Comparing the efficacy of imaging techniques in detecting myometrial invasion, cervicalinvolvement and pelvic lymph-nodal metastasis in endometrial cancer

Aim: To compare sensitivity, specificity, positive predictive and negative predictive value of
preoperative imaging techniques for detecting myometrial invasion, cervix involvement, and alsopelvic
lymph nodal metastasis in endometrial cancer
Materials and Methods: The medical records of patients who underwent an operation for endometrial
cancer in the years between 2005 and 2017 were collected from the database at our institution.
Preoperative imaging reports of 252 ultrasonography (USG), 89 computerized tomographies (CT),147 
magnetic resonance imaging (MRI) of patients with endometrial cancer, and postoperative pathologic
reports were collected and compared.
Results: In our study 252 ultrasonography (USG), 89 computerized tomography (CT), 147 magnetic
resonance imaging (MRI) examinations were evaluated. Among deep myometrial invasion; all imaging 
modalities have low specificities (respectively 26.7%, 37.9%, and 32.4%) but higher sensitivities
(respectively 68.5%, 79.1%, and 89.4%). To rule out cervical invasion all modalities have high and
comparable sensitivities (respectively 98.3%, 95.0%, and 87.0%). On the other hand, USG has
superiority to detect cervical invasion over CT and MRI (respectively 71.4%, 15.4%, and 22.7%). CT 
has much highersensitivity than MRI for detection of pelvic lymph node metastasis (87.5% vs 53.1%).
Conclusion: Preoperative imaging modalities have high sensitivities for deep myometrial invasion, but 
low detection rates for cervical involvement and pelvic lymph node metastasis. MRI should be the
preferred modality for myometrial invasion, on the other hand, The USG is much better to detect
cervical involvement. CT has superiority on other imaging modalities among lymph node metastasis.