title: MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer - a multicenter prospective comparative study.
abstract: OBJECTIVE
  The aim of this prospective multicenter study was to evaluate and compare the diagnostic performance of PET/CT, MRI and transvaginal two-dimensional ultrasound (2DUS) in the preoperative assessment of endometrial cancer (EC).
  
  
  METHODS
  318 consecutive women with EC were included when referred to three Danish tertiary gynecological centers for surgical treatment. Preoperatively they were PET/CT-, MRI-, and 2DUS scanned. The imaging results were compared to the final pathological findings. This study was approved by the National Committee on Health Research Ethics.
  
  
  RESULTS
  For predicting myometrial invasion, we found sensitivity, specificity, PPV, NPV, and accuracy for PET/CT to be 93%, 49%, 41%, 95% and 61%, for MRI to be 87%, 57%, 44%, 92%, and 66% and for 2DUS to be 71%, 72%, 51%, 86% and 72%. For predicting cervical invasion, the values were 43%, 94%, 69%, 85% and 83%, respectively, for PET/CT, 33%, 95%, 60%, 85%, and 82%, respectively, for MRI, and 29%, 92%, 48%, 82% and 78% for 2DUS. Finally, for lymph node metastases, the values were 74%, 93%, 59%, 96%, and 91% for PET/CT and 59%, 93%, 40%, 97% and 90% for MRI. When comparing the diagnostic performance we found PET/CT, MRI and 2DUS to be comparable in predicting myometrial invasion. For cervical invasion and lymph node metastases, however, PET/CT was the best.
  
  
  CONCLUSIONS
  None of the modalities can yet replace surgical staging. However, they all contributed to important knowledge and were, furthermore, able to upstage low-risk patients who would not have been recommended lymph node resection based on histology and grade alone.
authors.affiliation: Gynecologic Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Sleisby@dadlnet.dk
authors.forename: Sofie Leisby
authors.initials: SL
authors.lastname: Antonsen
authors.forename: Lisa Neerup
authors.initials: LN
authors.lastname: Jensen
authors.forename: Annika
authors.initials: A
authors.lastname: Loft
authors.forename: Anne Kiil
authors.initials: AK
authors.lastname: Berthelsen
authors.forename: Junia
authors.initials: J
authors.lastname: Costa
authors.forename: Ann
authors.initials: A
authors.lastname: Tabor
authors.forename: Ingelise
authors.initials: I
authors.lastname: Qvist
authors.forename: Mette Rodi
authors.initials: MR
authors.lastname: Hansen
authors.forename: Rune
authors.initials: R
authors.lastname: Fisker
authors.forename: Erik Søgaard
authors.initials: ES
authors.lastname: Andersen
authors.forename: Lene
authors.initials: L
authors.lastname: Sperling
authors.forename: Anne Lerberg
authors.initials: AL
authors.lastname: Nielsen
authors.forename: Jon
authors.initials: J
authors.lastname: Asmussen
authors.forename: Estrid
authors.initials: E
authors.lastname: Høgdall
authors.forename: Carsten L
authors.initials: CL
authors.lastname: Fagö-Olsen
authors.forename: Ib Jarle
authors.initials: IJ
authors.lastname: Christensen
authors.forename: Lotte
authors.initials: L
authors.lastname: Nedergaard
authors.forename: Kirsten
authors.initials: K
authors.lastname: Jochumsen
authors.forename: Claus
authors.initials: C
authors.lastname: Høgdall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods; D014621:Vagina / Q000000981:diagnostic imaging