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Genitourinary Imaging |
1 From the Departments of Radiology (K.K., H.H., Y.K., K.K.Y., Y.L.), Biostatistics (M.R.S.), and Gynecologic Oncology (C.B.P.), University of California-San Francisco, Box 0628, 505 Parnassus Ave, San Francisco, CA 94143-0628. Received September 9, 1998; revision requested October 26; revision received November 25; accepted April 16, 1999. K.K. supported in part by a grant from the French Society of Radiology. K.K.Y. supported in part by a GE-AUR Radiology Research Associate Fellowship. Address reprint requests to H.H. (e-mail: Hedvig.Hricak@radiology.ucsf.edu).
PURPOSE: To apply a meta-analysis to compare the utility of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging in staging endometrial cancer.
MATERIALS AND METHODS: Data were obtained from a MEDLINE literature search and from manual reviews of article bibliographies. Articles were selected that included results in patients with proved endometrial cancer and imaging-histopathologic correlation and that presented data that allowed calculation of contingency tables. Data for the imaging evaluation of myometrial and cervical invasion were abstracted independently by two authors. Data on year of publication, International Federation of Gynecology and Obstetrics (FIGO) stage distribution, and methodologic quality were also collected. A subgroup analysis was performed to compare contrast medium–enhanced MR imaging with nonenhanced MR imaging, US, and CT.
RESULTS: Six studies met the inclusion criteria for CT; 16, for US; and 25, for MR imaging. Summary receiver operating characteristic analysis showed no significant differences in the overall performance of CT, US, and MR imaging. In the assessment of myometrial invasion, however, contrast-enhanced MR imaging performed significantly better than did nonenhanced MR imaging or US (P < .002) and demonstrated a trend toward better results, as compared with CT. The lack of data on the assessment of cervical invasion at CT or US prevented meta-analytic comparison with data obtained at MR imaging. Results were not influenced by year of publication, FIGO stage distribution, or methodologic quality.
CONCLUSION: Although US, CT, or MR imaging can be used in the pretreatment evaluation of endometrial cancer, contrast-enhanced MR imaging offers "one-stop" examination with the highest efficacy.
Index terms: Computed tomography (CT), comparative studies, 854.12111 • Lymphatic system, neoplasms, 99.33 • Magnetic resonance (MR), comparative studies, 854.1214 • Pelvic organs, CT, 854.12111 • Pelvic organs, MR, 854.1214, 854.12143 • Pelvic organs, US, 854.1298 • Ultrasound (US), comparative studies, 854.1298 • Uterine neoplasms, 854.32 • Uterus, endometrium, 854.32
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