title: Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology.
abstract: OBJECTIVE
  To investigate the added value of secondary reports issued by radiologists subspecializing in gynaecologic imaging for determining deep myometrial invasion of endometrial cancer on MRI.
  
  
  METHODS
  Initial (from referring institutions) and secondary (by subspecialized radiologists) interpretations of MRI of 55 patients with endometrial cancer were retrospectively reviewed. A radiologist blinded to clinicopathological information assessed both reports for the presence of deep myometrial invasion. Reference standard was based on hysterectomy specimens. Kappa coefficients (k) were used to measure their concordance. McNemar testing and receiver operating characteristic (ROC) analysis was used to compare sensitivities, specificities and areas under the curves (AUCs).
  
  
  RESULTS
  Deep myometrial invasion was present in 25 (45.5 %) patients. Among 27.3 % (15/55; k = 0.458) patients with discrepant results, secondary interpretations were correct in 10 (66.7 %) cases. Sensitivity was higher in secondary than in initial reports (76.0 % vs. 48.0 %, p = 0.039) while no significant difference was seen in specificity (70.0 % vs. 76.7 %, p = 0.668). At ROC analysis, there was a tendency for higher AUCs in secondary reports (0.785 vs 0.669, p = 0.096).
  
  
  CONCLUSIONS
  Secondary readings of MRI by subspecialized gynaecologic oncologic radiologists may provide incremental value in determining deep myometrial invasion of endometrial cancer.
  
  
  CONCLUSIONS
  • Deep myometrial invasion is an important prognostic factor in endometrial cancer. • Assessment of deep myometrial invasion is often discrepant between initial and secondary reports. • Secondary reports showed higher sensitivity and accuracy. • Secondary review of MRI may provide incremental value in endometrial cancer patients.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Sungmin
authors.initials: S
authors.lastname: Woo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. iwishluv@empas.com.|Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. iwishluv@empas.com.
authors.forename: Sang Youn
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.|Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 110-744, Korea.
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.|Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 110-744, Korea.
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006176:Gynecology / Q000592:standards; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D012372:ROC Curve; D000072177:Radiologists / Q000592:standards; D012017:Referral and Consultation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000473:pathology*
keywords: Deep myometrial invasion; Endometrial cancer; Gynaecologic oncologic imaging; Magnetic resonance imaging; Subspecialty