***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To assess the diagnostic accuracy of fused T2-weighted and high-b-value diffusion-weighted ( DW ) magnetic resonance ( MR ) images at 3 T for evaluation of myometrial invasion in patients with endometrial cancer . MATERIAL S AND METHODS Institutional review board approval and informed consent were obtained . From May 2006 to October 2007 , 48 consecutive patients aged 25 - 80 years ( mean age , 57 years ) who had endometrial cancer were prospect ively enrolled for preoperative evaluation by using a 3-T MR unit .  Two radiologists interpreted the depth of myometrial invasion on T2-weighted images , dynamic contrast material -enhanced MR images , and fused T2-weighted and DW MR images ( b = 1000 sec/mm(2 ) ) . Statistical methods included kappa statistics for reader agreement , Pearson analysis for pathologic correlation , accuracy assessment , and receiver operating characteristic analysis for diagnostic performance comparison . Surgical pathologic findings were the reference st and ard . RESULTS Reader agreement was excellent for fused T2-weighted and DW images ( weighted kappa , 0.79 ) , with a significant pathologic correlation regarding the depth of myometrial invasion ( r = 0.94 , P < .0001 ) . For assessing any myometrial involvement , addition of fused T2-weighted and DW imaging to dynamic contrast-enhanced or dynamic contrast-enhanced and T2-weighted imaging was significantly better compared with dynamic contrast-enhanced imaging alone ( P < .001 ) or dynamic contrast-enhanced and T2-weighted ( P = .001 ) imaging ; T2-weighted imaging combined with fused T2-weighted and DW imaging also was better than dynamic contrast-enhanced and T2-weighted imaging ( P = .001 ) . Tumor apparent diffusion coefficients were 0.60 - 1.32 x 10(-3 ) mm(2)/sec ( median , 0.75 x 10(-3 ) mm(2)/sec ) , with no significant correlation with the depth of myometrial invasion ( P = .31 , r = -0.15 ) . CONCLUSION Fused T2-weighted and high-b-value DW images at 3 T can provide accurate information for preoperative evaluation of myometrial invasion Abstract Objectives To prospect ively assess the efficacy of 3-T magnetic resonance ( MR ) imaging using the three-dimensional turbo spin-echo T2-weighted and diffusion-weighted technique ( 3D-TSE/DW ) compared with that of conventional imaging using the two-dimensional turbo spin-echo T2-weighted and dynamic contrast-enhanced technique ( 2D-TSE/DCE ) for the preoperative staging of endometrial cancer , with pathological analysis as the reference st and ard . Methods Seventy-one women with endometrial cancer underwent MR imaging using 3D-TSE/DW  ( b = 1,000 s/mm2 ) and 2D-TSE/DCE .  Two radiologists independently assessed the two imaging sets . Accuracy , sensitivity , and specificity for staging were analysed with the McNemar test ; the areas under the receiver operating characteristic curve ( Az ) were compared with a univariate z-score test . Results The results for assessing deep myometrial invasion , accuracy , sensitivity , specificity and Az , respectively , were as follows : 3D-TSE/DW — observer 1 , 87 % , 95 % , 85 % and 0.96 ; observer 2 , 92 % , 84 % , 94 % and 0.95 ; 2D-TSE/DCE — observer 1 , 80 % , 79 % , 81 % and 0.89 ; observer 2 , 86 % , 84 % , 87 % and 0.86 . Most of the values were higher with 3D-TSE/DW without significant differences ( P > 0.12 ) . For assessing cervical stromal invasion , there were no significant differences in those values for both observers ( P > 0.6 ) . Conclusions Accuracy of 3D-TSE/DW was at least equivalent to that of the conventional technique for the preoperative assessment of endometrial cancer . Key Points• New techniques in MR imaging help assess patients with endometrial cancer . • A 3D T2-weighted TSE sequence seems equally as accurate as conventional techniques . • Three-dimensional TSE/DW imaging does not require intravenous contrast material and is relatively quick . • Tumour extent of endometrial cancer can be clearly shown on diffusion-weighted images . • Junctional zone can be visualised well on 3D-TSE T2-weighted images Objective To determine the diagnostic accuracy of diffusion-weighted ( DW ) magnetic resonance ( MR ) imaging in the preoperative assessment of myometrial invasion by endometrial cancer . Material s and methods In this prospect i ve study , 47 patients with histologically confirmed endometrial cancer underwent preoperative MR imaging and total hysterectomy .  The MR protocol included spin-echo multishot T2-weighted , dynamic T1-weighted and DW images acquired with b-values of 0 and 500 s/mm2 . Myometrial tumour spread was classified as superficial ( < 50 % ) or deep ( ≥50 % myometrial thickness ) . Postoperative histopathological findings served as a reference st and ard . Indices of diagnostic performance were assessed for each sequence . Results At histopathological examination , superficial myometrial invasion was found in 34 patients and deep myometrial invasion in 13 . In the assessment of tumour invasion , sensitivity , specificity , positive and negative predictive values of T2-weighted images were 92.3 % , 76.5 % , 60.0 % and 96.3 % , respectively . The corresponding values for dynamic images were 69.2 % , 61.8 % , 40.9 % and 84.0 % , and for DW images 84.6 % , 70.6 % , 52.4 % and 92.3 % . T2-weighted and DW imaging proved to be the most accurate techniques for tumour spread determination . Conclusion DW imaging proved to be accurate in assessing myometrial invasion , and it could replace dynamic imaging as an adjunct to routine T2-weighted imaging for preoperative evaluation of endometrial cancer PURPOSE To prospect ively assess the usefulness of diffusion-weighted magnetic resonance imaging ( MRI ) with background body signal suppression ( DWIBS ) at 3 T for the preoperative evaluation of endometrial cancer . MATERIAL S AND METHODS Fifty-two consecutive patients with biopsy-proven endometrial cancer were examined with a 3 T MR scanner , followed by a hysterectomy . MR examinations included T2-weighted ( T2WI ) , DWIBS , and dynamic contrast-enhanced T1-weighted imaging ( DCEI ) . The apparent diffusion coefficient ( ADC ) was calculated in the tumor and normal myometrium . According to tumor grade , the mean ADC of the tumor was analyzed . The depth of myometrial invasion was independently assessed by two radiologists for three MRI data sets on a five-point scale . RESULTS The mean ADC of the tumors was significantly lower than that of normal myometrium ( P < 0.001 ) . The mean ADC of grade s 2 or 3 was significantly lower than grade 1 ( P < 0.01 ) . For predicting myometrial invasion , the specificity , accuracy , and area under the curve of combined T2WI and DWIBS in both readers were similar to DCEI ( P > 0.05 ) . Interreader agreement in all MRI data sets was excellent . CONCLUSION DWIBS at 3 T has potential for being an effective method for the preoperative evaluation of endometrial cancer A prospect i ve study was undertaken to assess the value of both T2-weighted spin-echo ( SE ) and contrast-enhanced dynamic gradient-echo ( GRE ) sequences using MR imaging in differentiating the deep myometrial invasion from lower stages produced by endometrial carcinoma . For the correlation of MR findings with the histopathologic findings , patients who had no myometrial invasion ( stage 1 a ) and patients in whom tumors were confined to the superficial myometrium ( stage 1 b ) at pathologic examination were combined as lower stages . Twenty patients with endometrial carcinoma were studied using both techniques . The absence of any detectable tumor ( stage 1 a ) or the presence of a tumor confined to inner half of myometrium ( stage 1 b ) and extention of tumor to the outer half of myometrium ( stage 1 c ) were used as the diagnostic criteria . In pathologic examination of excised specimens , deep myometrial invasion was detected in 9 of 20 patients . The sensitivity , specificity , accuracy , positive predictive values ( PPV ) and negative predictive values ( NPV ) of T2-weighted SE in differentiating deep myometrial invasion from combined lower stages were 88 , 91 , 90 , 88 , and 91 % , respectively , whereas corresponding values for contrast-enhanced dynamic GRE sequences were 78 , 100 , 90 , 100 , and 85 % . Statistical difference between two sequences did not reach a significant level . We conclude that in cases of absence of visible junctional zone with SE sequence , contrast-enhanced dynamic GRE MR imaging may be helpful BACKGROUND Despite their low risk for recurrence , many women with endometrial adenocarcinoma receive postoperative radiation therapy ( RT ) . This study was developed to determine if adjunctive external beam irradiation lowers the risk of recurrence and death in women with endometrial cancer International Federation of Gynaecology and Obstetrics ( FIGO ) stages IB , IC , and II ( occult disease ) . METHODS Four hundred forty-eight consenting patients with " intermediate risk " endometrial adenocarcinoma were r and omized after surgery to either no additional therapy ( NAT ) or whole pelvic radiation therapy ( RT ) .  They were followed to determine toxicity , date and location of recurrence , and overall survival . A high intermediate risk ( HIR ) subgroup of patients was defined as those with ( 1 ) moderate to poorly differentiated tumor , presence of lymphovascular invasion , and outer third myometrial invasion ; ( 2 ) age 50 or greater with any two risk factors listed above ; or ( 3 ) age of at least 70 with any risk factor listed above . All other eligible participants were considered to be in a low intermediate risk ( LIR ) subgroup . RESULTS Three hundred ninety-two women met all eligibility requirements ( 202 NAT , 190 RT ) . Median follow-up was 69 months . In the entire study population , there were 44 recurrences and 66 deaths ( 32 disease or treatment-related deaths ) , and the estimated 2-year cumulative incidence of recurrence ( CIR ) was 12 % in the NAT arm and 3 % in the RT arm ( relative hazard ( RH ) : 0.42 ; P=0.007 ) . The treatment difference was particularly evident among the HIR subgroup ( 2-year CIR in NAT versus RT : 26 % versus 6 % ; RH=0.42 ) . Overall , radiation had a substantial impact on pelvic and vaginal recurrences ( 18 in NAT and 3 in RT ) . The estimated 4-year survival was 86 % in the NAT arm and 92 % for the RT arm , not significantly different ( RH : 0.86 ; P=0.557 ) . CONCLUSIONS Adjunctive RT in early stage intermediate risk endometrial carcinoma decreases the risk of recurrence , but should be limited to patients whose risk factors fit a high intermediate risk definition BACKGROUND Pelvic lymph nodes are the most common site of extrauterine tumor spread in early-stage endometrial cancer , but the clinical impact of lymphadenectomy has not been addressed in r and omized studies . We conducted a r and omized clinical trial to determine whether the addition of pelvic systematic lymphadenectomy to st and ard hysterectomy with bilateral salpingo-oophorectomy improves overall and disease-free survival . METHODS From October 1 , 1996 , through March 31 , 2006 , 514 eligible patients with preoperative International Federation of Gynecology and Obstetrics stage I endometrial carcinoma were r and omly assigned to undergo pelvic systematic lymphadenectomy ( n = 264 ) or no lymphadenectomy ( n = 250 ) . Patients ' clinical data , pathological tumor characteristics , and operative and early postoperative data were recorded at discharge from hospital . Late postoperative complications , adjuvant therapy , and follow-up data were collected 6 months after surgery . Survival was analyzed by use of the log-rank test and a Cox multivariable regression analysis . All statistical tests were two-sided . RESULTS The median number of lymph nodes removed was 30 ( interquartile range = 22 - 42 ) in the pelvic systematic lymphadenectomy arm and 0 ( interquartile range = 0 - 0 ) in the no-lymphadenectomy arm ( P < .001 ) . Both early and late postoperative complications occurred statistically significantly more frequently in patients who had received pelvic systematic lymphadenectomy ( 81 patients in the lymphadenectomy arm and 34 patients in the no-lymphadenectomy arm , P = .001 ) . Pelvic systematic lymphadenectomy improved surgical staging as statistically significantly more patients with lymph node metastases were found in the lymphadenectomy arm than in the no-lymphadenectomy arm ( 13.3 % vs 3.2 % , difference = 10.1 % , 95 % confidence interval [ CI ] = 5.3 % to 14.9 % , P < .001 ) 
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Conclusion  DWI  has high sensitivity and specificity for detecting deep myometrial invasion and more importantly can reliably rule out deep myometrial invasion .
Therefore , it would be worthwhile to add a DWI sequence to the st and ard MRI protocol s in preoperative evaluation of endometrial cancer in order to detect deep myometrial invasion , which along with other poor prognostic factors like age , tumor grade , and LVSI would be useful in stratifying high risk groups thereby helping in the tailoring of surgical approach in patient with low risk of endometrial carcinoma