Analysis of Risk Factors for Lymphatic Metastasis in Endometrial Carcinoma and Utility of Three-Dimensional Magnetic Resonance Imaging in Gynecology

BACKGROUND: The aim of our study was to evaluate the utility of three-dimensional magnetic resonance imaging (3D-MRI) in gynecologic fields. We examined the relation between tumor volume measured with 3D-MRI and lymph node metastasis in patients with endometrial carcinoma. METHODS: A retrospective analysis of 84 patients with endometrial carcinoma who underwent hysterectomy, bilateral salpingo-oophorectomy with pelvic/para-aortic lymphadenectomy at our institute was performed. Of these, the tumor volume of 59 patients could be calculated using 3D-MRI. Age, serum CA125 level, histologic type and grade, volume of tumors were examined in relation to pelvic/para-aortic lymph node metastasis as preoperative risk factors. Tumor volume measurements were calculated using 3D-MRI with AqariusNET Server 4G software. Univariate and multivariate associations between the preoperative risk factors and pelvic/para-aortic lymph node metastasis were analyzed. Receiver operating characteristic (ROC) curves were used to determine the best cut-off points for CA125 levels and tumor volume to predict lymph metastasis. RESULTS: The mean age, CA125 value and tumor volume were 61.6 years, 51.6 (IU/L) and 11.6 (cm(3)), respectively. Lymphatic metastasis occurred in 16.0% (10 of 59) patients. Univariate analysis indicated that a high CA125 level and a tumor volume were risk factors (P = 0.0111, 0.0123 respectively). Multivariate analysis revealed that tumor volume was an independent risk factor for lymphatic metastasis (hazard ratio (HR) 12.7, 95% CI 1.06 - 154). The potential cut-off values of CA-125 level and tumor volume were 29 IU/L (sensitivity: 0.744; specificity: 0.821) and 12.79 cm(3) (sensitivity: 0.821; specificity: 0.744), respectively. CONCLUSIONS: Our results suggest that tumor volume calculated with 3D-MRI correlates with lymph node metastasis in endometrial carcinoma.