The Value Of Magnetic Resonance Imaging In Preoperative Diagnosis Of Endometrial Cancer

Objective: To investigate the clinical value of magnetic resonance imaging(MRI)in preoperative evaluation of eendometrial cancer.Materials and methods: A total of 173 patients with stage I-IV of endometrial cancer were included in the first affiliated Hospital of Guangxi Medical University from 2012 to December 31,2019.All patients underwent pelvic MRI scan within 1 month before operation.The data were analyzed by SPSS22.0software.Take the postoperative pathological results as the reference standard,and calculated the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of all diagnostic results of MRI.The Kappa test was carried out.Draw the receiver operating characteristic curve(ROC curve),and calculate the AUC value of the area under the curve.Results: 1.The diagnostic accuracy of preoperative pelvic MRI in stage IA,IB and stage II-IV was 75.7%,82.1%,88.4%,84.4% and 99.4%.The sensitivity and specificity were 72.3%,72.7%,62.5%,27.6%,50% and 82%,83.4%,89.7%,95.8% and 100%,respectively.The value of Kappa analysis was 0.415(P<0.05).2.The sensitivity of pelvic MRI in diagnosing without myometrial invasion,superficial myometrial invasion and deep myometrial invasion of endometrial cancer was 73.3%,70.25% and 86.4% respectively,The specificity was 89.2%,86.45% and 85.3%,the positive predictive value was 39.3%,90.9% and 66.7%,the negative predictive value was 97.2%,60% and 94.8%,and the accuracy was87.9%,75.7% and 85.5%,respectively.The area under the ROC curve with deep myometrial invasion was 0.863.The Kappa value of consistency test was0.551(P< 0.05).3.The accuracy,sensitivity and specificity of MRI in the diagnosis of cervical involvement were 87.3%,60%,89.2%,respectively,PPV and NPV were 34.6%,95.9%.The value of AUC was 0.746,and the value of Kappa analysis was 0.370(P<0.05).4.The sensitivity,specificity of MRI for lymph node metastasis were26.1%,96.7%,PPV and PPV were 54.5%,89.5%,the accuracy was 87.3%.The AUC value was 0.614,and the value of Kappa analysis was 0.292,(P<0.05).5.The sensitivity,specificity of MRI in the diagnosis of ovarian metastasis were 66.7%,100%,PPV and PPV were 100%,99.4%,the accuracy was 99.4%.The AUC value was 0.833,and the value of Kappa analysis was 0.797,(P<0.05).Postoperative pathological results showed that there was only one case of rectal lacunar metastasis,while three cases of rectal lacunar metastasis were detected by MRI,and two cases were misdiagnosed.MRI could not detect the fallopian tube metastasis,parametrial invasion,Intraperitoneal metastasis and and other distant metastases.Conclusion: The diagnostic performance of MRI is high in the diagnosis of endometrial cancer muscular invasion,and it is more valuable in the diagnosis of deep muscular invasion.The diagnostic value of MRI for cervical involvement is medium,but the specificity and PPV are high,which is more valuable in excluding cervical involvement.The diagnostic accuracy of MRI for ovarian metastasis is high,but there is a certain rate of missed diagnosis.The diagnostic value of other extrauterine metastasis except ovarian metastasis is very low.MRI has limited diagnostic value for lymph node metastasis,with low sensitivity and high false negative rate.It is easy to miss patients with potential lymph node metastasis and affect the treatment and prognosis of patients.Therefore,MRI should be combined with other examinations to evaluate lymph node metastasis when evaluating the preoperative staging of endometrial cancer.MRI examination can not replace surgical pathological staging.