title: MRI is highly specific in determining primary cervical versus endometrial cancer when biopsy results are inconclusive.
abstract: OBJECTIVE
  To evaluate utility of magnetic resonance imaging (MRI) in determining the primary site of endometrial versus cervical tumours when the biopsy results are inconclusive.
  
  
  METHODS
  Forty-eight patients who underwent a total hysterectomy for unknown primary adenocarcinoma of the uterus after endometrial and/or endocervical biopsies were included in the study. The 48 available pelvic MRI images were reviewed by two body radiologists independently and jointly to resolve discordance, blinded to any clinical and pathological information. The clinical information and histopathology were reviewed by a radiology fellow and a pathologist specializing is gynaecological oncology. The final surgical pathology was used as the reference standard to confirm the origin of the primary tumour.
  
  
  RESULTS
  The radiologists correctly identified the primary sites in 85% of the cases (41/48). There was substantial agreement between the two readers (kappa statistics = 0.79). Both radiologists found that T2 and dynamic T1-weighted images (WI) were most helpful in making the diagnosis, and dynamic T1WI helped resolve problematic cases. The sensitivity and specificity for detecting endometrial and cervical cancer on MRI were 88% and 88% and 75% and 93%, respectively.
  
  
  CONCLUSIONS
  MRI has high sensitivity and specificity in determining the origin of the primary endometrial versus cervical tumours when endometrial/endocervical curettage is inconclusive.
authors.affiliation: Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: H
authors.initials: H
authors.lastname: He
authors.forename: P
authors.initials: P
authors.lastname: Bhosale
authors.forename: W
authors.initials: W
authors.lastname: Wei
authors.forename: P
authors.initials: P
authors.lastname: Ramalingam
authors.forename: R
authors.initials: R
authors.lastname: Iyer
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004717:Endometrium / Q000473:pathology*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007044:Hysterectomy; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA