Diagnostic Accuracy of MRI for Detecting Cervical Invasion in Patients with Endometrial Carcinoma: A Meta-Analysis

Background: Clinical management and the prognosis of endometrial cancer is closely related to cervical invasion. The diagnostic performance of MRI for detecting cervical invasion has not been comprehensively assessed. We aim to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative assessment of cervical invasion and to analyze the influence of different imaging protocols in patients with endometrial carcinoma.Methods: An extensive search of articles about MRI in assessing cervical invasion in patients with endometrial carcinoma was performed in PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials from January 2000 to July 2019. Two reviewers independently evaluated the methodological quality of each study by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Diagnostic accuracy results and additional useful information were extracted. Pooled estimation data was obtained by statistical analysis. Results: A total of 42 eligible studies were included in the meta-analysis. Significant evidence of heterogeneity was found for detecting cervical invasion (I2 = 74.1%, P = 0.00 for sensitivity and I2 = 56.2%, P = 0.00 for specificity). And the pooled sensitivity and specificity of MRI were 0.58 and 0.95 respectively. The use of higher field strength (3.0 T) demonstrated higher pooled sensitivity (0.74). Using diffusion-weighted imaging (DWI) alone presented higher pooled sensitivity (0.86) than using other sequences. Studies that used dynamic contrast-enhanced MRI (DCE-MRI) alone showed higher sensitivity (0.80) and specificity (0.96) than that used T2-weighted image (T2WI) alone.Conclusions: MRI shows high specificity for detecting cervical infiltration in endometrial carcinoma. Using DWI or a 3.0-T device may improve the pooled sensitivity. The use of DCE-MRI demonstrate higher pooled sensitivity and specificity than T2WI.