title: Magnetic resonance imaging performs better than endocervical curettage for preoperative prediction of cervical stromal invasion in endometrial carcinomas.
abstract: OBJECTIVE
  Preoperative 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.
  
  
  METHODS
  Over 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.
  
  
  RESULTS
  For 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021 Bergen, Norway. ingfrid.haldorsen@helse-bergen.no
authors.forename: Ingfrid S
authors.initials: IS
authors.lastname: Haldorsen
authors.forename: Anna
authors.initials: A
authors.lastname: Berg
authors.forename: Henrica M J
authors.initials: HM
authors.lastname: Werner
authors.forename: Inger J
authors.initials: IJ
authors.lastname: Magnussen
authors.forename: Harald
authors.initials: H
authors.lastname: Helland
authors.forename: Oyvind O
authors.initials: OO
authors.lastname: Salvesen
authors.forename: Jone
authors.initials: J
authors.lastname: Trovik
authors.forename: Helga B
authors.initials: HB
authors.lastname: Salvesen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology*; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D011300:Preoperative Care; D012680:Sensitivity and Specificity