Introduction/Background The preoperative stage assessment of endometrial cancer, determined by the FIGO staging system, is based on imaging and determines the extent of the surgical procedure. Uncertain situations or technical difficulties require MRI as a reference technique. In published papers the accuracy of this technique is done upon a high quality examination (expert radiologist in a reference center), whereas everyday practice shows otherwise. The aim of this retrospective cohort study is to evaluate the concordance between preoperative MRI data and final histopathological examination.

Methodology A retrospective observational study of 106 patients operated for endometrial cancer was performed between July 2021 and February 2022. All patients included were women who had the primary radical surgery for all histological types. The exclusion criteria were lack of preoperative pelvic and abdominal MRI assessment. The final histopathological data from surgical operations were compared with preoperative imaging data.

Results For deep myometrial infiltration the accuracy of MRI was 66,7%, sensitivity was 75%, specificity was 45,5%. For the cervical stroma infiltration the accuracy was 84,1%, sensitivity was 47,6%, specificity was 81,4%. For the parametrium infiltration the accuracy was 84,1%, sensitivity was 28,6%, specificity was 91,8%. Nodal metastases were detected in 15,9% patients (11,6% in PLN and 4,3% PLN&PALN). The accuracy of the MRI for the detection of nodal metastasis was 75,4%, sensitivity 30,8%, specificity 84,2%. Further analysis evaluated the impact of the following features on the MRI efficiency: histological type, patient age, presence of myomas and the reference status of the radiology center.

Conclusion Unsatisfactory results of MRI imaging, particularly that overestimate the local infiltration, lead to performing too extensive lymphadenectomy, especially that the ability of detecting LN metastasis by MRI has low rate. All quality bias should be taken into consideration when analyzing the results of the MRI to tailor the surgical treatment.