Preoperative evaluation of myometrial invasion in endometrial carcinoma bymagnetic resonance imaging (MRI) and hysteroscopy: diagnostic efficacy of MRI combined with hysteroscopy

Objective To evaluate the preoperative diagnostic usefulness of magnetic re sonance imaging (MRI) combined with hysteroscopy, for the assessment of myo metrial invasion in endometrial carcinoma. Design Prospective observational study. Setting Department of Obstetrics and Gynaecology, The Ryukyu University Hos pital, Okinawa, Japan. Subjects 73 patients with untreated endometrial carcinoma. Interventions The findings of myometrial tumour invasion preoperatively obs erved by MRI and hysteroscopy were compared with the histopathological find ings from surgical specimens. Main outcome measures The sensitivity and specificity of MRI combined with hysteroscopy in diagnosing myometrial tumour invasion. Results In diagnosing myometrial tumour invasion (absence or presence of my ometrial invasion), the sensitivities and specificities were 82.0% and 100% in MRI, 80.0% and 95.7% in hysteroscopy, and 92.0% and 95.7% in MRI combin ed with hysteroscopy. The sensitivity in MRI combined with hysteroscopy was significantly higher with a false-negative rate of only 8.0%, than that of the other two methods (P=0.025; P=0.014). The differences in specificity w ere not statistically significant among these three methods (P>0.05). MRI h ad a 87.8% accuracy in assessing the depth of myometrial invasion. Conclusion These results indicate that MRI combined with hysteroscopy is an excellent diagnostic approach, superior to MRI or hysteroscopy alone, for the evaluation of myometrial tumour invasion, because MRI and hysteroscopy combined can compensate for the disadvantage or defect in each diagnostic p rocedure.