among mathematical modeling with the use of magnetic resonance (MR) imaging-based texture features and deep myometrial invasion (DMI), lymphovascular space invasion (LVSI), and histologic high-grade endometrial carcinoma. |
A total of 180 texture features were extracted and ultimately limited to 11 features for DMI, 12 for LVSI, and 16 for high-grade tumor for random forest modeling. With random forest models, areas under the receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were estimated at 0.84, 79.3%, 82.3%, 81.0%, 76.7%, and 84.4% for DMI; 0.80, 80.9%, 72.5%, 76.6%, 74.3%, and 79.4% for LVSI; and 0.83, 81.0%, 76.8%, 78.1%, 60.7%, and 90.1% for high-grade tumor, respectively. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of visual assessment for DMI were 84.5%, 82.3%, 83.2%, 77.7%, and 87.8% (reader 3). |
3 |
| 50. Kinkel K, Kaji Y, Yu KK, et al. Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology. 1999; 212(3):711-718. |
Meta-analysis |
6 studies |
To apply a meta-analysis to compare the utility of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging in staging endometrial cancer. |
Six studies met the inclusion criteria for CT; 16, for US; and 25, for MR imaging. Summary receiver operating characteristic analysis showed no significant differences in the overall performance of CT, US, and MR imaging. In the assessment of myometrial invasion, however, contrast-enhanced MR imaging performed significantly better than did nonenhanced MR imaging or US (P < .002) and demonstrated a trend toward better results, as compared with CT. The lack of data on the assessment of cervical invasion at CT or US prevented meta-analytic comparison with data obtained at MR imaging. Results were not influenced by year of publication, FIGO stage distribution, or methodologic quality. |
Good |
| 51. Savelli L, Ceccarini M, Ludovisi M, et al. Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol. 2008; 31(5):560-566. |
Observational-Dx |
74 women |
Prospective study to compare the accuracy of TVUS and MRI in the preoperative staging of endometrial carcinoma. |
Sensitivity, specificity, PPV, NPV, and accuracy for TVUS in the evaluation of myometrial infiltration were 84%, 83%, 79%, 88% and 84%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for MRI were 84%, 81%, 77%, 87% and 82% respectively. Sensitivity, specificity, PPV, NPV, and accuracy for detection of cervical involvement were 93%, 92%, 72%, 98% and 92% for TVUS; and 79%, 87%, 58%, 95% and 85% for MRI. |
2 |
| 52. Sala E, Crawford R, Senior E, et al. Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma. Int J Gynecol Cancer. 2009; 19(1):141-146. |
Observational-Dx |
50 patients |
To assess the added value of DCE-MRI in predicting advanced stage disease in patients with endometrial carcinoma. |
The depth of myometrial invasion was correctly determined in 78% (39/50) of the cases on T2-weighted alone, increasing to 92% (46/50) with the addition of DCE-MRI (95% CI for improvement, 4.4%-23.6%, P=0.016). The addition of DCE-MRI led to the correct detection of deep myometrial invasion in all cases. Tumor extension to uterine cornu was the only variable significantly associated (P=0.014) with incorrect estimation of depth of myometrial invasion. |
3 |
| 53. Manfredi R, Mirk P, Maresca G, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology. 2004; 231(2):372-378. |
Observational-Dx |
37 consecutive patients |
Prospective study to assess the value of MRI in depicting the depth of myometrial infiltration, cervical invasion, and presence of enlarged lymph nodes in patients with endometrial adenocarcinoma compared with surgicopathologic findings. |
Respective sensitivity, specificity, diagnostic accuracy, and PPV and NPV in assessing myometrial infiltration were 87%, 91%, 89%, 87%, and 91%; those for cervical infiltration, 80%, 96%, 92%, 89%, and 93%; and those for lymph node assessment, 50%, 95%, 90%, 50%, and 95%. There was significant agreement between MRI and surgicopathologic findings in assessment of myometrial invasion (P<.001). Myometrial and cervical invasion and lymph node enlargement were correctly assessed with MRI in 28 (76%) of 37 patients. Quantitative analysis showed a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and precontrast phases (P<.001). |
2 |
| 54. Deng L, Wang QP, Yan R, et al. The utility of measuring the apparent diffusion coefficient for peritumoral zone in assessing infiltration depth of endometrial cancer. Cancer Imaging 2018;18:23. |
Observational-Dx |
58 patients |
To investigate the diagnostic value of the apparent diffusion coefficient (ADC) of the peritumoral zone for assessing the infiltration depth of endometrial cancer. |
The ADCm values of tumors and peritumoral zones were 0.83 x 10(- 3) mm(2)/sec and 1.06 x 10(- 3) mm(2)/sec, respectively. There was no significant difference between the ADCm values of the tumors in the superficial and deep myometrial invasion groups (P > 0.05). However, the ADCm value at the peritumoral zone in the deep myometrial invasion group (1.23 x 10(- 3) mm(2)/sec) significantly differed from that in the superficial myometrial invasion group (0.99 x 10(- 3) mm(2)/sec) (p = 0.005). In assessments of deep myometrial invasion, the sensitivity, specificity, negative predictive value, and positive predictive value were 0.58, 0.93, 0.84, and 0.77, respectively, for the ADCm cutoff value of the peritumoral zone, and 0.71, 0.80, 0.87, and 0.60. respectively, for visual inspection. The accuracy of myometrial invasion depth assessment using the ADCm cutoff value and visual inspection were 83 and 78%, respectively. The Az for both was 0.76. |
3 |
| 55. Das SK, Niu XK, Wang JL, et al. Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis. Cancer Imaging 2014;14:32. |
Meta-analysis |
7 studies |
To perform a systematic review and a meta-analysis in order to estimate the diagnostic accuracy of diffusion weighted imaging (DWI) in the preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma. |
Seven studies enrolling a total of 320 individuals met the study inclusion criteria. The summary area under theROC curve was 0.91. There was no evidence of publication bias (P = 0.90, bias coefficient analysis). Sensitivity andspecificity of DWI for detection of deep myometrial invasion across all studies were 0.90 and 0.89, respectively. Positiveand negative likelihood ratios with DWI were 8 and 0.11 respectively. In patients with high pre-test probabilities, DWIenabled confirmation of deep myometrial invasion; in patients with low pre-test probabilities, DWI enabled exclusion ofdeep myometrial invasion. The worst case scenario (pre-test probability, 50%) post-test probabilities were 89% and 10%for positive and negative DWI results, respectively. |
Good |
| 56. Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S. Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol. 2010; 20(3):754-762. |
Observational-Dx |
47 patients |
To determine the diagnostic accuracy of DWI MRI in the preoperative assessment of myometrial invasion by endometrial cancer. |
At histopathological examination, superficial myometrial invasion was found in 34 patients and deep myometrial invasion in 13. In the assessment of tumor invasion, sensitivity, specificity, PPV and NPV of T2-weighted images were 92.3%, 76.5%, 60.0% and 96.3%, respectively. The corresponding values for dynamic images were 69.2%, 61.8%, 40.9% and 84.0%, and for DWI 84.6%, 70.6%, 52.4% and 92.3%. T2-weighted and DWI proved to be the most accurate techniques for tumor spread determination. |
1 |
| 57. Takeuchi M, Matsuzaki K, Nishitani H. Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion. Acta Radiol. 2009;50(8):947-953. |
Observational-Dx |
67 endometrial lesions (45 cancers and 22 benign lesions): 33 patients with endometrial cancer |
To verify the feasibility of DWI MRI to distinguish benign and malignant endometrial lesions, and to evaluate myometrial invasion of endometrial cancer. |
The ADC values (x10(-3) mm(2)/s) in cancer and benign lesions were 0.84 +/- 0.19 and 1.58 +/- 0.36, respectively (P<0.01). The staging accuracy (superficial or deep myometrial invasion) was 94% for DWI and 88% for gadolinium-enhanced T1-weighted images. Coexisting adenomyosis and infiltrative myometrial invasion caused staging errors on gadolinium-enhanced T1-weighted images, whereas DWI could demonstrate the tumor extent correctly. |
3 |
| 58. Ghosh A, Singh T, Singla V, Bagga R, Srinivasan R, Khandelwal N. Read-out segmented echo planar diffusion imaging of the female pelvis-utility in endometrial carcinoma-a preliminary experience. Br J Radiol 2018;91:20180018. |
Observational-Dx |
5 patients |
To discuss the difficulties of single-shot-echo-planar (ss-ep) DWI and evaluate a new diffusion-weighted imaging (DWI) technique-readout segmented echo planar (rs-ep) DWI in endometrial carcinoma and discuss the imaging physics. |
The rs-ep-DWI had less imaging artefacts, less bowel-related susceptibility and geometric distortion compared to ss-ep-DWI. There was statistically significant greater SNR in ss-ep-DWI compared to rs-ep-DWI. This resulted in increased graininess of the readout segmented diffusion images. Artefacts in SS-EPI-DTI may make fibre tracking fallacious and rs-ep DTI may have fewer artefacts. |
3 |
| 59. Kawaguchi M, Kato H, Hatano Y, et al. Inchworm sign of endometrial cancer on diffusion-weighted MRI: radiology-pathology correlation. Clin Radiol 2018;73:907 e9-07 e14. |
Observational-Dx |
345 patients |
To perform radiology-pathology correlation of the inchworm sign on diffusion-weighted imaging (DWI) in patients with endometrial cancer. |
The inchworm sign on DWI images was observed in 32 (9.3%) patients. On T2-weighted images, areas of hypointense stalk on DWI images showed hypointensity in 31 (97%) patients and hyperintensity in one (3%). Among them, the depth of myometrial invasion at histopathology was superficial (<50% myometrial invasion) in 28 (87.5%) patients and deep (>/=50% myometrial invasion) in four (12.5%). As a result of histopathological investigation, the hypointense stalk of the inchworm sign was mainly composed of various degrees of stromal proliferation, including smooth muscle cells and metaplastic fibromuscular stroma, with or without intervening endometrial cancer. |
3 |
| 60. Liu J, Yuan F, Wang S, et al. The ability of ADC measurements in the assessment of patients with stage I endometrial carcinoma based on three risk categories. Acta Radiol 2019;60:120-28. |
Observational-Dx |
80 EC patients and 18 cervical patients |
To investigate the role of apparent diffusion coefficient (ADC) measurements in the assessment of stage I EC patients based on three risk categories. |
The mean ADC values ( x 10(-3) mm(2) /s) were 0.851 +/- 0.131, 0.734 +/- 0.108, and 0.710 +/- 0.108 for groups 1, 2 and 3, respectively. Significant statistical differences were achieved for the three groups ( P = 0.0005). The mean ADC values of group 1 were significantly lower than those in group 2 + 3 (0.725 +/- 0.106; P = 0.0001). For the prediction of groups 2 + 3, the area under the curve of 0.786 and the cut-off value of </= 0.742 were identified, with a sensitivity, specificity, and accuracy of 66.67%, 84.09%, and 73.53%, respectively. |
3 |
| 61. Nougaret S, Reinhold C, Alsharif SS, et al. Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade. Radiology 2015;276:797-808. |
Observational-Dx |
70 patients |
To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. |
No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P < .0001). There was no significant difference in the ADCs between grades 1 and 2 tumors (P > .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P < .02). |
3 |
| 62. Nagar H, Dobbs S, McClelland HR, Price J, McCluggage WG, Grey A. The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer. Gynecol Oncol. 2006; 103(2):431-434. |
Observational-Dx |
135 consecutive women |
Retrospective study to determine the diagnostic accuracy of MRI in detecting cervical involvement by endometrial cancer. |
For cervical involvement by MRI, sensitivity was 72%, specificity 93.2%, PPV 89.8%, NPV 80.2%, positive likelihood ratio 10.7 and negative likelihood ratio 0.3. For cervical stromal invasion alone, the sensitivity was 84.4%, specificity 87.4%, PPV 67.5%, NPV 94.7%, positive likelihood ratio 6.7 and negative likelihood ratio 0.18. MRI is able to accurately predict cervical involvement in endometrial cancer and allows a decision to be made on the type of hysterectomy to be offered. |
3 |
| 63. Haldorsen IS, Berg A, Werner HM, et al. Magnetic resonance imaging performs better than endocervical curettage for preoperative prediction of cervical stromal invasion in endometrial carcinomas. Gynecol Oncol 2012;126:413-8. |
Observational-Dx |
338 patients |
To assess if introduction of magnetic resonance imaging (MRI) in addition to the standardly applied endocervical curettage (ECC), improved the preoperative prediction of cervical stromal invasion. |
For assessment of cervical stromal invasion sensitivity (specificity) [accuracy] values were 65% (79%) [77%] for ECC and 59% (91%) [84%] for MRI. Among patients diagnosed with both preoperative tests (n=129), MRI yielded significantly higher specificity (p=0.001) and accuracy (p=0.005) than ECC. MRI independently predicted cervical stromal invasion with an odds ratio (OR) of 11.2 (p<0.001) compared to OR of 2.7 (p=0.07) for ECC. |
2 |
| 64. Lin G, Huang YT, Chao A, et al. Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T. Eur Radiol 2017;27:1867-76. |
Observational-Dx |
83 patients |
To compare the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for detecting cervical stromal invasion in endometrial cancer. |
For assessing cervical stromal invasion, the diagnostic accuracy, sensitivity, and specificity, respectively for Reader 1/Reader 2, were as follows: DW MR imaging- 95.2 %/91.6 %, 91.7 %/100 %, and 95.8 %/90.1 %; DCE MR imaging- 91.6 %/88 %, 58.3 %/50 %, and 97.2 %/94.4 %. The diagnostic performance of DW MR imaging (Reader 1: areas under the receiver operating characteristic curve (AUC) = 0.98; Reader 2: AUC = 0.97) was significantly higher than that of DCE MR imaging (p = 0.009 for Reader 2) or T2-weighted MR imaging (Reader 1: p = 0.006; Reader 2: p = 0.013). Patients with cervical stromal invasion showed a significantly greater canal width (p < 0.0001) and myometrial invasion extent (p = 0.006). |
2 |
| 65. Xu G, Wang D, Ling X, et al. Diagnostic Value of Assessment of Cervical Involvement in Early-Stage Endometrial Adenocarcinoma: Comparison of Magnetic Resonance Imaging (MRI) Versus Hysteroscopy. Med Sci Monit 2018;24:7952-57. |
Observational-Dx |
88 patients |
To compare magnetic resonance imaging (MRI) and hysteroscopy (HS) for assessing cervical involvement in early-stage endometrial adenocarcinoma in order to establish a more reliable screening method to aid in clinical decision-making. |
The accuracy of assessing cervical conditions was 93.2% by MRI and 55.7% by HS. Among these variables, the accuracy, specificity, and positive predictive values of MRI were significantly different from those of HS, while the sensitivity and negative predictive values of MRI and HS were not significantly different from each other. Age, tumor size, tumor differentiation, and depth of myometrial invasion were not associated with the differences in cervical assessment between MRI and HS. However, the tumor location may affect assessment by HS. |
3 |
| 66. Foti PV, Farina R, Coronella M, et al. Endometrial carcinoma: MR staging and causes of error. Radiologia Medica. 118(3):487-503, 2013 Apr. |
Observational-Dx |
20 patients |
To prospectively determine the diagnostic capabilities of magnetic resonance (MR) imaging in detecting myometrial and cervical invasion and lymph node involvement in endometrial carcinoma and to identify the causes of errors in staging endometrial carcinoma. |
In assessing myometrial invasion, MR imaging showed 70% accuracy, 80% sensitivity, 40% specificity, 80% positive predictive value (PPV), and 40% negativepredictive value (NPV). In detecting cervical invasion, MR imaging had 95% accuracy, 100% sensitivity, 94.4% specificity, 66.7% PPV, and 100% NPV. In evaluating lymph node involvement, MR imaging showed 100% accuracy, sensitivity, specificity, PPV and NPV. Errors in evaluating myometrial invasion were caused by polypoid tumour, adenomyosis and leiomyomas, whereas those in evaluating cervical invasion were caused by dilatation and curettage. |
3 |
| 67. Hori M, Kim T, Murakami T, et al. MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: comparison with imaging at 1.5 T. J Magn Reson Imaging. 2009; 30(3):621-630. |
Observational-Dx |
30 patients |
To prospectively compare MRI at 3.0 T and 1.5 T in the same patients for preoperative evaluation of endometrial carcinoma. |
Image homogeneity of T2-weighted images at 3.0 T was significantly inferior to that at 1.5 T (P=0.007). The scores of image homogeneity and susceptibility artifacts were not significantly different between 3.0 T gadolinium-enhanced imaging and 1.5 T imaging (P=0.09 and 0.36). Kappa statistics showed good interobserver agreement between the two radiologists for local-regional staging on T2-weighted images (kappa>0.6). The area under the receiver operating characteristic curve (Az) values for T2-weighted imaging in terms of myometrial invasion, cervical invasion, and lymph node metastases were 0.88 (3.0 T) vs 0.91 (1.5 T), 0.84 vs 0.83, and 0.94 vs 0.95 for reader 1, respectively. There were no significant differences between imaging at 3.0 T and at 1.5 T in Az values for either reader (P>0.35). |
2 |
| 68. Torricelli P, Ferraresi S, Fiocchi F, et al. 3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer. AJR. 2008; 190(2):489-495. |
Observational-Dx |
52 patients (43 postmenopausal) |
To evaluate the diagnostic accuracy of 3.0 T MRI in determining the depth of myometrial infiltration in patients with endometrial cancer. |
MRI performed on a 3.0 T unit was in agreement with histopathology in assessing the depth of invasion in 86.4% (44/52) of the patients with a mean sensitivity, specificity, PPV, NPV, and accuracy of 83.5%, 93.9%, 77.8%, 92.2%, and 89.7%, respectively. Performance values were also assessed for single stages of myometrial infiltration. For the detection of an intramucosal lesion (MRI, 12/52; histopathology, 6/52), sensitivity was 100%; specificity, 86.9%; PPV, 50%; NPV, 100%; and accuracy, 88.5%. For the detection of myometrial infiltration that was <50% (MRI, 12/52; histopathology, 16/52), sensitivity was 62.5%; specificity, 94.4%; PPV, 83.3%; NPV, 85%; and accuracy, 84.6%. For the detection of myometrial infiltration that was >50% (MRI, 28/52; histopathology, 30/52), sensitivity was 93.3%; specificity, 100%; PPV, 100%; NPV, 91.7%; and accuracy, 96.2%. The following artifacts were found: abdominal wall movement, 9 patients (not affecting image quality); peristalsis, 16 patients (2 deeply affecting, 1 affecting, and 13 scarcely affecting); magnetic susceptibility artifact, 4 patients (not affecting); chemical shift, 20 patients (four scarcely affecting and 16 not affecting); and dielectric effect, six patients (4 deeply affecting and 2 affecting). |
3 |
| 69. Alcazar JL, Pineda L, Martinez-Astorquiza Corral T, et al. Transvaginal/transrectal ultrasound for assessing myometrial invasion in endometrial cancer: a comparison of six different approaches. J Gynecol Oncol 2015;26:201-7. |
Observational-Dx |
169 women |
To compare the diagnostic performance of six different approaches for assessing myometrial infiltration using ultrasound in women with carcinoma of the corpus uteri. |
The impression of examiner and subjective model performed similarly (sensitivity 79.5% and 80.5%, respectively;specificity 89.6% and 90.3%, respectively). Both methods had significantly better sensitivity than Karlsson's criteria (sensitivity31.8%, p<0.05) and endometrial thickness (sensitivity 47.7%, p<0.05), and better specificity than tumor/uterine volume ratio(specificity 28.3%, p<0.05) and TDS (specificity 41.5%, p<0.05). |
2 |
| 70. Chan JK, Kapp DS, Cheung MK, et al. Prognostic factors and risk of extrauterine metastases in 3867 women with grade 1 endometrioid corpus cancer. Am J Obstet Gynecol 2008;198:216 e1-5. |
Observational-Dx |
3867 patients |
To evaluate the role of surgical staging in patients with grade 1 endometrioid uterine cancer. |
Twelve thousand seven hundred and twelve women were reported with endometrioid carcinoma, including 3867 with grade 1 disease, of which 25.5% had stage IC or more advanced disease, 15.4% with disease extending beyond the uterine corpus, 7.3% with extrauterine metastases, and 3.3% with lymph node metastases. Onmultivariate analysis, younger age and earlier stage remained as significant prognostic factors for improved survival. |
3 |
| 71. Connor JP, Andrews JI, Anderson B, Buller RE. Computed tomography in endometrial carcinoma. Obstet Gynecol. 2000; 95(5):692-696. |
Observational-Dx |
492 women |
A retrospective review to determine the value of CT scans for preoperatively detecting extrauterine-nodal disease and postoperative recurrent disease in patients with endometrial cancer. |
Among 492 women eligible for analysis, 178 (36%) had a total 326 CT scans. Sensitivity, specificity, PPV, and NPV of preoperative CT scans for nodal involvement were 57%, 92%, 50%, and 94%, respectively. Recurrence diagnosed by CT in asymptomatic patients was 4.4% and 46% of patients with suspected recurrence were confirmed by CT. Kaplan-Meyer analysis showed no survival advantage in women with subclinical recurrences diagnosed by CT scan. Routine preoperative CT scanning rarely alters treatment and is a poor predictor of nodal disease. CT in the postoperative period might be helpful for detection and follow-up of recurrent disease, but there was no difference in survival when subclinical recurrence was found by CT. |
3 |
| 72. Kitajima K, Suzuki K, Senda M, et al. Preoperative nodal staging of uterine cancer: is contrast-enhanced PET/CT more accurate than non-enhanced PET/CT or enhanced CT alone? Ann Nucl Med 2011;25:511-9. |
Observational-Dx |
40 patients |
To determine whether contrast-enhanced PET/CT is more accurate than either non-enhanced PET/CT or enhanced CT alone for nodal staging of uterine cancer. |
Of the 40 patients, 21 underwent pelvic lymphadenectomy only. Region-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT were 61.4% (27/44), 98.1% (308/314), and 93.6% (335/358), respectively, whereas those of PET/ldCT were 52.3% (23/44), 96.8% (304/314), and 91.3% (327/358), respectively, and those of enhanced CT were 40.9% (18/44), 97.8% (307/314), and 90.8% (325/358), respectively. Although PET/ceCT had the best sensitivity among the three imaging modalities, a significant difference was observed only between PET/ceCT and enhanced CT (p = 0.0027). Although PET/ceCT had better sensitivity and accuracy than PET/ldCT, the differences between the two imaging methods did not reach statistical significance (p = 0.046 and p = 0.047, respectively). |
2 |
| 73. Bollineni VR, Ytre-Hauge S, Bollineni-Balabay O, Salvesen HB, Haldorsen IS. High Diagnostic Value of 18F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature. J Nucl Med 2016;57:879-85. |
Meta-analysis |
21 studies |
To evaluate the diagnostic performance of 18F-FDG PET/CT for the preoperative assessment of lymph node metastases (LNM) in endometrial cancer patients and for the assessment of endometrial cancer recurrence (ECR) after primary surgical treatment. |
The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and AUC (with 95% CI) of 18F-FDGPET/CT for detection of LNM were 0.72 (95% CI, 0.63–0.80), 0.94 (95% CI, 0.93–0.96), 10.9 (95% CI, 7.9–15.1), 0.36 (95% CI, 0.27– 0.48), 39.7 (95% CI, 21.4–73.6), and 0.94 (95% CI, 0.85–0.99), respectively, whereas the corresponding numbers for detection of ECR were 0.95 (95% CI, 0.91–0.98), 0.91 (95% CI, 0.86–0.94), 8.8 (95% CI, 6.0–12.7), 0.08 (95% CI, 0.05–0.15), 171.7 (95% CI, 67.9– 434.3), and 0.97 (95% CI, 0.95–0.98), respectively. The overall diagnosticaccuracy (Q* index) in LNM and ECR were 0.88 and 0.93, respectively. |
Good |
| 74. Tanaka T, Terai Y, Yamamoto K, Yamada T, Ohmichi M. The diagnostic accuracy of fluorodeoxyglucose-positron emission tomography/computed tomography and sentinel node biopsy in the prediction of pelvic lymph node metastasis in patients with endometrial cancer: A retrospective observational study. Medicine (Baltimore). 97(38):e12522, 2018 Sep. |
Observational-Dx |
121 patients |
To evaluate the combined diagnostic accuracy of FDG PET/CT and SNB in the prediction of pelvic lymph node metastasis in endometrial cancer patients. |
FDG PET/CT had lower sensitivity (36.8% versus 57.9%, P = .1) and a higher specificity (96.4% versus 84.8%, P < .01) than SNB. The kappa statistics of FDG PET/CT and SNB were 0.37 (95% CI, 0.15-0.59) and 0.72 (95% CI, 0.53-0.90), respectively. The sensitivity of SNB was significantly higher than that of FDG PET/CT in all hemi-pelvises (HPs) in which the short axis of the largest metastatic lymph node was <5 mm in diameter (72.7% versus 18.2%, P = .01). In contrast, the sensitivity of FDG PET/CT was higher than that of SNB in all HPs in which the short axis of the largest metastatic lymph node was >/=5 mm in diameter (62.5% versus 37.5%, P = .2); however, the difference was not statistically significant. When the combined diagnosis of FDG PET/CT and SNB was made, the sensitivity and specificity were 84.2% and 82.1%, respectively. |
3 |
| 75. Galakhoff C, Masselot J, Dam N, Pejovic MH, Prade P, Duvillard P. Lymphography in the initial evaluation of endometrial carcinoma. Gynecol Oncol. 1988; 31(2):276-284. |
Observational-Dx |
288 patients |
To determine whether lymphography is of any value in the choice of therapy and to evaluate its diagnostic and prognostic contributions. Lymphangiograms performed as part of the initial diagnostic work-up of endometrium cancer were reviewed. |
A histological examination of the lymph nodes was carried out for 138 patients. Lymphography is not very sensitive but is highly specific, detecting only 50% of metastases with a high false positive rate. Its diagnostic and prognostic value for operable patients is minimal, but is useful for the follow-up of lymph nodes of patients treated by radiation therapy. |
4 |
| 76. Rockall AG, Meroni R, Sohaib SA, et al. Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer. 2007; 17(1):188-196. |
Observational-Dx |
96 patients |
To assess diagnostic performance of T2-weighted and dynamic gadolinium-enhanced T1-weighted MRI in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. |
For the identification of any myometrial invasion, the sensitivity, specificity, PPV and NPV, (superficial or deep) were 0.94, 0.50, 0.93, 0.55, respectively, on T2-weighted and 0.92, 0.50, 0.92, 0.50, respectively, on dynamic T1-weighted, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91, respectively, on T2-weighted and 0.72, 0.88, 0.72, 0.88, respectively, on dynamic T1-weighted. For any cervical invasion, the sensitivity, specificity, PPV and NPV (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90, respectively, on T2-weighted and 0.50, 0.90, 0.46, 0.92 respectively, on dynamic T1-weighted, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95, respectively, on T2-weighted and 0.50, 0.96, 0.57, 0.95, respectively, on dynamic T1-weighted. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. MRI may allow accurate categorization of cases into low-risk or high-risk groups ensuring suitable extent of surgery and adjuvant therapy. |
3 |
| 77. Kim HJ, Cho A, Yun M, Kim YT, Kang WJ. Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer. Ann Nucl Med 2016;30:104-13. |
Observational-Dx |
287 patients |
To compare the diagnostic accuracy of 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting lymph node (LN) metastases in the preoperative staging of endometrial cancer. |
Histologic examination revealed LN metastases in 51 patients (17.8%). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0% with (18)F-FDG PET/CT and 34.0% with MRI, and specificities of 95.4 % with PET/CT and 95.0% with MRI. The NPV of PET/CT was 94.3%, and that of MRI was 87.2%. On a lesion base analysis, sensitivity of PET/CT was 79.4% while that of MRI was 51.6%. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6%, respectively. |
3 |
| 78. Lin G, Ho KC, Wang JJ, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging. 2008;28(1):128-135. |
Observational-Dx |
50 patients |
To evaluate DWI for detection of pelvic lymph node metastasis in patients with cervical and uterine cancers. Histopathologic results used as reference standard. |
The relative ADC values between tumor and nodes were significantly lower in metastatic than in benign nodes (0.06 vs 0.21 x 10(-3) mm(2)/s, P<0.001; cutoff value 0.10 x 10(-3) mm(2)/s). Compared to conventional MRI, the method combining size and relative ADC values resulted in better sensitivity (25% vs 83%) and similar specificity (98% vs 99%). The smallest metastatic lymph node detected by this method measured 5 mm on its short axis. The combination of size and relative ADC values was useful in detecting pelvic lymph node metastasis in patients with cervical and uterine cancers. |
2 |
| 79. Rechichi G, Galimberti S, Oriani M, Perego P, Valsecchi MG, Sironi S. ADC maps in the prediction of pelvic lymph nodal metastatic regions in endometrial cancer. Eur Radiol 2013;23:65-74. |
Observational-Dx |
40 patients |
To evaluate the usefulness of apparent diffusion coefficient (ADC) in discriminating metastatic from nonmetastatic pelvic lymph nodal sites in endometrial cancer. |
Average (± standard deviation) mean and minimum ADC region value (0.87?±?0.15 and 0.74?±?0.07?×?10(-3) mm(2)/s) of metastatic sites (n?=?7) were significantly lower than those of non-metastatic ones (n?=?89; 1.07?±?0.20 and 1.02?±?0.20; p-value?=?0.010 and 0.0004). Mean short-axis and short-to-long axis ratios of metastatic nodes were 7.47 mm and 0.68. Using the minimum ADC region value with threshold 0.807?×?10(-3) mm(2)/s, sensitivity, specificity, positive and negative predictive value and accuracy were 100 %, 98.3 %, 63.6 %, 100 % and 98.3 %, respectively (reader 1). |
2 |
| 80. Salani R, Khanna N, Frimer M, Bristow RE, Chen LM. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecologic Oncology. 146(1):3-10, 2017 07. |
Review/Other-Dx |
N/A |
To provide an update on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy. |
No results stated in abstract. |
4 |
| 81. Fischerova D.. Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review. [Review]. Ultrasound in Obstetrics & Gynecology. 38(3):246-66, 2011 Sep. |
Review/Other-Dx |
N/A |
To review examination techniques, sonographic features and clinical considerations in ultrasound assessment of gynecological tumors. |
No results stated in abstract. |
4 |
| 82. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009; 373(9658):125-136. |
Experimental-Tx |
1,408 patients; 85 different centers |
To investigate whether pelvic lymphadenectomy could improve survival of women with endometrial cancer. |
The hazard ratio for overall survival was 1.04 and for recurrence-free survival was 1.25. The results show no evidence of benefit in terms of overall or recurrence-free survival for pelvic lymphadenectomy in women with early endometrial cancer. Pelvic lymphadenectomy cannot be recommended as routine procedure for therapeutic purposes outside of clinical trials. |
1 |
| 83. Numazaki R, Miyagi E, Konnai K, et al. Analysis of stage IVB endometrial carcinoma patients with distant metastasis: a review of prognoses in 55 patients. Int J Clin Oncol 2009;14:344-50. |
Observational-Tx |
55 patients |
To clarify the prognosis of patients with stage IVB endometrial carcinoma and the validity of treatment. |
The median survivals of the group of 35 patients who were initially treated with surgery and the group of 10 patients who underwent radiotherapy or chemotherapy as their initial treatment followed by surgery were 11.5 months and 9.5 months, respectively. The residual tumor diameter after surgery was precisely measured in 40 of these 45 patients. The prognosis was significantly better in the patients with a residual tumor diameter of less than 2 cm compared to those with a tumor diameter of 2 cm or greater, and the median survival periods in these two groups were 23.5 months and 11.5 months, respectively (P = 0.027). Furthermore, the prognosis of patients with lung metastasis was significantly better than that of patients with non-lung hematogenous metastasis; the median survival periods of these two groups were 18.5 months and 10.5 months, respectively (P = 0.014). |
2 |
| 84. Kitajima K, Kita M, Suzuki K, Senda M, Nakamoto Y, Sugimura K. Prognostic significance of SUVmax (maximum standardized uptake value) measured by [(1)(8)F]FDG PET/CT in endometrial cancer. Eur J Nucl Med Mol Imaging. 2012; 39(5):840-845. |
Observational-Dx |
57 patients |
To determine if the preoperative SUVmax measured by FDG-PET/CT has prognostic value in patients with endometrial cancer. |
The median duration of follow-up was 33.1 months (range 4 to 68 months). SUVmax was significantly higher in patients with a higher FIGO stage (P=0.0015), higher tumor histological grade (P<0.0001), myometrial invasion (P=0.0020), larger tumor size (P=0.0056) and lymph node metastasis (P=0.027). Univariate analysis showed that SUVmax (uncategorized value), FIGO stage, tumor histological grade, lymph node metastasis and lymphovascular space invasion were significantly associated with recurrence. However, multivariate analysis showed that only SUVmax (P=0.045, hazard ratio 1.11, 95% CI, 1.0028-1.231) was significantly associated with recurrence. Based on Receiver-operator characteristic curve analysis and log-rank tests, patients with a high a SUVmax (=12.7) had a significantly lower disease-free survival rate than those with a low SUVmax (<12.7; P=0.00042). |
3 |
| 85. Raoufi J, Iscan SC, Hanedan C, et al. Incidence of suspicious axillary lymph node involvement in fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography in gynecologic cancers. Turk J Obstet Gynecol 2018;15:99-104. |
Observational-Dx |
251 patients |
To analyze the incidence of suspicious axillary lymph nodes in gynecologic cancers. |
Twenty-one and a half percent (n=20/93) of patients with endometrium cancer, 14.1% (n=14/99) of patients with ovarian cancer, and 10% (n=6/59) of those with cervical cancer had suspicious axillary lymph nodes. Patients with an maximum SUV (SUVmax) uptake higher than 3 underwent axillary lymph node biopsy. None of them was found to have axillary metastases of gynecologic cancers in the pathologic evaluation. In one patient with endometrial cancer, an obscure breast ductal carcinoma was diagnosed, another patient with endometrial cancer was found to have follicular lymphoma. The third patient with endometrial cancer had no malignancy in axillary lymph node biopsy, but had Hurthle cell neoplasia in a thyroid biopsy; the patient did not accept any surgical or medical treatment for endometrial cancer and died 23 months later. There were three (7.5%) metachronous cancers out of 40 gynecologic cancers; two patients were explained above, the third patient with endometrium cancer, who was not histopathologically evaluated although the axillary SUVmax was <3, had rectosigmoid cancer and glioblastoma metachronously. |
3 |
| 86. Gee MS, Atri M, Bandos AI, Mannel RS, Gold MA, Lee SI. Identification of Distant Metastatic Disease in Uterine Cervical and Endometrial Cancers with FDG PET/CT: Analysis from the ACRIN 6671/GOG 0233 Multicenter Trial. Radiology 2018;287:176-84. |
Observational-Dx |
153 cervical cancer patients and 203 endometrial cancer patients |
To assess the accuracy of staging positron emission tomography (PET)/computed tomography (CT) in detecting distant metastasis in patients with local-regionally advanced cervical and high-risk endometrial cancer in the clinical trial by the American College of Radiology Imaging Network (ACRIN) and the Gynecology Oncology Group (GOG) (ACRIN 6671/GOG 0233) and to compare central and institutional reader performance. |
Overall prevalence of distant metastasis was 13.7% (21 of 153) for cervical cancer and 11.8% (24 of 203) for endometrial cancer. Central reader PET/CT interpretation demonstrated sensitivity, specificity, positive predictive value (PPV), and negative predictive value of 54.8%, 97.7%, 79.3%, and 93.1% for cervical cancer metastasis versus 64.6%, 98.6%, 86.1%, and 95.4% for endometrial cancer, respectively. By comparison, local institutional review demonstrated sensitivity, specificity, PPV, and negative predictive value of 47.6%, 93.9%, 55.6%, and 91.9% for cervical cancer metastasis and 66.7%, 93.9%, 59.3%, and 95.5% for endometrial cancer, respectively. For central readers, the specificity and PPV of PET/CT detection of cervical and endometrial cancer metastases were all significantly higher compared with that of local institutional review (P < .05). Central reader area under the receiver operating characteristic curve (AUC) values were 0.78 and 0.89 for cervical and endometrial cancer, respectively; these were not significantly different from local institutional AUC values (0.75 and 0.84, respectively; P > .05 for both). |
2 |
| 87. Fung-Kee-Fung M, Dodge J, Elit L, et al. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol 2006;101:520-9. |
Review/Other-Dx |
16 studies |
To determine the optimum follow-up of women who are clinically disease-free following potentially curative treatment for endometrial cancer. |
Sixteen non-comparative retrospective studies were identified. The overall risk of recurrence was 13% for all patients and 3% or less for patients at low risk. Approximately 70% of all recurrences were symptomatic, and 68% to 100% of recurrences occurred within approximately the first 3 years of follow-up. No reliable differences in survival were detected between patients with symptomatic or asymptomatic recurrences nor were differences in patient outcomes reported by type of follow-up strategy employed. Detection of asymptomatic recurrences ranged from 5% to 33% of patients with physical examination, 0% to 4% with vaginal vault cytology, 0% to 14% with chest X-ray, 4% to 13% with abdominal ultrasound, 5% to 21% with abdominal/pelvic CT scan, and 15% in selected patients with CA 125. |
4 |
| 88. Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. [Review]. American Journal of Obstetrics & Gynecology. 204(6):466-78, 2011 Jun. |
Review/Other-Tx |
N/A |
To review the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy. |
Although gynecologic cancers account for only 10% of all new cancer cases in women, these cancers account for 20% of all female cancer survivors. Improvements in cancer care have resulted in almost 10 million cancer survivors, and this number is expected to grow. Therefore, determining the most cost-effective clinical surveillance for detection of recurrence is critical. Unfortunately, there has been a paucity of research in what are the most cost-effective strategies for surveillance once patients have achieved a complete response. Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of most gynecologic cancer recurrences. There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy. |
4 |
| 89. Labi FL, Evangelista S, Di Miscia A, Stentella P. FIGO Stage I endometrial carcinoma: evaluation of lung metastases and follow-up. Eur J Gynaecol Oncol. 2008; 29(1):65-66. |
Review/Other-Dx |
210 patients |
To evaluate the incidence of lung metastases in the follow-up of women submitted to surgery for endometrial carcinoma, in particular for FIGO Stage I. |
One patient out of the group studied has developed lung metastasis 6 years after surgery. She was staged as FIGO IB (T1b Mx G1). |
4 |
| 90. Berchuck A, Anspach C, Evans AC, et al. Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma. Gynecol Oncol 1995;59:20-4. |
Observational-Tx |
354 patients |
To examine the effect of postsurgical surveillance on survival of patients with FIGO stage I/II endometrial adenocarcinoma. |
Among the 354 patients in this study, 44 (12%) developed recurrent disease. Sites of recurrence included 12 (27%) isolated vaginal, 12 (27%) pelvic with vagina or abdomen, 4 (10%) isolated lung, 13 (29%) pelvic/abdominal with other distant sites, and 3 (7%) other distant sites. At diagnosis of recurrence 61% of patients had symptoms related to their cancer, 68% had physical exam findings suggestive of recurrence, and 84% had symptoms and/or signs. Findings consistent with recurrent cancer were detected by Pap smear in 25% and on chest radiograph in 20%. Among the 44 patients who developed recurrent disease, 8 (18%) remain alive without evidence of disease, including 6/12 (50%) with isolated vaginal disease and 2/34 (6%) with other patterns of recurrent disease (P = 0.01). Among the 12 patients with isolated vaginal recurrence, 1/3 (33%) in whom recurrent disease was diagnosed by Pap smear alone was salvaged compared to 5/9 (56%) who had symptoms or signs of vaginal recurrence. None of the three patients in whom an abnormal chest radiograph was the only evidence of recurrence survived. |
2 |
| 91. Magrina JF, Zanagnolo V, Giles D, Noble BN, Kho RM, Magtibay PM. Robotic surgery for endometrial cancer: comparison of perioperative outcomes and recurrence with laparoscopy, vaginal/laparoscopy and laparotomy. Eur J Gynaecol Oncol 2011;32:476-80. |
Observational-Tx |
67 patients |
To evaluate the results of robotic surgery for the primary treatment of endometrial cancer patients amenable to surgery and to compare them tomatched patients treated by laparoscopy, laparotomy or a vaginal/laparoscopy (vaginal hysterectomy, bilateral salpingoophorectomy and laparoscopic lymphadenectomy) approach. |
Mean operating times for patients undergoing robotic, laparoscopy, vaginal/laparoscopy or laparotomy approach were 181.9,189.5, 202.7 and 162.7 min, respectively (p = 0.006); mean blood loss was 141.4, 300.8, 300.0 and 472.6 ml, respectively (p < 0.001);mean number of nodes was 24.7, 27.1, 28.6, and 30.9, respectively (p = 0.008); mean length of hospital stay was 1.9, 3.4, 3.5 and5.6 days, respectively (p < 0.001). There were no significant differences in intra- or postoperative complications among the fourgroups. The conversion rate was 2.9% for robotics and 10.8% for the laparoscopy group (0.001). There were no differences relativeto recurrence rates among the four groups: 9%, 14%, 11% and 15% for robotics, laparoscopy, vaginal/laparoscopy, and laparotomy,respectively. |
1 |
| 92. Hunn J, Tenney ME, Tergas AI, et al. Patterns and utility of routine surveillance in high grade endometrial cancer. Gynecol Oncol 2015;137:485-9. |
Observational-Dx |
254 patients |
To evaluate surveillance methods and their utility in detecting recurrence of disease in a high grade endometrial cancer population. |
Two hundred and fifty-four patients met the criteria for inclusion. Vaginal cytology was performed in the majority of early stage patients, but was utilized less in advanced stage patients. CA-125 and CT imaging were used more frequently in advanced stage patients compared to early stage. Thirty-six percent of patients experienced a recurrence and the majority of initial recurrences (76%) had a distant component. Modalities that detected cancer recurrences were: symptoms (56%), physical exam (18%), surveillance CT (15%), CA-125 (10%), and vaginal cytology (1%). All local recurrences were detected by symptoms or physical exam findings. While the majority of loco-regional and distant recurrences (68%) were detected by symptoms or physical exam, 28% were detected by surveillance CT scan or CA 125. One loco-regional recurrence was identified by vaginal cytology but no recurrences with a distant component detected by this modality. |
3 |
| 93. Faria SC, Sagebiel T, Balachandran A, Devine C, Lal C, Bhosale PR. Imaging in endometrial carcinoma. Indian J Radiol Imaging 2015;25:137-47. |
Review/Other-Dx |
N/A |
To review the value of imaging in diagnosis, staging, treatment planning, and detection of recurrent disease in patients with endometrial carcinoma (EC). |
No results stated in abstract. |
4 |
| 94. Sala E, Wakely S, Senior E, Lomas D. MRI of malignant neoplasms of the uterine corpus and cervix. AJR. 2007; 188(6):1577-1587. |
Review/Other-Dx |
N/A |
To review the role of MRI in the imaging of malignant neoplasms of the uterine corpus and cervix, describing its role in staging, treatment planning, and follow-up. |
MRI is not officially incorporated in the International Federation of Gynecology and Obstetrics (FIGO) staging system, but is already widely accepted as the most reliable imaging technique for the diagnosis, staging, treatment planning, and follow-up of both endometrial and cervical cancer. |
4 |
| 95. Donati OF, Lakhman Y, Sala E, et al. Role of preoperative MR imaging in the evaluation of patients with persistent or recurrent gynaecological malignancies before pelvic exenteration. European Radiology. 23(10):2906-15, 2013 Oct. |
Observational-Dx |
50 patients |
To determine the diagnostic performance of MRI in assessing local tumour extent and evaluate associations between MRI features and survival in patients undergoing MRI before pelvic exenteration for persistent or recurrent gynaecological cancers. |
Areas under receiver operating characteristic curves (AUCs) for invasion of the bladder, rectum and pelvic sidewall were 0.96, 0.90 and 0.98 for reader 1 and 0.95, 0.88 and 0.90 for reader 2. Corresponding sensitivities/specificities were 87.0 %/92.6 %, 81.3 %/97.0 % and 87.5 %/97.2 % for reader 1, and 87.0 %/100.0 %, 75.0 %/97.0 % and 75.0 %/94.4 % for reader 2. Inter-reader agreement was excellent for organ invasion (kappa = 0.81-0.85). Pelvic sidewall invasion on MRI was associated with overall and recurrence-free survival (P = 0.01-0.04 for the two readers). |
3 |
| 96. Kadkhodayan S, Shahriari S, Treglia G, Yousefi Z, Sadeghi R. Accuracy of 18-F-FDG PET imaging in the follow up of endometrial cancer patients: systematic review and meta-analysis of the literature. Gynecol Oncol 2013;128:397-404. |
Meta-analysis |
11 studies |
To review the available literature on the accuracy of 18-F-FDG PET imaging in the follow up of the endometrial cancer patients and presented the results in systematic review and meta-analysis format. |
Eleven studies (541 patients in total) were included in the analysis. Pooled diagnostic indices (patient basis) for detection of overall recurrence were as follows: sensitivity 95.8% [92.2–98.1], specificity 92.5% [89.3–94.9], positive likelihood ratio (LR+) 9.53 [6.52–13.91], negative likelihood ratio (LR-) 0.075[0.044–0.128], and diagnostic odds ratio (DOR) 204 [91.97–453.5]. 18-F-FDG performance was better in studies conducted by PET/CT as compared to PET. The treatment plan changed in 22–35% of the studied patients |
Good |
| 97. Saga T, Higashi T, Ishimori T, et al. Clinical value of FDG-PET in the follow up of post-operative patients with endometrial cancer. Ann Nucl Med. 2003; 17(3):197-203. |
Observational-Dx |
21 patients |
Retrospectively evaluate the clinical usefulness of FDG-PET in the follow-up of postoperative patients with endometrial cancer. FDG-PET findings were compared with their serum levels of tumor markers, CT and/or MRI findings, and the final outcome. |
FDG-PET, with CT/MRI: sensitivity 100.0%, specificity 88.2%, accuracy 93.3%. Combined conventional imaging: sensitivity 84.6%, specificity 85.7%, and accuracy 85.0%. Tumor markers: sensitivity 100.0%, specificity 70.6%, accuracy 83.3%. FDG-PET was accurate in detecting recurrence and evaluating therapeutic response, and could afford important information in the management of postoperative patients with endometrial cancer. |
3 |
| 98. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
