Utility of Pelvic MRI and Tumor Markers HE4 and CA125 to Predict Depth of Myometrial Invasion and Cervical Involvement in Endometrial Cancer
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Abstract
Objective: The purpose of this pilot study was to determine whether the MRI and biomarkers human epididymis protein 4 (HE4) and CA125 correlate with depth of myometrial invasion, histologic grade, cervical involvement and nodal metastases in patients with endometrioid adenocarcinoma of the uterus.
Materials and methods: This was a prospective, observational study in women with biopsy-proven endometrial adenocarcinoma of the uterus. Preoperative pelvic MRI was performed and concentration of HE4 and CA125 were assessed before surgery. All surgical specimens were reviewed by a single expert pathologist. The results were compared with the final histopathology report of surgical staging.
Results: Included were a total of 68 women with endometrioid adenocarcinoma of the uterus, most (76%) with stage I disease. Levels of serum HE4 greater than 140PM and CA125 greater than 35 ku/L were observed in 12 (17%) and 26 (38.2%) of patients respectively whose greater proportion were cases with deep myometrial invasion and high grade tumor. In the evaluation of deep tumoral invasion (> 50%) of the myometrium sensitivity, specificity, and diagnostic accuracy of MRI were 68.9%, 94.8% and 83.8% respectively. For lymph node involvement these values were 50%, 95.1% and 91.1% respectively and for cervical stromal involvement were 64.3%, 98.1% and 91.1% respectively.
Conclusion: Higher stage, deep myometrial invasion, and lymph node or cervical stromal involvement increase diagnostic accuracy of MRI. Higher levels of HE4 and CA125 were observed in patients with deep myometrial invasion and higher grade of tumor.
American Cancer Society. Cancer facts & figures 2010, Atlanta, Ga, 2010:1-62.
SoroskyJI.Endometrial cancer.ObstetGynecol 2008;111:436-47.
Frederick PJ, Straughn JM Jr. The role of comprehensive surgical staging in patients with endometrial cancer. Cancer Control 2009;16:23-9.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin Clinical management guidelines for obstetrician-gynecologists management of endometrial cancer. ManagEndomet Cancer 2005; 65:1–13.
Aalders JG, Thomas G. Endometrial cancer--revisiting the importance of pelvic and para aortic lymph nodes. GynecolOncol 2007; 104: 222-31.
Loeb S, Partin AW, Schaeffer EM. Complications of
Pelvic Lymphadenectomy: Do the Risks Outweigh the Benefits? Rev Urol 2010; 12: 20–4.
Mohan DS, Samuels MA, Selim MA, Shalodi AD, Ellis RJ, Samuels JR, Et al. Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. GynecolOncol 1998; 70: 165-71.
Trimble EL, Kosary C, Park RC. Lymph node sampling and survival in endometrial cancer. GynecolOncol 1998;71:340-3.
Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN, Mariani A, Dowdy SC. Currentissues in the management of endometrial cancer. Mayo ClinProc 2008;83:97-112.
Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J ObstetGynecol 2000;182:1328-34.
Drapkin R, von Horsten HH, Lin Y, Mok SC, Crum CP, Welch WR, Et al. Human epididymis protein 4 (HE4) is a secreted glycoprotein that is overexpressed by serous and endometrioid ovarian carcinomas. Cancer Res 2005; 65: 2162-9.
Köbel M, Kalloger SE, Boyd N, McKinney S, Mehl E, Palmer C, Et al. Ovarian carcinoma subtypes are different diseases: implications for biomarker studies. PLoS Med 2008; 5: e232.
Sebastianelli A, Renaud MC, Grégoire J, Roy M, Plante M. Preoperative CA 125tumour marker in endometrial cancer: correlation with advanced stage disease. JObstetGynaecol Can 2010;32:856-60.
Hsieh CH, ChangChien CC, Lin H, Huang EY, Huang CC, Lan KC, Et al. Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer? GynecolOncol 2002;86:28-33.
Chung HH, Kim JW, Park NH, Song YS, Kang SB, Lee HP. Use of preoperative serum CA-125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer. ActaObstetGynecolScand 2006;85:1501-5.
Moore RG, Miller CM, Brown AK, Robison K, Steinhoff M, Lambert-Messerlian G. Utility of tumor marker HE4 to predict depth of myometrial invasion in endometrioid adenocarcinoma of the uterus. Int J Gynecol Cancer 2011;21:1185-90.
Frei KA, Kinkel K. Staging endometrial cancer: role of magnetic resonance imaging. J MagnReson Imaging 2001;13:850-5.
Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, Et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008;100:1707-16.
Savelli L, Ceccarini M, Ludovisi M, Fruscella E, De Iaco PA, Salizzoni E, Et al. Preoperative local staging of endometrial cancer: transvaginalsonography vs. magnetic resonance imaging. Ultrasound ObstetGynecol 2008;31:560-6.
Vasconcelos C, Félix A, Cunha TM. Preoperative assessment of deep myometrialand cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and histopathologic evaluation.
J ObstetGynaecol 2007;27:65-70.
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| Issue | Vol 9, No 4 (December 2015) | |
| Section | Original Articles | |
| Keywords | ||
| Endometrial Carcinoma CA125 HE4 MRI Surgical Staging | ||
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