Assessment of Myometrial Invasion of Endometrial Carcinoma Using Fusion of T2WI and DWI Taking Histopathology as Gold Standard: Fusion Method to Evaluate Myometrial Invasion

Sumaiya Muzaffar; Saman Chaudhry; Kiran Sarfaraz; Mehwish Nizam; . Sara; Samim Amin

doi:10.54393/pjhs.v6i7.3129

Authors

Sumaiya Muzaffar Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, Pakistan
Saman Chaudhry Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, Pakistan
Kiran Sarfaraz Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, Pakistan
Mehwish Nizam Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, Pakistan
. Sara Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, Pakistan
Samim Amin Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i7.3129

Keywords:

Endometrial Carcinoma, Myometrial Invasion, T2-Weighted Imaging, Diffusion-Weighted Imaging

Abstract

Precise evaluation of myometrial invasion in endometrial carcinoma is crucial. MRI; especially combination of T2WI and DWI has shown great potential as non-invasive method for this assessment. Objective: To determine positive predictive value of T2WI and DWI fusion in diagnosis of deep myometrial invasion of endometrial carcinoma taking histopathology as gold standard. Methods: This cross sectional study was piloted on 71 patients recruited from Radiology and Gynaecology departments of SGRH, Lahore. All histologically confirmed cases of endometrial carcinoma underwent pelvic MRI, including T2WI and DWI were included. The fused T2WI-DWI images were evaluated for presence and depth of myometrial invasion. Final histopathology reports post-surgery were used as gold standard to determine the PPV of the fused approach. Results: The positive predictive value of T2WI-DWI for detecting deep myometrial invasion calculated is 94.4%. Conclusions: Current findings suggest that, fusion of T2WI and DWI proved to be highly effective tool in diagnosing deep myometrial invasion in cases of endometrial carcinoma, taken histopathology as gold standard. The results indicate that this combined imaging approach offers strong PPV and overall accuracy, supporting its use as reliable, non-invasive method for preoperative evaluation.

References

Pervez SN, Junaid M, Alam S, Baloch FA, Khan P, Bibi N. Prevalence and Histopathological Findings of Endometrioid Carcinoma and Associated Risk Factors: A Cross-Sectional Study: Prevalence and Histopathology of Endometrioid Carcinoma. Pakistan Journal of Health Sciences. 2024 Nov: 13-8. doi: 10.54393/pjhs.v5i11.2320. DOI: https://doi.org/10.54393/pjhs.v5i11.2320

Lu KH and Broaddus RR. Endometrial cancer. New England Journal of Medicine. 2020 Nov; 383(21): 2053-64. doi: 10.1056/NEJMra1514010. DOI: https://doi.org/10.1056/NEJMra1514010

Restaino S, Paglietti C, Arcieri M, Biasioli A, Della Martina M, Mariuzzi L et al. Management of patients diagnosed with endometrial cancer: comparison of guidelines. Cancers. 2023 Feb; 15(4): 1091. doi: 10.3390/cancers15041091. DOI: https://doi.org/10.3390/cancers15041091

Wang J, Xu P, Yang X, Yu Q, Xu X, Zou G et al. Association of myometrial invasion with lymphovascular space invasion, lymph node metastasis, recurrence, and overall survival in endometrial cancer: a meta-analysis of 79 studies with 68,870 patients. Frontiers in Oncology. 2021 Oct; 11: 762329. doi: 10.3389/fonc.2021.762329. DOI: https://doi.org/10.3389/fonc.2021.762329

Jónsdóttir B, Marcickiewicz J, Borgfeldt C, Bjurberg M, Dahm‐Kähler P, Flöter‐Rådestad A et al. Preoperative and intraoperative assessment of myometrial invasion in endometrial cancer-A Swedish Gynecologic Cancer Group (SweGCG) study. Acta Obstetricia et Gynecologica Scandinavica. 2021 Aug; 100(8): 1526-33. doi: 10.1111/aogs.14146. DOI: https://doi.org/10.1111/aogs.14146

Koskas M, Amant F, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. International Journal of Gynecology and Obstetrics. 2021 Oct; 155: 45-60. doi: 10.1002/ijgo.13866. DOI: https://doi.org/10.1002/ijgo.13866

Neves TR, Correia MT, Serrado MA, Horta M, Caetano AP, Cunha TM. Staging of endometrial cancer using fusion T2-weighted images with diffusion-weighted images: a way to avoid gadolinium?. Cancers. 2022 Jan; 14(2): 384. doi: 10.3390/cancers14020384. DOI: https://doi.org/10.3390/cancers14020384

Xie M, Ren Z, Bian D, Li D, Yu L, Zhu F et al. High resolution diffusion-weighted imaging with readout segmentation of long variable echo-trains for determining myometrial invasion in endometrial carcinoma. Cancer Imaging. 2020 Sep; 20(1): 66. doi: 10.1186/s40644-020-00346-7. DOI: https://doi.org/10.1186/s40644-020-00346-7

Nurdillah I, Rizuana IH, Suraya A, Syazarina SO. A comparison of dynamic contrast-enhanced magnetic resonance imaging and T2-weighted imaging in determining the depth of myometrial invasion in endometrial carcinoma-a retrospective study. Journal of Personalized Medicine. 2022 Jul; 12(8): 1268. doi: 10.3390/jpm12081268. DOI: https://doi.org/10.3390/jpm12081268

Mohamed Shatat OM, Fakhry S, Helal MH. The fusion of T2 weighted MRI and diffusion-weighted imaging in evaluating the depth of myometrial invasion in endometrial cancer. Journal of Clinical Practice and Research. 2019; 41(4): 375. doi: 10.14744/etd.2019.43815. DOI: https://doi.org/10.14744/etd.2019.43815

Essmat A. Correlation between depth of myometrial invasion and degree of lymph node affection in cases of endometrial cancer. Open Journal of Obstetrics and Gynecology. 2021 Apr; 11(4): 360-8. doi: 10.4236/ojog.2021.114036. DOI: https://doi.org/10.4236/ojog.2021.114036

Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Gynecological Cancer. 2021 Jan; 31(1): 12-39. doi: 10.1136/ijgc-2020-002230. DOI: https://doi.org/10.1136/ijgc-2020-002230

Raffone A, Travaglino A, Raimondo D, Neola D, Renzulli F, Santoro A et al. Prognostic value of myometrial invasion and TCGA groups of endometrial carcinoma. Gynecologic Oncology. 2021 Aug; 162(2): 401-6. doi: 10.1016/j.ygyno.2021.05.029. DOI: https://doi.org/10.1016/j.ygyno.2021.05.029

Gil RT, Cunha TM, Horta M, Alves I. A acurácia do estudo de difusão na avaliação pré-operatória do carcinoma do endométrio. Radiologia Brasileira. 2019 Jul; 52: 229-36. doi: 10.1590/0100-3984.2018.0054. DOI: https://doi.org/10.1590/0100-3984.2018.0054

Anjum H, Khattak M, Ghayur MS, Rehman M, Iftikhar S. Diagnostic Accuracy Of Diffusion-Weighted Magnetic Resonance Imaging In The Diagnosis Of Myometrial Invasion Among Patients With Endometrial Carcinoma. Journal of Medical Sciences. 2024 Mar; 32(1): 35-9. doi: 10.52764/jms.24.32.1.7. DOI: https://doi.org/10.52764/jms.24.32.1.7

Fatma MS, Marwa AE, Nermin YS, Maged RE. Role of Diffusion and T2-Weighted Magnetic Resonance Imaging in Preoperative Assessment of Myometrial Invasion and Staging of Endometrial Carcinoma. The Medical Journal of Cairo University. 2024 Sep; 92(09): 921-9. doi: 10.21608/mjcu.2024.389919. DOI: https://doi.org/10.21608/mjcu.2024.389919

Arian A, Ahmadi E, Gity M, Setayeshpour B, Delazar S. Diagnostic value of T2 and diffusion-weighted imaging (DWI) in local staging of endometrial cancer. Journal of Medical Imaging and Radiation Sciences. 2023 Jun; 54(2): 265-72. doi: 10.1016/j.jmir.2023.01.002. DOI: https://doi.org/10.1016/j.jmir.2023.01.002

Raja S, Sharma PK, Subramonian SG, Ravipati C, Natarajan P. Enhancing Preoperative Assessment of Endometrial Cancer: The Role of Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Myometrial Invasion. Cureus. 2024 Jun; 16(6). doi: 10.7759/cureus.62111. DOI: https://doi.org/10.7759/cureus.62111

Wang LJ, Tseng YJ, Wee NK, Low JJ, Tan CH. Diffusion-weighted imaging versus dynamic contrast-enhanced imaging for pre-operative diagnosis of deep myometrial invasion in endometrial cancer: A meta-analysis. Clinical Imaging. 2021 Dec; 80: 36-42. doi: 10.1016/j.clinimag.2021.06.027. DOI: https://doi.org/10.1016/j.clinimag.2021.06.027

Ibrahim R and Metwally ZI. Unveiling the Impact of Dynamic Contrast-Enhanced and Diffusion-Weighted MRI in Endometrial and Cervical Carcinoma Management. Ain Shams Medical Journal. 2024 Dec; 75(4): 858-73. doi: 10.21608/asmj.2024.326282.1324. DOI: https://doi.org/10.21608/asmj.2024.326282.1324