Research Progress of MRI-based Radiomics and Deep Learning in Lymphovascular Space Invasion of Endometrial Carcinoma

Authors

  • Wenqing Mo Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China
  • Wenyu Tang Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China
  • Jing Huang Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China
  • Renqing Zhao Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China
  • Qixin Wu Department of Radiology, Chongzuo People's Hospital, Chongzuo, Guangxi, 532200, China

DOI:

https://doi.org/10.54097/4tgers42

Keywords:

Endometrial Carcinoma, Magnetic Resonance Imaging, Radiomics, Deep Learning, Lymphovascular Space Invasion, Nomogram

Abstract

Endometrial carcinoma (EC) is a highly prevalent malignant tumor of the female reproductive system, with a continuously rising global incidence and an increasing trend toward younger age at onset. Lymphovascular space invasion (LVSI) is an important independent prognostic risk factor for endometrial cancer and is closely associated with lymph node metastasis, distant recurrence, and poor overall survival. It is a core indicator for clinical risk stratification, selection of surgical extent, and formulation of postoperative adjuvant therapy. However, LVSI is a microscopic pathological change that can only be definitively diagnosed using postoperative pathological specimens. Subjective imaging interpretation of routine preoperative pelvic MRI cannot directly detect LVSI, and therefore cannot meet the clinical need for accurate preoperative risk assessment. MRI-based radiomics can mine high-throughput quantitative features that are invisible to the naked eye within tumor images, and deep learning can automatically learn hierarchical image features. Together, they provide a new avenue for noninvasive preoperative prediction of LVSI status in endometrial cancer. This article systematically reviews the research progress of MRI-based radiomics and deep learning in the field of LVSI prediction in endometrial cancer, elaborates on the standard radiomics workflow, traditional radiomics models, deep learning models, and the diagnostic performance of combined clinical-imaging prediction models, summarizes key issues in current research such as limited sample size, cross-center domain shift, insufficient reproducibility, and lack of prospective validation, and provides an outlook on future directions including clinical translation, multi-omics integration, and explainable artificial intelligence.

Downloads

Download data is not yet available.

References

[1] Sung, H., Ferlay, J., Siegel, R. L., et al. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 71(3), 209–249. https://doi.org/10.3322/caac.21660. DOI: https://doi.org/10.3322/caac.21660

[2] Concin, N., Matias-Guiu, X., Cibula, D., et al. (2025). ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: update 2025. Lancet Oncol, 26(8), e423–e435. https://doi.org/10.1016/S1470-2045(25)00167-6. DOI: https://doi.org/10.1016/S1470-2045(25)00167-6

[3] Praiss, A. M., Huang, Y., St Clair, C. M., et al. (2020). A modern assessment of the surgical pathologic spread and nodal dissemination of endometrial cancer. Gynecol Oncol, 157(2), 329–334. https://doi.org/10.1016/j.ygyno.2020.02.014. DOI: https://doi.org/10.1016/j.ygyno.2020.02.014

[4] Siegenthaler, F., Epstein, E., Büchi, C. A., et al. (2023). Prognostic value of lymphovascular space invasion according to the molecular subgroups in endometrial cancer. Int J Gynecol Cancer, 33(11), 1702–1707. https://doi.org/10.1136/ijgc-2023-004606. DOI: https://doi.org/10.1136/ijgc-2023-004606

[5] Hashimoto, C., Shigeta, S., Shimada, M., et al. (2023). Diagnostic Performance of Preoperative Imaging in Endometrial Cancer. Curr Oncol, 30(9), 8233–8244. https://doi.org/10.3390/curroncol30090597. DOI: https://doi.org/10.3390/curroncol30090597

[6] Michalet, M., Azria, D., Tardieu, M., et al. (2021). Radiomics in radiation oncology for gynecological malignancies: a review of literature. Br J Radiol, 94(1125), 20210032. https://doi.org/10.1259/bjr.20210032. DOI: https://doi.org/10.1259/bjr.20210032

[7] Guo, W., Wang, T., Lv, B., et al. (2023). Advances in Radiomics Research for Endometrial Cancer: A Comprehensive Review. J Cancer, 14(18), 3523–3531. https://doi.org/10.7150/jca.89347. DOI: https://doi.org/10.7150/jca.89347

[8] Eminović, S., Babarović, E., Klarić, M., et al. (2024). Blood Vessel Invasion Is an Independent Prognostic Factor in Endometrial Endometrioid Carcinoma Compared to Lymph Vessel Invasion and Myometrial Invasion Pattern. Cancers (Basel), 16(13). https://doi.org/10.3390/cancers16132385. DOI: https://doi.org/10.3390/cancers16132385

[9] Ayhan, A., Şahin, H., Sari, M. E., et al. (2019). Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer. Int J Gynecol Cancer, 29(3), 505–512. https://doi.org/10.1136/ijgc-2018-000069. DOI: https://doi.org/10.1136/ijgc-2018-000069

[10] Narayan, K., Lin, M. Y., Kondalsamy-Chennakesavan, S., et al. (2021). Lymphovascular Space Invasion (LVSI)-Based Prognostic Clusters in Endometrial Cancer Patients Treated with Primary Surgery and Adjuvant Radiotherapy. Indian Journal of Gynecologic Oncology, 19(4), 63. https://doi.org/10.1007/s40944-021-00566-0. DOI: https://doi.org/10.1007/s40944-021-00566-0

[11] Zanfagnin, V., Huang, Y., Mc Gree, M. E., et al. (2019). Predictors of extensive lymphatic dissemination and recurrences in node-positive endometrial cancer. Gynecologic Oncology, 154(3), 480–486. https://doi.org/10.1016/j.ygyno.2019.07.006. DOI: https://doi.org/10.1016/j.ygyno.2019.07.006

[12] Bereby-Kahane, M., Dautry, R., Matzner-Lober, E., et al. (2020). Prediction of tumor grade and lymphovascular space invasion in endometrial adenocarcinoma with MR imaging-based radiomic analysis. Diagn Interv Imaging, 101(6), 401–411. https://doi.org/10.1016/j.diii.2020.01.003. DOI: https://doi.org/10.1016/j.diii.2020.01.003

[13] Zwanenburg, A., Vallières, M., Abdalah, M. A., et al. (2020). The Image Biomarker Standardization Initiative: Standardized Quantitative Radiomics for High-Throughput Image-based Phenotyping. Radiology, 295(2), 328–338. https://doi.org/10.1148/radiol.2020191145. DOI: https://doi.org/10.1148/radiol.2020191145

[14] Lefebvre, T. L., Ueno, Y., Dohan, A., et al. (2022). Development and Validation of Multiparametric MRI-based Radiomics Models for Preoperative Risk Stratification of Endometrial Cancer. Radiology, 305(2), 375–386. https://doi.org/10.1148/radiol.212873. DOI: https://doi.org/10.1148/radiol.212873

[15] Ma, W., Meng, W., Yin, J., et al. (2025). Predictive value of models based on MRI radiomics and clinical indicators for lymphovascular space invasion in endometrial cancer. BMC Cancer, 25(1), 796. https://doi.org/10.1186/s12885-025-14217-6. DOI: https://doi.org/10.1186/s12885-025-14217-6

[16] Luo, Y., Mei, D., Gong, J., et al. (2020). Multiparametric MRI-Based Radiomics Nomogram for Predicting Lymphovascular Space Invasion in Endometrial Carcinoma. J Magn Reson Imaging, 52(4), 1257–1262. https://doi.org/10.1002/jmri.27142. DOI: https://doi.org/10.1002/jmri.27142

[17] Zhang, K., Zhang, Y., Fang, X., et al. (2021). Nomograms of Combining Apparent Diffusion Coefficient Value and Radiomics for Preoperative Risk Evaluation in Endometrial Carcinoma. Front Oncol, 11, 705456. https://doi.org/10.3389/fonc.2021.705456. DOI: https://doi.org/10.3389/fonc.2021.705456

[18] Renton, M., Fakhriyehasl, M., Weiss, J., et al. (2024). Multiparametric MRI radiomics for predicting disease-free survival and high-risk histopathological features for tumor recurrence in endometrial cancer. Front Oncol, 14, 1406858. https://doi.org/10.3389/fonc.2024.1406858. DOI: https://doi.org/10.3389/fonc.2024.1406858

[19] Li, X., Dessi, M., Marcus, D., et al. (2023). Prediction of Deep Myometrial Infiltration, Clinical Risk Category, Histological Type, and Lymphovascular Space Invasion in Women with Endometrial Cancer Based on Clinical and T2-Weighted MRI Radiomic Features. Cancers (Basel), 15(8). https://doi.org/10.3390/cancers15082209. DOI: https://doi.org/10.3390/cancers15082209

[20] Miccò, M., Gui, B., Russo, L., et al. (2022). Preoperative Tumor Texture Analysis on MRI for High-Risk Disease Prediction in Endometrial Cancer: A Hypothesis-Generating Study. J Pers Med, 12(11). https://doi.org/10.3390/jpm12111854. DOI: https://doi.org/10.3390/jpm12111854

[21] Yan, B., Zhao, T., Li, Z., et al. (2023). An MR-based radiomics nomogram including information from the peritumoral region to predict deep myometrial invasion in stage I endometrioid adenocarcinoma: a preliminary study. Br J Radiol, 96(1151), 20230026. https://doi.org/10.1259/bjr.20230026. DOI: https://doi.org/10.1259/bjr.20230026

[22] Chen, J., Wang, X., Lv, H., et al. (2023). Development and external validation of a clinical-radiomics nomogram for preoperative prediction of LVSI status in patients with endometrial carcinoma. J Cancer Res Clin Oncol, 149(15), 13943–13953. https://doi.org/10.1007/s00432-023-05044-y. DOI: https://doi.org/10.1007/s00432-023-05044-y

[23] Liu, X., Yan, B., Li, Y., et al. (2022). Radiomics feature as a preoperative predictive of lymphovascular invasion in early-stage endometrial cancer: A multicenter study. Front Oncol, 12, 966529. https://doi.org/10.3389/fonc.2022.966529. DOI: https://doi.org/10.3389/fonc.2022.966529

[24] Yi, Q., Wang, Y., Zou, S., et al. (2025). A comprehensive magnetic resonance imaging-based model for predicting lymphovascular space invasion in endometrial cancer: a retrospective observational study. Quant Imaging Med Surg, 15(12), 12522–12534. https://doi.org/10.21037/qims-2025-1031. DOI: https://doi.org/10.21037/qims-2025-1031

[25] Wang, Y., Liu, W., Lu, Y., et al. (2024). Fully Automated Identification of Lymph Node Metastases and Lymphovascular Invasion in Endometrial Cancer From Multi-Parametric MRI by Deep Learning. J Magn Reson Imaging, 60(6), 2730–2742. https://doi.org/10.1002/jmri.29344. DOI: https://doi.org/10.1002/jmri.29344

[26] Luo, H., Cheng, J., Wang, K., et al. (2025). An integrated radiomics and deep learning model on multisequence MRI for preoperative prediction of lymphovascular space invasion in endometrial cancer. BMC Med Imaging, 26(1), 22. https://doi.org/10.1186/s12880-025-02091-4. DOI: https://doi.org/10.1186/s12880-025-02091-4

[27] Yan, R., Zhang, X., Cao, Q., et al. (2025). Multitask Deep Learning for Automated Segmentation and Prognostic Stratification of Endometrial Cancer via Biparametric MRI. J Magn Reson Imaging, 62(4), 1009–1020. https://doi.org/10.1002/jmri.70012. DOI: https://doi.org/10.1002/jmri.70012

[28] Lecointre, L., Dana, J., Lodi, M., et al. (2021). Artificial intelligence-based radiomics models in endometrial cancer: A systematic review. Eur J Surg Oncol, 47(11), 2734–2741. https://doi.org/10.1016/j.ejso.2021.06.023. DOI: https://doi.org/10.1016/j.ejso.2021.06.023

[29] Stanzione, A., Cuocolo, R., Del Grosso, R., et al. (2021). Deep Myometrial Infiltration of Endometrial Cancer on MRI: A Radiomics-Powered Machine Learning Pilot Study. Acad Radiol, 28(5), 737–744. https://doi.org/10.1016/j.acra.2020.02.028. DOI: https://doi.org/10.1016/j.acra.2020.02.028

[30] Li, Q., Huang, Y., Xia, Y., et al. (2023). Radiogenomics for predicting microsatellite instability status and PD-L1 expression with machine learning in endometrial cancers: A multicenter study. Heliyon, 9(12), e23166. https://doi.org/10.1016/j.heliyon.2023.e23166. DOI: https://doi.org/10.1016/j.heliyon.2023.e23166

[31] Petrila, O., Stefan, A., Gafitanu, D., et al. (2023). The Applicability of Artificial Intelligence in Predicting the Depth of Myometrial Invasion on MRI Studies-A Systematic Review. Diagnostics (Basel), 13(15). https://doi.org/10.3390/diagnostics13152592. DOI: https://doi.org/10.3390/diagnostics13152592

Downloads

Published

30-10-2026

Issue

Section

Articles