Assessing the clinical value of pre-operative imaging in endometrial carcinoma by symptoms and low-risk versus high-risk histology
This study aimed to assess the concordance between pre-operative imaging results and intra-operative findings in patients with endometrial carcinoma, based on pre-operative risk stratification and the clinical indication for obtaining imaging. We identified all patients who had surgery for newly diagnosed endometrial carcinoma at our institution from January 2017 to January 2021 and categorized them as low or high risk. We reviewed pre-operative images or radiologic evidence of extra-uterine disease and correlated with intra-operative findings, and we categorized the findings as true positive or false negative. We identified a total of 1970 patients for this analysis. Within the study cohort, 1247 tumors (63.3%) were low-risk histology, 719 (36.5%) were high-risk histology, and 4 patients (0.2%) had no pre-operative biopsy. Pre-operative imaging was performed for 676 low-risk (54.2%) and 700 high-risk patients (97.4%) (p <.001) and detected the presence of extra-uterine disease in 50 of 676 low-risk (7.4%) and 140 of 700 high-risk patients (20%). In the low-risk cohort, there was radiologic evidence of extra-uterine disease present for 12 of 60 patients (20%) with an abnormal exam or ultrasound, 16 of 126 patients (12.7%) with symptoms or a delayed diagnosis, and 16 of 490 asymptomatic patients (3.3%). In the high-risk cohort, there was radiologic evidence of extra-uterine disease present for 32 of 66 patients (48.5%) with symptoms or a delayed diagnosis, 21 of 46 patients (45.7%) with an abnormal exam or ultrasound, and 84 of 583 asymptomatic patients (14.4%). A total of 122 of 1376 patients (8.9%) had a change in clinical management based on pre-operative imaging findings: 32 of 676 (4.7%) low-risk and 90 of 700 high-risk patients (12.9%). Over 90% of patients with low-risk tumors had no findings suspicious for metastatic disease on pre-operative imaging, indicating limited utility in that cohort. However, pre-operative imaging yielded clinically meaningful information in patients with high-risk histology, particularly, those with symptoms, delayed diagnosis, or concerning exam findings.