Preoperative imaging of uterine malignancy: A low-value service.
OBJECTIVE
The aim of this study is to examine the value of computed tomography (CT) or magnetic resonance imaging (MRI) before surgical treatment of uterine malignancy.


METHODS
Retrospective chart review was undertaken of women who underwent hysterectomy for uterine cancer at the University of Virginia. Radiologic reports were examined for evidence of cervical or extrauterine disease or incidental findings and correlated with detection of extrauterine disease at surgery.


RESULTS
Overall, 204 of 448 patients (45%) had preoperative imaging. Scans were ordered nearly evenly by referring clinicians and gynecologic oncologists (GO) (95 vs. 122, 44% vs. 56%). Imaging was most common among patients with grade 3 endometrioid or non-endometrioid histology (86 of 101, 85%). Women referred with low grade disease had more false positive (4 of 112, 4%) than true positive scans (2 of 113, 2%). Overall, 23 of 190 (12%) reviewed preoperative scans indicated suspected extrauterine disease. Two of these 23 women were low risk by intra-operative "Mayo criteria" and had stage 1A disease; 14 of 23 (61%) had stage II or greater disease.


CONCLUSIONS
Preoperative CT or MRI is of low value in predicting extra-uterine disease among uterine cancer patients with low grade disease. Women with low grade disease had false positive results more frequently than true detection of extrauterine disease. Abnormal imaging findings are more common and predictive of extrauterine disease in women with grade 3 or non-endometrioid histology but the value of these scans remains unclear.
Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA, United States; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States. Electronic address: wdbaker@virginia.edu.
William
W
Baker
Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA, United States; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States.
Elizabeth
E
Pelkofski
Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA, United States; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States.
Jonas
J
Te Paske
Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA, United States; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States.
Sarah
S
Erickson
Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA, United States; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States.
Linda
L
Duska
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
Health care delivery outcomes; Imaging; Minimally invasive surgery; Uterine cancer