utility of pelvic mri and tumor markers he4 and ca125 to predict depth of myometrial invasion and cervical involvement in endometrial cancer

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.