•A high degree of concordance between MRI and final histopathology is essential for accurate surgical planning. MRI is paramount for local staging of cancer

• In this study, 82.6% of patients underwent surgery at the appropriate facility with the correct procedure based on MRI findings, which is an improvement from the previous study. 

•We think that consistent same gynaecology radiologist with experience in gynaecology oncology during MDT discussions has helped us attain the above standard

•MMR status analysis showed 77% were MMR proficient, while 18.75% were MMR deficient.

•Among MMR-deficient cases, 77% had MLH1 promoter methylation, and 22% were negative, requiring germline testing referrals.

•All 22 % of MMR-deficient MLH 1 Promoter hypermethylation negative patients had germ-line testing within 4 weeks.

•Informed consent was taken in all cases before referral for germ-line testing.

 

According to the national audit on staging accuracy of MRI in endometrial cancer by Duncan et al published in 2011, MRI accuracy was compared to target cut-offs of 82, 86 and 70% for cervical stromal invasion, myometrial invasion and lymph node metastases respectively1.

Targets for MRI staging were achieved nationally for two of the three standards: diagnostic accuracy for depth of myometrial invasion, 82%; cervical extension, 90%; and pelvic nodal involvement, 94%; the latter two being well above the targets.

Statistical analysis demonstrated no significant difference in the use of intravenous contrast medium but did show some evidence of increasing accuracy in assessing the depth of myometrial invasion with growing caseload.

NICE Guidance G42 says that all patients with endometrial cancer should be offered testing on IHC for MMR status

If IHC is abnormal with loss of MLH1, or loss of both MLH1 and PMS2 protein expression, do MLH1 promoter hypermethylation testing of tumour DNA. If MLH1 promoter hypermethylation is not detected, offer germline genetic testing to confirm Lynch syndrome.

If IHC is abnormal with loss of MSH2, MSH6 or isolated PMS2 protein expression, offer germline genetic testing to confirm Lynch syndrome.