{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:09:10Z","timestamp":1792735750140,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005795","name":"Chang Gung Memorial Hospital, Linkou","doi-asserted-by":"publisher","award":["CORPG3G0401"],"award-info":[{"award-number":["CORPG3G0401"]}],"id":[{"id":"10.13039\/501100005795","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Young women with endometrial cancer (EC) can choose fertility-sparing treatment for stage 1A disease without myometrial invasion (MI). The surgical diagnostic procedure (SDP) may affect the accuracy of magnetic resonance imaging (MRI) to assess MI. Here, we evaluated different SDP and compared the MI on MRI results with further pathologic results after hysterectomy. We retrospectively collected data on 263 patients with clinical stage IA EC diagnosed between January 2013 and December 2015. Patients were classified into four groups based on SDP, including diagnostic hysteroscopic biopsy (DHB, group 1), operative hysteroscopic partial resection (OHPR, group 2), operative hysteroscopic complete resection (OHCR, group 3), and cervical dilatation and fractional curettage (D&amp;C, group 4). The sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of MRI to assess MI were 73.1%, 46.7%, 63.9%, 71.8%, and 48.3%, respectively. Three hysteroscopic procedures (groups 1 to 3) had a trend with a higher odds ratio of discrepancy between MRI and histopathology (p = 0.068), especially in group 2 (odds ratio 2.268, p = 0.032). Here, we found MRI accuracy of MI was better in patients with EC diagnosed with D&amp;C. Three diagnostic procedures using hysteroscopy might interfere with the diagnostic power of MI on MRI.<\/jats:p>","DOI":"10.3390\/cancers13133275","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T10:03:19Z","timestamp":1625047399000},"page":"3275","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prediction of Myometrial Invasion in Stage I Endometrial Cancer by MRI: The Influence of Surgical Diagnostic Procedure"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6515-0996","authenticated-orcid":false,"given":"Wei-Chun","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyaun 333, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Institute of Biomedical Engineering, International Intercollegiate Ph.D. Program, National Tsing Hua University, Hsinchu 300, Taiwan"},{"name":"Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung 204, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9807-1672","authenticated-orcid":false,"given":"Le-Tien","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyaun 333, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Ting","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung 204, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2004-1526","authenticated-orcid":false,"given":"Yu-Bin","family":"Pan","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shir-Hwa","family":"Ueng","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Hsueh","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyaun 333, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-Chang","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyaun 333, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.3389\/fonc.2019.01440","article-title":"Global, Regional, and National Burden of Endometrial Cancer, 1990\u20132017: Results from the Global Burden of Disease Study, 2017","volume":"9","author":"Zhang","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3322\/caac.20138","article-title":"Cancer statistics, 2012","volume":"62","author":"Siegel","year":"2012","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s13669-012-0032-5","article-title":"The Clinical Management of Endometrial Cancer in Young Women","volume":"2","author":"Lai","year":"2013","journal-title":"Curr. Obstet. Gynecol. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2005). ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: Management of endometrial cancer. Obs. Gynecol., 106, 413\u2013425.","DOI":"10.1097\/00006250-200508000-00050"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1148\/radiology.212.3.r99au29711","article-title":"Radiologic staging in patients with endometrial cancer: A meta-analysis","volume":"212","author":"Kinkel","year":"1999","journal-title":"Radiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1148\/radiol.2503080874","article-title":"Myometrial invasion in endometrial cancer: Diagnostic accuracy of diffusion-weighted 3.0-T MR imaging-initial experience","volume":"250","author":"Lin","year":"2009","journal-title":"Radiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.tjog.2009.10.006","article-title":"Obstetric outcomes of pregnancy after conservative treatment of endometrial cancer: Case series and literature review","volume":"50","author":"Chao","year":"2011","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1097\/IGC.0000000000000098","article-title":"Fertility-preserving treatment in young women with endometrial adenocarcinoma: A long-term cohort study","volume":"24","author":"Wang","year":"2014","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"214","DOI":"10.3802\/jgo.2014.25.3.214","article-title":"Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia","volume":"25","author":"Shan","year":"2014","journal-title":"J. Gynecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/AOG.0b013e318234d97c","article-title":"Progestin intrauterine device in an adolescent with grade 2 endometrial cancer","volume":"119","author":"Brown","year":"2012","journal-title":"Obs. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"67","DOI":"10.5468\/OGS.2013.56.2.67","article-title":"Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases","volume":"56","author":"Kim","year":"2013","journal-title":"Obs. Gynecol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Boussios, S., Mikropoulos, C., Samartzis, E., Karihtala, P., Moschetta, M., Sheriff, M., Karathanasi, A., Sadauskaite, A., Rassy, E., and Pavlidis, N. (2020). Wise Management of Ovarian Cancer: On the Cutting Edge. J. Pers. Med., 10.","DOI":"10.3390\/jpm10020041"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.ygyno.2019.05.022","article-title":"Combination simvastatin and metformin synergistically inhibits endometrial cancer cell growth","volume":"154","author":"Kim","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"341","DOI":"10.3389\/fonc.2018.00341","article-title":"Metformin as a Therapeutic Target in Endometrial Cancers","volume":"8","author":"Lee","year":"2018","journal-title":"Front. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.7150\/jca.8009","article-title":"Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance","volume":"5","author":"Li","year":"2014","journal-title":"J. Cancer"},{"key":"ref_16","first-page":"825","article-title":"Surgical staging in endometrial cancer: Clinical-pathologic findings of a prospective study","volume":"63","author":"Boronow","year":"1984","journal-title":"Obs. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.ygyno.2009.08.011","article-title":"A review of the challenges faced in the conservative treatment of young women with endometrial carcinoma and risk of ovarian cancer","volume":"115","author":"Zivanovic","year":"2009","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6803","DOI":"10.2147\/CMAR.S188087","article-title":"Fertility-preserving treatment in women with early endometrial cancer: The Chinese experience","volume":"10","author":"Wang","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e90","DOI":"10.3802\/jgo.2019.30.e90","article-title":"Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients","volume":"30","author":"Mitsuhashi","year":"2019","journal-title":"J. Gynecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.ejrad.2015.01.004","article-title":"Subendometrial enhancement and peritumoral enhancement for assessing endometrial cancer on dynamic contrast enhanced MR imaging","volume":"84","author":"Fujii","year":"2015","journal-title":"Eur. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00004728-199401000-00017","article-title":"Assessing myometrial invasion by endometrial carcinoma with dynamic MRI","volume":"18","author":"Ito","year":"1994","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1148\/radiology.185.1.1523309","article-title":"Myometrial invasion by endometrial carcinoma: Assessment with plain and gadolinium-enhanced MR imaging","volume":"185","author":"Sironi","year":"1992","journal-title":"Radiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1136\/ijgc-00009577-200103000-00006","article-title":"Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection","volume":"11","author":"Cunha","year":"2001","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1148\/radiol.11110984","article-title":"Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: Comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging","volume":"262","author":"Beddy","year":"2012","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s00330-014-3139-4","article-title":"MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: A systematic review and meta-analysis","volume":"24","author":"Andreano","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1007\/s00330-018-5515-y","article-title":"Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology","volume":"29","author":"Nougaret","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1007\/s00330-008-1271-8","article-title":"Accuracy of integrated FDG-PET\/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer","volume":"19","author":"Kitajima","year":"2009","journal-title":"Eur. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1080\/13645706.2019.1624576","article-title":"PET-CT scan in the preoperative workup of early stage intermediate- and high-risk endometrial cancer","volume":"29","author":"Franchi","year":"2020","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s40644-020-00357-4","article-title":"Diagnostic value of 18F-FDG PET\/MRI for staging in patients with endometrial cancer","volume":"20","author":"Tsuyoshi","year":"2020","journal-title":"Cancer Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13244-019-0696-8","article-title":"Role of MRI in staging and follow-up of endometrial and cervical cancer: Pitfalls and mimickers","volume":"10","author":"Nikolic","year":"2019","journal-title":"Insights Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.ajog.2020.05.049","article-title":"Abnormal uterine bleeding and the risk of endometrial cancer: Can subendometrial vascular ultrasound be of help to discriminate cancer from adenomyosis?","volume":"223","author":"Scioscia","year":"2020","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1148\/rg.2018180080","article-title":"Adenomyosis: A Sonographic Diagnosis","volume":"38","author":"Cunningham","year":"2018","journal-title":"Radiographics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejogrb.2017.04.015","article-title":"BGCS uterine cancer guidelines: Recommendations for practice","volume":"213","author":"Sundar","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/IGC.0000000000000609","article-title":"ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up","volume":"26","author":"Colombo","year":"2016","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s12094-017-1809-9","article-title":"SEOM clinical guidelines for endometrial cancer (2017)","volume":"20","author":"Santaballa","year":"2018","journal-title":"Clin. Transl. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.3802\/jgo.2020.31.e18","article-title":"Japan Society of Gynecologic Oncology 2018 guidelines for treatment of uterine body neoplasms","volume":"31","author":"Yamagami","year":"2020","journal-title":"J. Gynecol. Oncol."},{"key":"ref_37","unstructured":"Network, N.C.C. (2021, June 03). Uterine Neoplasm (Version 3.2021). Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/uterine_blocks.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.ygyno.2020.12.024","article-title":"Endometrial cancer: A society of gynecologic oncology evidence-based review and recommendations, part II","volume":"160","author":"Hamilton","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.crad.2015.06.097","article-title":"Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: Diffusion-weighted and dynamic contrast-enhanced MRI at 3 T","volume":"70","author":"Lin","year":"2015","journal-title":"Clin. Radiol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3275\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:23:44Z","timestamp":1760163824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,30]]},"references-count":39,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["cancers13133275"],"URL":"https:\/\/doi.org\/10.3390\/cancers13133275","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,30]]}}}