MRI May Help Predict Endometrial Cancer Prognosis

MRI may be useful as a prognostic indicator in patients with endometrial cancer (EC), evaluating recurrence-free survival, according to a study presented at RSNA 2016.

Researchers from Texas performed a retrospective study to evaluate MRI characteristics of EC and correlate with pathology, genomic features, and recurrence-free survival. Three radiologists evaluated images from 71 patients with biopsy-proven EC. They recorded the depth of myometrial invasion (DMI) as less than 50% and equal to or more than 50%. Qualitative signal intensity (SI) was recorded as greater than myometrium, equal to myometrium, and less than myometrium on sagittal T2WI and DCE sequences, graded 1-3. Regions of interest (ROI) were drawn on tumor on sagittal T2WI and DCE sequences at 30 seconds (early) and 90 seconds (delayed). Chart review identified the presence of microsatellite instability (MSI) (genomic marker) and grade/sub-type of EC.

Twelve patients were lost to follow-up, and recurrence-free survival analysis was performed on 59 patients. The results showed a statistically significant correlation between lower delayed DCE SI and the presence of MSI. The three readers showed substantial agreement (0.62) based on Kappa analysis for qualitative tumor SI on DCE images. Tumors with SI greater than myometrium on T2WI showed higher DMI.

The patients with delayed DCE SI ROI of greater than 209, had better recurrence-free survival and patients with MSI-stable disease and increased delayed DCE SI had better recurrence-free survival. No correlation between MRI SI and tumor sub-type or grade was found.

The researchers concluded that patients with MSI-stable EC showing high SI on delayed DCE had better recurrence-free survival. Tumors with high T2WI SI demonstrated aggressive features on pathology.