Pitfalls in staging uterine neoplasm with imaging: a review

This review analyzes current pitfalls in pretreatment staging of endometrial and cervical carcinoma with magnetic resonance imaging (MRI) based on a critical review of the literature. Technical, patient, and tumor-related characteristics were analyzed to improve further staging of uterine neoplasm with MRI. For endometrial carcinoma staging, contrast-enhanced dynamic imaging appears essential to avoid false-positive findings for deep myometrial invasion by better delineating tumor from normal myometrium. However, leiomyomas, adenomyosis, and grade 3 tumors provide difficulties in staging for pathologists and radiologists. Slice orientation perpendicular to the long axis of the cervical channel might improve false-negative findings for deep stromal invasion on T2-weighted images in endometrial and cervical cancer. Contrast-enhanced sequences do not improve diagnosis of parametrial or vaginal invasion in cervical cancer. Assessment of lymph node invasion by any imaging modality has limited sensitivity in detecting lymph node metastasis smaller than 5 mm. Knowledge of diagnostic criteria is critical to avoid false-negative findings for bladder wall invasion. Higher spatial resolution with dedicated multichannel pelvic phase array coils, smaller fields of view and section thickness, and careful comparison of T2-weighted and contrast-enhanced sequences are strategies that might avoid misinterpretation of pelvic MRI in staging uterine neoplasm. Similar content being viewed by others

Kinkel K, Kaji Y, Yu KK, et al. (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718 Scheidler J, Hricak H, Yu KK, et al. (1997) Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA 278:1096–1101 Frei KA, Kinkel K, Bonel HM, et al. (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging—a meta-analysis and Bayesian analysis. Radiology 216:444–449 Hricak H, Powell CB, Yu KK, et al. (1996) Invasive cervical carcinoma: role of MR imaging in pretreatment work-up—cost minimization and diagnostic efficacy analysis. Radiology 198:403–409 Scoutt LM, McCarthy SM, Flynn SD, et al. (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology 194:567–572 Cunha TM, Felix A, Cabral I (2001) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and gross visual inspection. Int J Gynecol Cancer 11:130–136 Sheu MH, Chang CY, Wang JH, Yen MS (2001) Preoperative staging of cervical carcinoma with MR imaging: a reappraisal of diagnostic accuracy and pitfalls. Eur Radiol 11:1828–1833 Acs G (2002) Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol 19:237–254 Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855 Yamashita Y, Mizutani H, Torashima M, et al. (1993) Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR 161:595–599 Saez F, Urresola A, Larena JA, et al. (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466 Hricak H, Hamm B, Semelka RC, et al. (1991) Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imaging. Radiology 181:95–106 Sironi S, Colombo E, Villa G, et al. (1992) Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. Radiology 185:207–212 Yamashita Y, Harada M, Sawada T, et al. (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501 Tanaka YO, Nishida M, Tsunoda H, et al. (2003) A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation. Eur Radiol 13:2038–2045 Minderhoud-Bassie W, Treurniet FE, Koops W, et al. (1995) Magnetic resonance imaging (MRI) in endometrial carcinoma; preoperative estimation of depth of myometrial invasion. Acta Obstet Gynecol Scand 74:827–831 Fanning J, Tsukada Y, Piver MS (1990) Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 37:47–50 Ohguri T, Aoki T, Watanabe H, et al. (2002) MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas. Eur Radiol 12:2737–2742 Ben-Shachar I, Vitellas KM, Cohn DE (2004) The role of MRI in the conservative management of endometrial cancer. Gynecol Oncol 93:233–237 Hricak H, Stern JL, Fisher MR, et al. (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305 Matsushita H, Kodama S, Kase H, et al. (1996) [Usefulness of magnetic resonance imaging in the determination of cervical involvement in endometrial cancer]. Nippon Sanka Fujinka Gakkai Zasshi 48:821–826 Matsushita M, Kurata H, Kase H, et al. (2001) MR imaging underestimates stromal invasion in patients with adenocarcinoma of the uterine cervix. Eur J Gynaecol Oncol 22:201–203 Manfredi R, Mirk P, Maresca G, et al. (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378 Scheidler J, Heuck AF. Imaging of cancer of the cervix. Radiol Clin North Am 2002;40:577–590, vii Scheidler J, Heuck AF, Steinborn M, et al. (1998) Parametrial invasion in cervical carcinoma: evaluation of detection at MR imaging with fat suppression. Radiology 206:125–129 Bipat S, Glas AS, van der Velden J, et al. (2003) Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol 91:59–66 Subak LL, Hricak H, Powell CB, et al. (1995) Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 86:43–50 Van Hoe L, Vanbeckevoort D, Oyen R, et al. (1999) Cervical carcinoma: optimized local staging with intravaginal contrast-enhanced MR imaging—preliminary results. Radiology 213:608–611 Seki H, Azumi R, Kimura M, Sakai K. (1997) Stromal invasion by carcinoma of the cervix: assessment with dynamic MR imaging. AJR 168:1579–1585 Abe Y, Yamashita Y, Namimoto T, et al. (1998) Carcinoma of the uterine cervix. High-resolution turbo spin-echo MR imaging with contrast-enhanced dynamic scanning and T2-weighting. Acta Radiol 39:322–326 Van Vierzen PB, Massuger LF, Ruys SH, Barentsz JO (1998) Fast dynamic contrast enhanced MR imaging of cervical carcinoma. Clin Radiol 53:183–192 Narayan K, McKenzie A, Fisher R, et al. (2003) Estimation of tumor volume in cervical cancer by magnetic resonance imaging. Am J Clin Oncol 26:E163–E168 Wagenaar HC, Trimbos JB, Postema S, et al. (2001) Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 82:474–482 Heuck A, Scheidler J, Kimmig R, et al. (1997) [Lymph node staging in cervix carcinomas: the results of high-resolution magnetic resonance tomography (MRT) with a phased-array body coil]. Rofo 166:210–214 Bellin MF, Roy C, Kinkel K, et al. (1998) Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles—initial clinical experience. Radiology 207:799–808 Keller TM, Michel SC, Frohlich J, et al. (2004) USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results. Eur Radiol 14:937–944 Follen M, Levenback CF, Iyer RB, et al. (2003) Imaging in cervical cancer. Cancer 98:2028–2038 Todo Y, Sakuragi N, Nishida R, et al. (2003) Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol 188:1265–1272 Jhang H, Chuang L, Visintainer P, Ramaswamy G (2003) CA 125 levels in the preoperative assessment of advanced-stage uterine cancer. Am J Obstet Gynecol 188:1195–1197 Nicolet V, Carignan L, Bourdon F, Prosmanne O (2000) MR imaging of cervical carcinoma: a practical staging approach. Radiographics 20:1539–1549 Hawighorst H, Knapstein PG, Weikel W, et al. (1996) Cervical carcinoma: comparison of standard and pharmacokinetic MR imaging. Radiology 201:531–539 Kim SH, Han MC (1997) Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging. AJR 168:393–397 Acknowledgments Many thanks to P.D., Rosemarie Forstner, MD, and Teresa M. Cunha, PhD, for help in searching for clinical examples of false-negative and false-positive findings in patients that have been staged for endometrial or cervical cancer. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Kinkel, K. Pitfalls in staging uterine neoplasm with imaging: a review. Abdom Imaging 31, 164–173 (2006). https://doi.org/10.1007/s00261-005-0383-8 Published: Issue date: DOI: https://doi.org/10.1007/s00261-005-0383-8