Researchers have re-evaluated the utility of a technique called subendometrial enhancement (SEE) in assessing the interface between the endometrium and myometrium – the two main layers of the uterus. Using dynamic contrast-enhanced (CE) magnetic resonance imaging (MRI), they found that reliable areas of SEE for this assessment are infrequently observed, even in women without endometrial pathology. This challenges the assumption that SEE is a crucial imaging finding for identifying women eligible for fertility-sparing treatment in endometrial cancer. The findings suggest the need to re-evaluate the role of dynamic CE MRI in managing endometrial cancer. Uterus, Endometrium, Myometrium
Understanding the Uterine Layers
The uterus is a complex organ, composed of two main layers – the endometrium (the innermost lining) and the myometrium (the muscular wall). Accurately assessing the interface between these layers is crucial, especially in the context of endometrial cancer, the most common gynecologic malignancy in developed countries.
The Promise and Limitations of Subendometrial Enhancement
One imaging technique that has been used to evaluate the endometrium-myometrium interface is subendometrial enhancement (SEE). SEE is a thin layer of enhancement observed between the two layers on dynamic contrast-enhanced (CE) magnetic resonance imaging (MRI). It has been proposed as a crucial finding for identifying women with low-grade endometrial cancer who may be eligible for fertility-sparing treatment.
However, the current study suggests that the utility of SEE may be limited. The researchers found that reliable areas of SEE for assessing the endometrium-myometrium interface were infrequently observed, even in women without endometrial pathology. This challenges the assumption that SEE is a reliable marker for this assessment in endometrial cancer.
Implications for Endometrial Cancer Management
The findings of this study have important implications for the management of endometrial cancer. If SEE is not commonly observed, as the study suggests, then relying on it for assessing myometrial invasion in endometrial cancer may not be effective. This could contribute to the lower specificity of dynamic CE MRI in detecting myometrial invasion, which has been a significant challenge in endometrial cancer management.
The researchers note that the preference for dynamic CE MRI in selecting women for fertility-sparing treatment may need to be re-evaluated, especially since no significant difference exists in tumor-myometrium contrast between dynamic CE MRI and single-phase CE MRI. This study highlights the need for further research to determine the most appropriate imaging approach for managing endometrial cancer.
Limitations and Future Directions
The researchers acknowledge several limitations of their study, including the potential for selection bias and the relatively small sample size. Additionally, they did not explore the use of various time resolutions for assessing SEE, which may impact its detection.
Future studies with larger and more diverse patient populations, as well as investigations into the influence of different time resolutions, could help validate the findings and provide a more comprehensive understanding of the role of SEE in uterine imaging.
Author credit: This article is based on research by Sang Youn Kim, Myoung Seok Lee, Min Hoan Moon, Chang Kyu Sung, Sohee Oh.
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