Pre-operative MRI staging of endometrial cancer in a multicentre cancer network: can we match single centre study results?

OBJECTIVES: To evaluate the staging accuracy of magnetic resonance imaging (MRI) for endometrial cancer in daily practice over a 3-year period at a tertiary referral centre receiving scans from a large number of hospitals with varying protocols. To compare these daily practice results to published data from single-centre studies. METHODS: After ethical approval, MRI staging records for 270 studies from nine network and three centre hospitals were retrospectively collected and compared with final operative histopathology. The International Federation of Gynaecology and Obstetrics (FIGO) stage, depth of invasion assessment and cervical stromal invasion were analysed and reasons for discrepancies reviewed. RESULTS: MRI-based complete FIGO stage was fully concordant with histopathology in 65.6%. MRI accuracy for depth of myometrial invasion and cervical stromal invasion was 73.3% and 89.3% respectively. Our results did not match the high accuracy previously reported in studies based on single centres. CONCLUSIONS: Published MRI staging accuracy from small single-centre studies were not replicated in a tertiary referral centre receiving scans with heterogeneous protocols over a 3-year period. These results highlight the challenges faced in daily practice and may reflect achievable and realistic MRI staging accuracies in large rapid throughput referral networks. Adherence to standardised high-quality protocols may help to improve future results. KEY POINTS: • Three-year MRI-staging accuracy for endometrial cancer in a multicentre cancer network • Daily practice MRI-staging accuracy did not meet results of single-centre studies • Large scale cancer network MRI-staging accuracies should be further evaluated • Treatment recommendations should be based on achievable MRI-staging accuracies.

Long-term donor outcomes after living kidney donation.

Kidney transplant is the first choice of treatment for end-stage renal failure. The issue of long-term donor safety again has been raised by recent increases in living-donor kidney transplants worldwide, relaxation of donor selection criteria, and the introduction of new surgical techniques. In this review, we collated the results of various studies to discuss the effects of donation on the quality of life of donors, encompassing their physical, mental, and social well-being. We found that the health risks donors face are minimal in the long term with respect to renal function, hypertension, and life span. Furthermore, donors scored higher in quality of life studies than did persons in the general population. Despite these findings, there is a clear need to monitor the minimal risks with long-term follow-up of donors to promptly recognize and treat any negative health effects. Such data from thorough follow-up studies also would provide accurate information on longterm donor health and improve the safe expansion of donor selection criteria.