Prediction of deep myometrial invasion in patients with endometrial cancer: Clinical utility of contrast-enhanced MR imaging - A meta-analysis and Bayesian analysis

PURPOSE: To determine if, in a patient with an endometrial cancer, in addit ion to the knowledge of tumor grade, preoperative magnetic resonance (MR) i maging findings contribute to treatment stratification and specialist refer ral. MATERIALS AND METHODS: By using a MEDLINE literature search and institution al pathology reports, pretest probabilities for myometrial invasion were co rrelated with tumor grade. Likelihood ratios (LRs) were obtained through su mmary receiver operating characteristics. RESULTS: The mean pretest probabilities of deep myometrial invasion were de rived from seven articles (1,875 patients) and from 125 institutional patho logy reports. LRs for the prediction of myometrial invasion with contrast-e nhanced MR imaging were derived from nine studies (742 patients); positive and negative LRs were 10.11 and 0.1, respectively. The mean weighted pretes t probabilities of deep myometrial invasion in patients with tumor grades 1 , 2, or 3 were 13%, 35%, or 54%, respectively. Posttest probabilities of de ep myometrial invasion for grades 1, 2, or 3 increased to 60%, 840/0, or 92 %, respectively, for positive and decreased to 1%, 5%, or 10%, respectively , for negative MR imaging findings. CONCLUSION: Use of contrast-enhanced MR imaging significantly affects the p osttest probability of deep myometrial invasion in patients with all grades of endometrial cancer and could be used to select patients for specialist referral.