title: Preoperative local staging of endometrial cancer: the challenge of imaging techniques and serum biomarkers.
abstract: The aim of this study is to prospectively evaluate and compare the accuracy of high-frequency TVS and of two type of MRI (dynamic contrast-enhanced MRI or diffusion-weighted MRI), in association with HE4 in preoperative endometrial cancer (EC) staging.
  
  
  
  Starting from January 2012 to February 2015, all patients with EC at prior endometrial biopsy, referred to the Division of Gynaecologic Oncology of the University Campus Bio-Medico of Rome, were prospectively included in the study. All of them underwent complete surgical staging hysterectomy and bilateral oophorectomy, pelvic and lumboaortic lymphadenectomy, according to 2011 NCCN guidelines. The day before surgery, patients underwent to transvaginal ultrasonography (TVS), HE4 serum dosage, and using a computer-based random procedure, to dynamic contrast-enhanced MRI (Group A) or to diffusion-weighted MRI (Group B), to assess myometrial invasion and cervical involvement.
  
  
  
  Starting from January 2012 to February 2015, a total of 79 patients were considered for the analysis and randomly divided into Group A (n = 38) and Group B (n = 41). Regarding myometrial invasion, MRI and TVS resulted comparable in terms of preoperative detection. Concerning the cervical infiltration, the association between TVS and HE4 is characterized by a better preoperative diagnostic validity (TVS + HE4 96.3 vs. 91 % for MRI and 85 % for the TVS).
  
  
  
  Our results, even the low number of enrolled patients, are promising and may lead to a greater efficiency and lower health care costs in identifying those women who require radical surgery and pelvic lymphadenectomy and should be addressed, in specialized centers.
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Plotti
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy. s.capriglione@unicampus.it.
authors.forename: Stella
authors.initials: S
authors.lastname: Capriglione
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaletta
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Nella
authors.initials: N
authors.lastname: Dugo
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Aloisi
authors.affiliation: Unit of Radiology, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128, Rome, Italy.
authors.forename: Claudia Lucia
authors.initials: CL
authors.lastname: Piccolo
authors.affiliation: Unit of Radiology, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Del Vescovo
authors.affiliation: Department of Obstetrics and Gynecology, Campus Bio Medico Universiy of Rome, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Terranova
authors.affiliation: Unit of Radiology, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128, Rome, Italy.
authors.forename: Bruno Beomonte
authors.initials: BB
authors.lastname: Zobel
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D016889:Endometrial Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging
chemical_list: D014408:Biomarkers, Tumor
keywords: Endometrial cancer; HE4; Magnetic resonance; Preoperative staging; Ultrasound