Radiologic staging in patients with endometrial cancer: A meta-analysis

PURPOSE: To apply a meta-analysis to compare the utility of computed tomogr aphy (CT), ultrasonography (US), acid magnetic resonance (MR) imaging in st aging endometrial cancer. MATERIALS AND METHODS: Data were obtained from a MEDLINE literature search and from manual reviews of article bibliographies. Articles were selected t hat included results in patients with proved endometrial cancer and imaging histopathologic correlation and that presented data that allowed calculati on of contingency tables. Data for the imaging evaluation of myometrial and cervical invasion were abstracted independently by two authors. Data on ye ar of publication, International Federation of Gynecology and Obstetrics (F IGO) stage distribution, and methodologic quality were also collected. A su bgroup analysis was performed to compare contrast medium-enhanced MR imagin g with nonenhanced MR imaging, US, and CT. RESULTS: Six studies met the inclusion criteria for CT; 16, for US; and 25, for MR imaging. Summary receiver operating characteristic analysis showed no significant differences in the overall performance of CT, US, and MR ima ging. In the assessment of myometrial invasion, however, contrast-enhanced MR imaging performed significantly better than did nonenhanced MR imaging o r US (P <.002) and demonstrated a trend toward better results, as compared with CT. The lack of data on the assessment of cervical invasion at CT or U S prevented meta-analytic comparison with data obtained at MR imaging. Resu lts were not influenced by year of publication, FIGO stage distribution, or methodologic quality. CONCLUSION: Although US, CT, or MR imaging can be used in the pretreatment evaluation of endometrial cancer, contrast-enhanced MR imaging offers "one- stop" examination with the highest efficacy.