Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging for Detecting Cervical Stromal Invasion in Endometrial Cancer: A Prospective Observational Study

Background Accurate preoperative assessment of endometrial cancer is essential for optimal surgical planning and prognostication. Cervical stromal invasion upstages the disease to stage II and often necessitates a more radical surgical approach. Magnetic resonance imaging (MRI) is considered the imaging modality of choice for local staging due to its superior soft-tissue contrast and multiplanar capability. Objective To evaluate the diagnostic accuracy of preoperative contrast-enhanced MRI in detecting cervical stromal invasion in patients with endometrial cancer, using postoperative histopathological examination as the reference standard. Methods This prospective observational study was conducted at a tertiary care center from June 2020 to October 2021. A total of 30 patients with histologically confirmed stage I or stage II endometrial carcinoma underwent preoperative contrast-enhanced pelvic MRI. MRI findings were compared with postoperative histopathological results. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and Youden’s J index. Results The mean age of the study population was 59 years, and most patients were postmenopausal with early-stage disease. Cervical stromal invasion was identified in 4 patients (13.3%) on MRI and in 5 patients (16.7%) on histopathological examination. MRI demonstrated a sensitivity of 80% and specificity of 100%, with a PPV of 100% and NPV of 96.2%. The overall diagnostic accuracy was 96.77%, and Youden’s J index was 0.8. Conclusion Preoperative contrast-enhanced MRI demonstrates high diagnostic accuracy and excellent specificity in detecting cervical stromal invasion in endometrial cancer. It is a reliable modality for preoperative staging and may aid in guiding surgical management. Further multicenter studies with larger sample sizes are required to validate these findings.