Introduction/Background High grade endometrial cancers are clinically aggressive, present with locally advanced disease with higher propensity for extrapelvic spread. Accurate mapping of the extent of spread prior to surgery is important to optimize treatment planning and decide route of surgery. This study was carried out to estimate the accuracy of preoperative imaging in prediction of advanced stages (III & IV) in high grade endometrial cancer

Methodology This was a prospective study conducted in patients with high grade endometrial carcinoma who underwent surgical staging from August 2022 to July 2023. All patients underwent preoperative MRI pelvis and CECT abdomen and thorax as per institutional protocol. Images were reported by a single radiologist. Preoperative imaging findings were correlated with postoperative histopathology reports. Sensitivity, specificity and accuracy of imaging tools were calculated.

Results 100 patients were studied. After surgery, 29 cases were diagnosed with advanced stages on histopathology report. Combined preoperative imaging (MRI & CECT) correctly detected advanced staging in 25 out of 29 cases. Early stage was falsely upstaged by imaging in 13 out of 71 cases (False positives). Sensitivity in picking up serosal involvement, adnexal involvement and pelvic nodes by MRI was 42.86%, 40% and 66.67%. Sensitivity in detecting para-aortic nodes in CECT was 68.75%. Only 1 out of 5 cases with peritoneal disease was picked up by imaging. The sensitivity, specificity and accuracy of combined CECT with MRI to detect advanced stage disease was 86.21%, 81.69% and 83%.

Conclusion Even though the sensitivity of MRI or CECT is poor to moderate in detection of individual parameters like serosal, adnexal, nodal and peritoneal involvement, MRI combined with CECT has high accuracy in detecting advanced stages in high grade endometrial cancers with good sensitivity and specificity.

Disclosures No conflict of interest.