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Resumen Antecedentes y objetivos El tratamiento estandar para el cancer de endometrio (CE) es la histerectomia simple con salpingo-ooforectomia bilateral. Las pacientes dentro del grupo de alto riesgo son las que se benefician de la linfadenectomia lumboaortica. En dicho grupo se encuentran las que presentan grado y subtipo histologico de mal pronostico y profundidad de invasion miometrial superior al 50% (M2). Este ultimo parametro puede ser brindado por el estudio intraoperatorio por congelacion (EIC) y la resonancia magnetica (RM), contribuyendo a decidir quienes se beneficiaran de la linfadenectomia. El objetivo es establecer el redito diagnostico de la RM y EIC para determinar la presencia de M2 en pacientes con CE. Materiales y metodos Estudio de tipo test diagnostico, corte transversal. Se incluyeron pacientes de sexo femenino con diagnostico histopatologico de CE, a las que se realizo RM inicial o basal y fueron intervenidas quirurgicamente en nuestra institucion entre el 1 de enero de 2010 y el 31 de diciembre de 2017. Se estudiaron las RM y los informes de EIC y se compararon con los datos del informe de anatomia patologica. Se efectuo un analisis estadistico de sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de ambas pruebas diagnosticas. Tambien se calculo la tasa de precision diagnostica de cada metodo discriminado, el porcentaje de subestimacion y sobrestimacion. Finalmente, se calculo el valor predictivo de la RM para determinar la presencia de M2 ajustandolo por las variables histologicas de mal pronostico conocidas. Resultados Para la determinacion de M2, la RM presento una sensibilidad del 63%, una especificidad del 87%, un VPP del 73% y un VPN del 81%. La tasa de precision diagnostica fue del 78,8%, un 13,12% por subestimacion y un 8,13% por sobrestimacion de M2. Por su parte, el EIC presento una sensibilidad del 69%, una especificidad del 86,7%, un VPP del 69% y un VPN del 86%. La tasa de precision diagnostica fue del 81,5%, un 9,24% por subestimacion y 9,24% por sobrestimacion de M2. El grado de concordancia entre ambos metodos es moderada (valor de kappa de 0,54, p Conclusiones En nuestra experiencia, la RM y el EIC presentan un adecuado redito diagnostico, pero a favor del EIC, para determinar M2. La contribucion de la RM al determinar la presencia y el sitio de invasion miometrial profunda, asi como de los factores que puedan resultar confundidores, sumado al aporte de la EIC, se traduce en que ambos metodos ayudan a disminuir el numero innecesario de linfadenectomias, con la morbimortalidad y los costos en salud asociados.

Background and objectives The standard treatment for endometrial cancer is simple hysterectomy with bilateral salpingo-oophorectomy. Patients with high risk also benefit from lumbo-aortic lymphadenectomy. High risk patients include those with grades and histologic subtypes associated with poor prognosis and depth of myometrial invasion greater than 50% (M2). To determine which patients would benefit from lumbo-aortic lymphadenectomy, the depth of myometrial invasion can be assessed by intraoperative frozen section or by magnetic resonance imaging (MRI). We aimed to determine the diagnostic yield of intraoperative frozen section and MRI for detecting the presence of M2 in patients with endometrial cancer. Materials and methods This cross-sectional study included women with a histologically confirmed diagnosis of endometrial cancer who underwent baseline MRI and surgical intervention in our institution between 1 January 2010 and 31 December 2017. We reviewed the MRI studies and the intraoperative frozen section reports and compared them with the information in the histopathology report. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the two tests. We also calculated the diagnostic accuracy of each method and the percentages of underestimation and overestimation. Finally, we calculated the predictive value of MRI for the presence of M2, adjusting it for the histologic variables known to be associated with poor prognosis. Results To detect M2, MRI had 63% sensitivity, 87% specificity, 73% PPV, and 81% NPV; the diagnostic accuracy was 78.8%, with 13.12% underestimation and 8.13% overestimation of M2. Intraoperative frozen section had 69% sensitivity, 86.7% specificity, 69% PPV, and 86% NPV; the diagnostic accuracy was 81.5%, with 9.24% underestimation and 9.24% overestimation of M2. The degree of concordance between the two methods was moderate (k = 0.54, p Conclusions In our experience, MRI and intraoperative frozen section have adequate diagnostic yields for determining M2, though intraoperative frozen section is slightly better. The contribution of MRI in determining the presence and the site of deep myometrial invasion, as well as the factors that can confound the diagnosis, when added to the contribution of intraoperative frozen section, means that both methods help reduce the number of unnecessary lymph node dissections and the morbidity, mortality, and health costs associated with this practice.

Urachal carcinomas (UrC) are rare non-urothelial bladder neoplasms, however the potential role for MR imaging in UrC has not been well established. Our objective was to assess the value of magnetic resonance imaging (MRI) in primary and recurrent UrC.This retrospective single-center study included all patients with UrC that underwent MRI between January 2005 and May 2020. Two radiologists reviewed MRIs independently followed by consensus with a third radiologist. For primary UrC, tumor location, size, morphology, invasion of peritoneum and/or local structures other than bladder and concordance between Mayo stage on MRI and pathology were assessed. MRI performed for recurrent UrC evaluated the pattern of recurrence. The reference standard was histopathological analysis.Ninety-six patients with UrC were identified of which 17 were included (9 men and 8 women, median age 50 years [IQR 42-62]). At initial MR staging (n = 10), all primary UrC were located at the bladder dome with median longest axis dimension of 6.0 cm. Most (70%) were mixed solid-and-cystic. Invasion of the peritoneum and/or local structures other than bladder was identified in 30%. Concordance between consensus MRI Mayo stage and final pathologic Mayo stage was 90%. At MR restaging (n = 7), UrC recurrence was most commonly seen at the bladder dome (71%). Overall, MRI showed a sensitivity of 85% and specificity of 50% for detecting recurrent tumor.MRI demonstrates value in evaluation of disease extent in primary and recurrent UrC, with high concordance between Mayo stage at MRI and pathology, and in the detection of local recurrences.