The Value of US and MRI in Diagnosing Endometrial Cancer and in the Evaluation of its Spread

Aim of the review: To select and analyze scientific publications of US and MRI in diagnosing endometrial cancer and in the evaluation of its spread and determine value of US and MRI. Objectives: 1. To evaluate the diagnostic parameters (accuracy, sensitivity, specificity) of MRI in diagnosing the spread of endometrial cancer. 2. To evaluate the diagnostic parameters of US in diagnosing the local spread of endometrial cancer in myometrium and compare the diagnostic parameters of the different US approaches. 3. To compare the diagnostic parameters of TV-US and MRI in diagnosing the spread of endometrial cancer in myometrium. 4. To evaluate the correlation of MRI parameters (ADC value, tumor volume, tumor vasculature, N/U ratio) with histologic grade of endometrial cancer. Methods: Publications for systematic literature review were searched in PubMed database. Keywords “endometrial cancer” OR “endometrial neoplasms” AND “preoperative staging” OR “MRI” OR “Ultrasound” OR „ADC value“ were used. Articles from 2009 to 2019 were included. Additional criteria were used for the articles: more than 20 patients in the study, patients with diagnosed endometrial cancer included in the study and the spread and aggressiveness of endometrial cancer was evaluated using US and MRI, accuracy of diagnostic methods were evaluated in study. Results: 21 articles were included in systematic literature review after three selection phases. Conclusions: 1. MRI has quite high accuracy, is quite sensitive and specific in the evaluation of the endometrial cancer invasion in myometrium, but sensitivity is quite low and specificity and accuracy are high in the evaluation of neoplasm spread in cervix and regional lymph nodes. 2. US is quite sensitive, specific and accurate method in the evaluation of endometrial cancer spread in myometrium. The subjective approaches is more sensitive than objective ones, but specificity and accuracy is not statistically significantly different. 3. According to many studies, MRI is more accurate, sensitive and specific than TV-US in the evaluation of endometrial cancer invasion in myometrium. 4. Using ADC mean value of MRI-DWI normal endometrium and neoplasm can be differentiated. Standard deviation, quartiles, 75, 90, 95 percentiles of ADC value can be useful in evaluating histologic grade of endometrial cancer. Other MRI parameters – maximal tumor diameter, N/U ratio, tumor volume, blood flow rate (Fb), contrast intravasation constant (k ep), tumor entropy of ADC map, mean of positive pixels can be useful in diagnosing of tumor spread and histologic grade, but more research is needed