J Gynecol Oncol.  2016 Jul;27(4):e38. 10.3802/jgo.2016.27.e38.

Long-term outcomes of magnetic resonance imaging-invisible endometrial cancer

• Choi HJ
• Lee S
• Park BK
• Kim TJ
• Kim CK
• Park JJ
• Choi CH
• Lee YY
• Lee JW
• Bae DS
• Kim BG

• KMID: 2374240
• DOI: http://doi.org/10.3802/jgo.2016.27.e38

Abstract

OBJECTIVE
Magnetic resonance imaging (MRI) is useful for staging endometrial cancer. The treatment and prognosis of MRI-invisible endometrial cancer remain unclear. The purpose of this study was to retrospectively evaluate the long-term outcomes of patients with MRI-invisible endometrial cancer.
METHODS
Between February 1995 and December 2011, we reviewed the medical records of 433 patients with endometrial cancer, which was staged IA on MRI. Of these patients, 89 had MRI-invisible cancer and 344 had MRI-visible cancer. Both cancers were treated with simple hysterectomy with or without lymph node dissection according to the surgeon's decision. Both cancers were compared regarding pathologic findings, recurrence rates, and survival rates.
RESULTS
The median sizes of MRI-invisible and MRI-visible cancers were 4 mm (0 to 40 mm) and 20 mm (0 to 89 mm), respectively (p<0.001). Myometrial invasion of these groups were detected in 20.2% (18/89) and 56.7% (195/344), respectively (p<0.001). Lymphadenectomy and follow-up imaging revealed no lymph node metastasis in patients with MRI-invisible cancers, while those revealed in 4.7% (16/344) of patients with MRI-visible cancers (p=0.052). The recurrence rates of MRI-invisible and MRI-visible cancers were 1.1% (1/89) and 7.8% (27/344), respectively (p=0.026). The recurrence-free survival rates of these groups were 98.9% (88/89) and 91.6% (315/344), respectively (p=0.022).
CONCLUSION
MRI-invisible endometrial cancer can be treated with less invasive surgery because of its lower tumor burden and better prognosis. This cancer may not require lymphadenectomy because of no metastasis or recurrence in lymph nodes.

Keyword

Endometrial Neoplasms; Lymph Nodes; Magnetic Resonance Imaging; Outcome; Stage

MeSH Terms

Adult
Aged
Aged, 80 and over
Endometrial Neoplasms/diagnostic imaging/*pathology
Female
Humans
Lymphatic Metastasis
*Magnetic Resonance Imaging
Middle Aged
Retrospective Studies