AUTHOR=Cui Tingting , Shi Feng , Gu Bei , Jin Yanfang , Guo Jinsong , Zhang Chao , Ren Jie , Yue Yunlong 

TITLE=Peritumoral Enhancement for the Evaluation of Myometrial Invasion in Low-Risk Endometrial Carcinoma on Dynamic Contrast-Enhanced MRI

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.793709

DOI=10.3389/fonc.2021.793709

ISSN=2234-943X

ABSTRACT=Objectives: To explore the clinical value of subendometrial enhancement (SEE), irregular thin-layered peritumoral early enhancement (ITLPE) and focal irregular peritumoral early enhancement (FIPE) on dynamic contrast-enhanced MRI (DCE-MRI) for myometrial invasion in low-risk endometrial carcinoma.
Methods: Seventy-seven patients with low-risk endometrial carcinoma who preoperatively underwent  DCE-MRI were included. Two radiologists independently evaluated and recorded occurrences of SEE, 
ITLPE and FIPE on DCE-MRI for all patients. Calculate interobserver agreement between the two radiologists and analyse the relationship between SEE, ITLPE, FIPE and myometrial invasion based on histological findings. For those with statistical significance, the sensitivity and specificity were calculated and the differences in evaluation of myometrial invasion were analyzed. For those with no statistical significance, the images were compared with the pathologic sections.
Results: Inter-observer agreement was good (k=0.80; 95% CI, 0.577-0.955 ) for SEE, very good (k=0.88; 95% CI, 0.761-0.972) (k=0.86; 95% CI, 0.739-0.973) for ITLPE and FIPE. After consensus, SEE was identified in 12/77 (15.6%) patients; ITLPE and FIPE were found in 53/77 (68.8%) and 30/77 (39.0%) patients, respectively. SEE, ITLPE and myometrial infiltration were significantly correlated (P=0.000), but not FIPE (P=0.725). The sensitivity and specificity of SEE and ITLPE for myometrial invasion in low-risk endometrial carcinoma were 95.0%, 52.9% and 85.0%, 88.0%, respectively. The AUC values of SEE and ITLPE for myometrial invasion were 0.740 (95% CI, 0.584-0.896), 0.866 (95% CI, 0.763-0.970) , respectively. The sensitivity and specificity presented with statistical differences between SEE and ITLPE for the evaluation of myometrial invasion (P=0.031, 0.016). According to the comparison between FIPE and pathologic findings, the irregular endomyometrial junction can be found in 30/77 (38.9%) cases, 24/30(80.0%)with myometrial infiltration, 6/30 (20.0%) cases without myometrial infiltration.
Conclusions: FIPE was the irregular endomyometrial junction and can be found in patients with or without myometrial infiltration and may lead to the overestimation of myometrial invasion by using SEE on DCE-MRI. ITLPE presented high diagnostic performance and specificity for myometrial invasion in low-risk endometrial carcinoma.