Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul;27(4):e38.
doi: 10.3802/jgo.2016.27.e38. Epub 2016 Apr 18.

Long-term outcomes of magnetic resonance imaging-invisible endometrial cancer

Hyun Jin Choi  1 , Sunyoung Lee  2 , Byung Kwan Park  3 , Tae Joong Kim  1 , Chan Kyo Kim  2 , Jung Jae Park  2 , Chel Hun Choi  1 , Yoo Young Lee  1 , Jeong Won Lee  1 , Duk Soo Bae  1 , Byoung Gie Kim  1
Affiliations

Long-term outcomes of magnetic resonance imaging-invisible endometrial cancer

Hyun Jin Choi et al. J Gynecol Oncol. 2016 Jul.

Abstract

Objective: Magnetic resonance imaging (MRI) is useful for staging endometrial cancer. The treatment and prognosis of MRI-invisible endometrial cancer remain unclear. The purpose of this study was to retrospectively evaluate the long-term outcomes of patients with MRI-invisible endometrial cancer.

Methods: Between February 1995 and December 2011, we reviewed the medical records of 433 patients with endometrial cancer, which was staged IA on MRI. Of these patients, 89 had MRI-invisible cancer and 344 had MRI-visible cancer. Both cancers were treated with simple hysterectomy with or without lymph node dissection according to the surgeon's decision. Both cancers were compared regarding pathologic findings, recurrence rates, and survival rates.

Results: The median sizes of MRI-invisible and MRI-visible cancers were 4 mm (0 to 40 mm) and 20 mm (0 to 89 mm), respectively (p<0.001). Myometrial invasion of these groups were detected in 20.2% (18/89) and 56.7% (195/344), respectively (p<0.001). Lymphadenectomy and follow-up imaging revealed no lymph node metastasis in patients with MRI-invisible cancers, while those revealed in 4.7% (16/344) of patients with MRI-visible cancers (p=0.052). The recurrence rates of MRI-invisible and MRI-visible cancers were 1.1% (1/89) and 7.8% (27/344), respectively (p=0.026). The recurrence-free survival rates of these groups were 98.9% (88/89) and 91.6% (315/344), respectively (p=0.022).

Conclusion: MRI-invisible endometrial cancer can be treated with less invasive surgery because of its lower tumor burden and better prognosis. This cancer may not require lymphadenectomy because of no metastasis or recurrence in lymph nodes.

Keywords: Endometrial Neoplasms; Lymph Nodes; Magnetic Resonance Imaging; Outcome; Stage.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Study flow chart. MRI, magnetic resonance imaging.
Fig. 2
Fig. 2
Magnetic resonance imaging (MRI)-invisible 1A endometrial cancer in a 68-year-old woman. A T2-weighted sagittal image shows no focal lesion within the hyperintense endometrium (arrows). Prior to the MRI scan, endometrial biopsy revealed grade II endometrioid adenocarcinoma. Pathologic examination following hysterectomy confirmed no residual cancer but scattered atypical endometrial glands. There was no metastasis in the pelvic and para-aortic lymph nodes. No recurrent cancer has been found for postoperative 49 months.
Fig. 3
Fig. 3
Magnetic resonance imaging (MRI)-visible 1A endometrial cancer in a 47-year-old woman. A T2-weighted sagittal image shows an endometrial cancer invading the superficial myometrium (arrows). Pathologic examination following hysterectomy confirmed a 4.3 cm grade I endometrioid adenocarcinoma invading superficial myometrium. There was no metastasis in the pelvic lymph nodes. No recurrent cancer has been found 46 months after surgery.
Fig. 4
Fig. 4
Recurrence-free survival rates of magnetic resonance imaging (MRI)-invisible and visible endometrial cancers. The graph illustrates that patients (blue) with MRI-invisible endometrial cancer have a higher recurrence-free survival rate than patients (green) with MRI-visible endometrial (p=0.022). The survival rates of these cancer groups are 98.9% (88/89) and 91.6% (315/344), respectively.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK, ASTEC study group Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–136. - PMC - PubMed
    1. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–1716. - PubMed
    1. 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;375:1165–1172. - PubMed
    1. Mitamura T, Watari H, Todo Y, Kato T, Konno Y, Hosaka M, et al. Lymphadenectomy can be omitted for low-risk endometrial cancer based on preoperative assessments. J Gynecol Oncol. 2014;25:301–305. - PMC - PubMed
    1. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol. 1984;63:825–832. - PubMed