Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging for Staging Endometrial Carcinoma: A Retrospective...

Background Globally, endometrial cancer is becoming more common. However, reporting has been delayed till the very end in India. Pre-operative mapping of the disease's extent, particularly myometrial invasion, aids in surgical planning and the selection of adjuvant therapy, lymphadenectomy, and fertility preservation. Because of its higher tissue resolution, magnetic resonance imaging (MRI) is the recommended non-invasive staging method; nonetheless, reported concordance with histology varies greatly. This study investigates the accuracy with which MRI depicts the actual disease stage in practical settings. Methodology We retrospectively reviewed 32 consecutive patients with primary endometrial carcinoma who underwent preoperative MRI followed by definitive surgical staging (January 2022-December 2023, tertiary academic centre). Socio-demographic, clinical, and imaging data were reviewed, and MRI findings for myometrial, cervical, adnexal, and nodal involvement were compared with hysterectomy histopathology (gold standard). Statistical analysis generated accuracy, sensitivity, specificity, and predictive values for key parameters. Results Participants had a mean age of 57 years; 87.5% were postmenopausal, and 59.4% were obese. Postmenopausal bleeding was the presenting symptom in 87.5%. MRI accurately determined myometrial invasion depth in 62.5% of cases, with an overall staging concordance of 53.1%. Upstaging occurred in 21.9% and downstaging in 25%. For myometrial invasion, MRI showed sensitivity 58.3%, specificity 65.0%, Positive Predictive Value (PPV) 50.0%, and Negative Predictive Value (NPV) 72.2%. Discordance was most frequent in borderline (<50%) invasion cases, where subtle histologic features escaped radiologic detection. Conclusion MRI remains an important tool for preoperative risk stratification in endometrial carcinoma and helps in counselling and guiding surgical management. However, the diagnostic accuracy can be increased with the use of more refined imaging such as diffusion-weighted and contrast-enhanced sequences, and closer multidisciplinary interpretation. Strengthening MRI-pathology alignment can reduce unnecessary lymphadenectomies and better support fertility-sparing pathways, particularly in resource-limited settings.