Preoperative imaging of uterine malignancy: A low-value service

The aim of this study is to examine the value of computed tomography (CT) or magnetic resonance imaging (MRI) before surgical treatment of uterine malignancy.

Retrospective chart review was undertaken of women who underwent hysterectomy for uterine cancer at the University of Virginia. Radiologic reports were examined for evidence of cervical or extrauterine disease or incidental findings and correlated with detection of extrauterine disease at surgery.

Overall, 204 of 448 patients (45%) had preoperative imaging. Scans were ordered nearly evenly by referring clinicians and gynecologic oncologists (GO) (95 vs. 122, 44% vs. 56%). Imaging was most common among patients with grade 3 endometrioid or non-endometrioid histology (86 of 101, 85%). Women referred with low grade disease had more false positive (4 of 112, 4%) than true positive scans (2 of 113, 2%). Overall, 23 of 190 (12%) reviewed preoperative scans indicated suspected extrauterine disease. Two of these 23 women were low risk by intra-operative "Mayo criteria" and had stage 1A disease; 14 of 23 (61%) had stage II or greater disease.

Preoperative CT or MRI is of low value in predicting extra-uterine disease among uterine cancer patients with low grade disease. Women with low grade disease had false positive results more frequently than true detection of extrauterine disease. Abnormal imaging findings are more common and predictive of extrauterine disease in women with grade 3 or non-endometrioid histology but the value of these scans remains unclear.