title: Preoperative tumor size at MRI predicts deep myometrial invasion, lymph node metastases, and patient outcome in endometrial carcinomas.
abstract: OBJECTIVE
  The aim of this study was to explore the relation between preoperative tumor size based on magnetic resonance imaging (MRI) and the surgical pathologic staging parameters (deep myometrial invasion, cervical stroma invasion, and metastatic lymph nodes) and to assess the prognostic impact of tumor size in endometrial carcinomas. Interobserver variability for the different tumor size measurements was also assessed.
  
  
  METHODS
  Preoperative pelvic MRI of 212 patients with histologically confirmed endometrial carcinomas was read independently by 3 radiologists. Maximum tumor diameters were measured in 3 orthogonal planes (anteroposterior, transverse, and craniocaudal planes [CC]), and tumor volumes were estimated. Tumor size was analyzed in relation to surgical staging results and patient survival. The multivariate analyses were adjusted for preoperative risk status based on endometrial biopsy. Intraclass correlation coefficients and receiver operating characteristics curves for the different tumor measurements were also calculated.
  
  
  RESULTS
  Anteroposterior tumor diameter independently predicted deep myometrial invasion (P < 0.001), whereas CC tumor diameter tended to independently predict lymph node metastases (P = 0.06). Based on receiver operating characteristic curves, the following tumor size cutoff values were identified: anteroposterior diameter greater than 2 cm predicted deep myometrial invasion (unadjusted odds ratio [OR], 12.4; P < 0.001; adjusted OR, 6.7; P < 0.001) and CC diameter greater than 4 cm predicted lymph node metastases (unadjusted OR, 6.2; P < 0.001; adjusted OR, 4.9; P = 0.009). Large tumor size was associated with reduced progression/recurrence-free survival (P ≤ 0.005 for all size parameters), and CC diameter had an independent impact on survival (adjusted hazards ratio, 1.04; P = 0.009). The interobserver variability for the different size measurements was very low (intraclass correlation coefficient, 0.78-0.85).
  
  
  CONCLUSIONS
  Anteroposterior tumor diameter greater than 2 cm predicts deep myometrial invasion, and CC tumor diameter greater than 4 cm predicts lymph node metastases. Tumor size is a strong prognostic factor in endometrial carcinomas. Preoperative tumor measurements based on MRI may potentially improve preoperative risk stratification models and thus enable better tailored surgical treatment in endometrial cancer.
authors: *Department of Radiology, Haukeland University Hospital; †Section for Radiology, Department of Clinical Medicine, University of Bergen; ‡Department of Obstetrics and Gynecology, Haukeland University Hospital; §Center for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen; ∥Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim; ¶Center for Cancer Biomarkers, the Gade Institute, Department of Clinical Medicine, University of Bergen; and #Department of Pathology, Haukeland University Hospital, Bergen, Norway.
authors: Sigmund
authors: S
authors: Ytre-Hauge
authors: Jenny A
authors: JA
authors: Husby
authors: Inger J
authors: IJ
authors: Magnussen
authors: Henrica M J
authors: HM
authors: Werner
authors: Øyvind O
authors: ØO
authors: Salvesen
authors: Line
authors: L
authors: Bjørge
authors: Jone
authors: J
authors: Trovik
authors: Ingunn M
authors: IM
authors: Stefansson
authors: Helga B
authors: HB
authors: Salvesen
authors: Ingfrid S
authors: IS
authors: Haldorsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary; D018450:Disease Progression; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009215:Myometrium; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015996:Survival Rate; D047368:Tumor Burden
references: Clin Radiol. 2012 Jan;67(1):2-12
references: 22119292
references: Eur Radiol. 2013 Oct;23(10):2916-25
references: 23732687
references: Gynecol Oncol. 2013 Nov;131(2):410-5
references: 24004646
references: Gynecol Oncol. 2013 Nov;131(2):294-8
references: 23954595
references: Clin Cancer Res. 2011 Jul 15;17(14):4825-33
references: 21616994
references: Gynecol Oncol. 2013 Jun;129(3):472-7
references: 23474346
references: Gynecol Oncol. 2012 Apr;125(1):103-8
references: 22100838
references: Br J Cancer. 2014 Jan 7;110(1):107-14
references: 24178757
references: Radiology. 2013 Mar;266(3):717-40
references: 23431227
references: Lancet. 2005 Aug 6-12;366(9484):491-505
references: 16084259
references: Cancer. 1991 Jun 1;67(11):2791-4
references: 2025843
references: Eur Radiol. 2009 Jul;19(7):1565-74
references: 19194709
references: Int J Gynaecol Obstet. 2009 May;105(2):103-4
references: 19367689
references: Int J Gynecol Cancer. 2013 May;23(4):690-7
references: 23518862
references: Cancer. 1987 Oct 15;60(8 Suppl):2035-41
references: 3652025
references: Ann Surg Oncol. 2009 Oct;16(10):2882-7
references: 19484311
references: Gynecol Oncol. 2002 Dec;87(3):274-80
references: 12468325
references: J Magn Reson Imaging. 2001 Jun;13(6):850-5
references: 11382943
references: Eur Radiol. 2012 Jul;22(7):1601-11
references: 22453859
references: Ann Oncol. 2013 Oct;24 Suppl 6:vi33-8
references: 24078661
references: Gynecol Oncol. 2005 Dec;99(3):564-70
references: 16246402
references: J Clin Oncol. 2012 Apr 20;30(12):1329-34
references: 22412131
references: J Gynecol Oncol. 2012 Oct;23(4):251-6
references: 23094128
references: Eur J Cancer. 2013 Nov;49(16):3431-41
references: 23932335
references: Lancet Oncol. 2012 Aug;13(8):e353-61
references: 22846840