Magnetic resonance imaging performs better than endocervical curettage for preoperative prediction of cervical stromal invasion in endometrial carcinomas

ObjectivePreoperative identification of cervical stromal invasion in endometrial carcinoma is important to select patients for primary radical hysterectomy. The objective of this prospective implementation study was 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.MethodsOver a six-year period, a total of 338 patients were surgically staged after preoperative assessment of the uterine cervix by ECC (years 1 through 3), and a combination of MRI and ECC (years 4 through 6). Suggested presence of cervical stromal invasion based on ECC (n = 321) and MRI (n = 146) were compared for diagnostic performance applying surgical FIGO stage 2009 as reference standard.ResultsFor 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.ConclusionsThe diagnostic performance of MRI compares favorably to that of ECC for preoperative assessment of cervical stromal invasion in endometrial carcinoma. Thus, the findings in this prospective implementation study support the value of preoperative MRI for assessment of cervical stromal invasion before radical hysterectomy.

► Preoperative identification of cervical stromal invasion is important.
► MRI had superior diagnostic performance to ECC in this prospective study.
► MRI was the only method independently predicting cervical stromal invasion.