Cervical Invasion of Endometrial Carcinoma — Evaluation by Parasagittal MR Imaging

Twenty-seven consecutive patients were examined by T2-(1 800/70 ms) and postcontrast T1-weighted (600/15) spin echo (SE) or dynamic (200/15) SE MR imaging to determine the usefulness of parasagittal MR imaging in assessing cervical invasion of endometrial carcinoma. The images were obtained in a direction parallel to the longitudinal axis of the uterus (parasagittal). The cervical epithelium, being hyperintense on the late phase dynamic and postcontrast T1-weighted SE images, had disappeared partially or totally in all 4 patients with cervical invasion. The enhanced cervical epithelium was completely seen in one patient with the tumor protruding into the cervical canal in a polyp-like form without cervical epithelial invasion. The same was also seen in the 22 patients with the tumor remaining in the corpus cavity. The enhanced parasagittal MR images facilitated the evaluation of the extent of the endometrial carcinoma.

Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging

The purpose of this study was to determine the accuracy of magnetic resonance imaging (MRI) for evaluating the depth of myometrial invasion, potential sources of pitfalls, and the usefulness of contrast-enhanced series. Eighty-five patients with a pathologic diagnosis of endometrial carcinoma underwent preoperative MRI (plain and contrast-enhanced). Grade of myometrial invasion, presence of junctional zone (JZ), fibromyomas, and tumoral thickness were evaluated by two groups of radiologists blinded to pathologic results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI in determining the depth of myometrial invasion were evaluated. The sensitivity/specificity for plain MR was 64.1-64.1/93.5-100 for both observers. Assessing deep myometrial invasion, sensitivity, and NPV improved significantly (P = 0.002, P = 0.003 for both observers) when comparing plain and whole study series. Tumoral thickness (P = 0.16, P = 0.13, for the two observers) and presence or absence of JZ (P = 0.41, P = 0.14) did not influence myometrial invasion assessment. Gadolinium-enhanced series improve the assessment of deep myometrial invasion in endometrial carcinoma. J. Magn. Reson. Imaging 2000;12:460-466.

Intrauterine sonography for preoperative assessment of cervical invasion in endometrial carcinoma

Cervical involvement is one of the major prognostic factors in carcinoma of the endometrium confined to the uterus. The purpose of this study was to determine whether intrauterine ultrasound with a high-frequency miniature probe can depict the degree of cervical involvement of the disease. Thirty-two women with endometrial carcinoma underwent preoperative transvaginal and intrauterine sonography. By both scans, the degree of cervical involvement was prospectively evaluated. Sonograms were compared with the findings from histologic examination. Intrauterine sonography was completed in 30 of the 32 patients. In these 30 patients, the degree of cervical involvement (none, endocervical gland, or cervical stroma) based on transvaginal scan was correct in 23 cases (77%), and that based on intrauterine scan was correct in 26 cases (87%). Three tumors with endocervical glandular involvement were correctly diagnosed by intrauterine sonography, whereas they were incorrectly diagnosed by transvaginal scan. The specificity and positive predictive value of intrauterine sonography for the assessment of the presence of cervical stromal invasion are 100% (26/26 and 3/3, respectively). Although this study is preliminary, our experience with intrauterine sonography shows that it has potential for assessing cervical stromal invasion in endometrial carcinoma.