title: Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology.
abstract: OBJECTIVE
  To report discriminant MRI features between cervical and endometrial carcinomas and to design an MRI- scoring system, with the potential to predict the origin of uterine cancer (cervix or endometrium) in histologically indeterminate cases.
  
  
  METHODS
  Dedicated pelvic MRIs of 77 patients with uterine tumors involving both cervix and corpus were retrospectively analyzed by two experts in female imaging. Seven MRI tumor characteristics were statistically tested for their discriminant ability for tumor origin compared to final histology: tumor location, perfusion pattern, rim enhancement, depth of myometrial invasion, cervical stromal integrity, intracavitary mass, and retained endometrial secretions. Kappa values were estimated to assess the levels of inter-rater reliability. On the basis of positive likelihood ratio values, an MRI-score was assigned.
  
  
  RESULTS
  K value was excellent for most of the imaging criteria. Using ROC curve analysis, the estimated optimal cut-off for the MRI-scoring system was 4 with 96.6% sensitivity and 100% specificity. Using a ≥4 cut-off for cervical cancers and <4 for endometrial cancers, 97.4% of the patients were correctly classified. 2/58 patients with cervical cancer had MRI score <4 and none of the patients with endometrial cancer had MRI score >4. The area under curve of the MRI-scoring system was 0.99 (95% CI 0.98-1.00). When the MRI-score was applied to 20/77 patients with indeterminate initial biopsy and to 5/26 surgically treated patients with erroneous pre-op histology, all cases were correctly classified.
  
  
  CONCLUSIONS
  The produced MRI-scoring system may be a reliable problem-solving tool for the differential diagnosis of cervical vs. endometrial cancer in cases of equivocal histology.
authors: Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vassilisis Sofias Ave., 11528, Athens, Greece. charisbourgioti@yahoo.com.
authors: Charis
authors: C
authors: Bourgioti
authors: Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vassilisis Sofias Ave., 11528, Athens, Greece. kchatoupis@yahoo.gr.
authors: Konstantinos
authors: K
authors: Chatoupis
authors: Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vassilisis Sofias Ave., 11528, Athens, Greece. epanourgias@yahoo.com.
authors: Evangelia
authors: E
authors: Panourgias
authors: Department of Health, Epidemiology and Medical Statistics, Medical School, University of Athens, 25 Alexandroupoleos Str., 11527, Athens, Greece. htzavara@med.uoa.gr.
authors: Chara
authors: C
authors: Tzavara
authors: Radiation Oncology Department, Alexandra Hospital, 80 Vassilisis Sofias Ave, 11528, Athens, Greece. kyrilliss@yahoo.com.
authors: Kyrillos
authors: K
authors: Sarris
authors: Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, University of Athens, 80 Vassilisis Sofias Ave., 11528, Athens, Greece. rodolaki@hol.gr.
authors: Alexandros
authors: A
authors: Rodolakis
authors: Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vassilisis Sofias Ave., 11528, Athens, Greece. lia.angela1312@gmail.com.
authors: Lia Angela
authors: LA
authors: Moulopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000473:pathology; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000473:pathology*; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010865:Pilot Projects; D012372:ROC Curve; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014594:Uterine Neoplasms
keywords: Cancer; Cervix uteri; Endometrium; Immunohistochemistry; Magnetic resonance imaging