Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta-analysis and Bayesian analysis.
OBJECTIVE
To determine if, in a patient with an endometrial cancer, in addition to the knowledge of tumor grade, preoperative magnetic resonance (MR) imaging findings contribute to treatment stratification and specialist referral.


METHODS
By using a MEDLINE literature search and institutional pathology reports, pretest probabilities for myometrial invasion were correlated with tumor grade. Likelihood ratios (LRs) were obtained through summary receiver operating characteristics.


RESULTS
The mean pretest probabilities of deep myometrial invasion were derived from seven articles (1,875 patients) and from 125 institutional pathology reports. LRs for the prediction of myometrial invasion with contrast-enhanced MR imaging were derived from nine studies (742 patients); positive and negative LRs were 10.11 and 0.1, respectively. The mean weighted pretest probabilities of deep myometrial invasion in patients with tumor grades 1, 2, or 3 were 13%, 35%, or 54%, respectively. Posttest probabilities of deep myometrial invasion for grades 1, 2, or 3 increased to 60%, 84%, or 92%, respectively, for positive and decreased to 1%, 5%, or 10%, respectively, for negative MR imaging findings.


CONCLUSIONS
Use of contrast-enhanced MR imaging significantly affects the posttest probability of deep myometrial invasion in patients with all grades of endometrial cancer and could be used to select patients for specialist referral.
Departments of Radiology, The University of California, San Francisco, CA, USA.
K A
KA
Frei
K
K
Kinkel
H M
HM
Bonél
Y
Y
Lu
C
C
Zaloudek
H
H
Hricak
D001499:Bayes Theorem; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D016001:Confidence Intervals; D003287:Contrast Media; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D005544:Forecasting; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D016013:Likelihood Functions; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011336:Probability; D012372:ROC Curve; D012017:Referral and Consultation; D015996:Survival Rate
D003287:Contrast Media