An Observational Study of the Accuracy of MRI in Staging Endometrial Adenocarcinoma in a Tertiary Care Hospital

Background: Endometrial adenocarcinoma is the most common histological subtype of endometrial cancer. Accurate preoperative staging is essential for determining the extent of surgery and planning appropriate adjuvant treatment. Magnetic resonance imaging (MRI) is considered the imaging modality of choice for local staging because of its superior soft-tissue contrast and multiplanar capability. However, its diagnostic accuracy requires validation against histopathological examination, which remains the gold standard. Therefore, the present study aimed to evaluate the diagnostic accuracy of MRI in the preoperative staging of endometrial adenocarcinoma by comparing MRI findings with postoperative histopathological examination in patients treated at a tertiary care hospital. Material and Methods: This observational study included 50 consecutive patients with histopathologically confirmed endometrial adenocarcinoma who underwent preoperative pelvic MRI followed by definitive surgical management. MRI findings regarding tumor size, depth of myometrial invasion, cervical stromal involvement, serosal involvement, and pelvic nodal status were compared with postoperative histopathological findings. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, with appropriate statistical evaluation methods. Results: The majority of patients were aged 51–60 years (38%) and were postmenopausal (74%). Grade I tumors constituted 64% of cases. MRI demonstrated good agreement with histopathology for tumor size and myometrial invasion. The overall diagnostic accuracy for superficial (<50%) and deep (>50%) myometrial invasion was 74% each. MRI showed excellent diagnostic performance for serosal involvement, with a sensitivity of 100%, specificity of 95.7%, NPV of 100%, and overall accuracy of 96%. For cervical stromal involvement, MRI demonstrated a sensitivity of 40%, specificity of 91.1%, and accuracy of 86%. Pelvic nodal involvement showed 100% sensitivity, 82.6% specificity, and 84% overall accuracy. MRI had consistently high negative predictive values for advanced disease, although positive predictive values for cervical stromal and nodal involvement were relatively low. Conclusion: MRI is a reliable, non-invasive modality for the preoperative staging of endometrial adenocarcinoma. It demonstrates high diagnostic accuracy for serosal involvement and good performance in assessing myometrial invasion, making it valuable for surgical planning. However, histopathological examination remains the gold standard because MRI has limited sensitivity for cervical stromal invasion and moderate specificity for pelvic nodal metastasis. Combining MRI findings with clinical and pathological assessment can improve treatment planning and patient outcomes.

Keywords: Endometrial adenocarcinoma, Magnetic resonance imaging, Histopathology, FIGO staging, Myometrial invasion, Cervical stromal involvement, Serosal involvement.