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

Abstract

To determine if, in a patient with an endometrial cancer, in addition to the knowledge of tumor grade, preoperative magnetic resonance (MR) imaging findings contribute to treatment stratification and specialist referral. By using a MEDLINE literature search and institutional pathology reports, pretest probabilities for myometrial invasion were correlated with tumor grade. Likelihood ratios (LRs) were obtained through summary receiver operating characteristics. The mean pretest probabilities of deep myometrial invasion were derived from seven articles (1,875 patients) and from 125 institutional pathology reports. LRs for the prediction of myometrial invasion with contrast-enhanced MR imaging were derived from nine studies (742 patients); positive and negative LRs were 10.11 and 0.1, respectively. The mean weighted pretest probabilities of deep myometrial invasion in patients with tumor grades 1, 2, or 3 were 13%, 35%, or 54%, respectively. Posttest probabilities of deep myometrial invasion for grades 1, 2, or 3 increased to 60%, 84%, or 92%, respectively, for positive and decreased to 1%, 5%, or 10%, respectively, for negative MR imaging findings. Use of contrast-enhanced MR imaging significantly affects the posttest probability of deep myometrial invasion in patients with all grades of endometrial cancer and could be used to select patients for specialist referral.