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Tsuchihashi S, Nagawa K, Shimizu H, Inoue K, Okada Y, Baba Y, Hasegawa K, Yasuda M, Kozawa E. Evaluation of Uterine Carcinosarcoma and Uterine Endometrial Carcinoma Using Magnetic Resonance Imaging Findings and Texture Features. Cureus 2024; 16:e55916. [PMID: 38601366 PMCID: PMC11003876 DOI: 10.7759/cureus.55916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/12/2024] Open
Abstract
Aim This study aimed to evaluate the diagnostic feasibility of magnetic resonance imaging (MRI) findings and texture features (TFs) for differentiating uterine endometrial carcinoma from uterine carcinosarcoma. Methods This retrospective study included 102 patients who were histopathologically diagnosed after surgery with uterine endometrial carcinoma (n=68) or uterine carcinosarcoma (n=34) between January 2008 and December 2021. We assessed conventional MRI findings and measurements (cMRFMs) and TFs on T2-weighted images (T2WI) and apparent diffusion coefficient (ADC) map, as well as their combinations, in differentiating between uterine endometrial carcinoma and uterine carcinosarcoma. The least absolute shrinkage and selection operator (LASSO) was used to select three features with the highest absolute value of the LASSO regression coefficient for each model and construct a discriminative model. Binary logistic regression analysis was used to analyze the disease models and conduct receiver operating characteristic analyses on the cMRFMs, T2WI-TFs, ADC-TFs, and their combined model to compare the two diseases. Results A total of four models were constructed from each of the three selected features. The area under the curve (AUC) of the discriminative model using these features was 0.772, 0.878, 0.748, and 0.915 for the cMRFMs, T2WI-TFs, ADC-TFs, and a combined model of cMRFMs and TFs, respectively. The combined model showed a higher AUC than the other models, with a high diagnostic performance (AUC=0.915). Conclusion A combined model using cMRFMs and TFs might be helpful for the differential diagnosis of uterine endometrial carcinoma and uterine carcinosarcoma.
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Affiliation(s)
- Saki Tsuchihashi
- Department of Radiology, Saitama Medical University Hospital, Saitama, JPN
- Department of Radiology, Japanese Red Cross Ogawa Hospital, Saitama, JPN
| | - Keita Nagawa
- Department of Radiology, Saitama Medical University Hospital, Saitama, JPN
| | - Hirokazu Shimizu
- Department of Radiology, Saitama Medical University Hospital, Saitama, JPN
| | - Kaiji Inoue
- Department of Radiology, Saitama Medical University Hospital, Saitama, JPN
| | - Yoshitaka Okada
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Masanori Yasuda
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University Hospital, Saitama, JPN
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Zadeh N, Bhatt A, Sripiparu V, Pasli M, Edwards G, Larkins MC, Peach MS. Malignant mixed mullerian tumors: a SEER database review of rurality and treatment modalities on disease outcome. Front Oncol 2024; 14:1296496. [PMID: 38390260 PMCID: PMC10881697 DOI: 10.3389/fonc.2024.1296496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Malignant Mixed Mullerian Tumors (MMMT) are rare and poorly understood sarcomas with limited research on risk factors, pathogenesis, and optimal treatments. This study aimed to address this knowledge gap and explore the impact of community size, patient characteristics, disease characteristics, and treatment modalities on MMMT outcomes. Methods Using the Surveillance, Epidemiology, and End Results database (SEER), the largest SEER cohort to date of 3,352 MMMT patients was analyzed for demographic factors, treatment modalities, and histologic characteristics. Data was processed, including the removal of incomplete entries, and analyzed in Python 3.1 using packages scikit-learn, lifelines, and torch; log-rank analysis and Cox proportional hazards models were used to evaluate a number of demographic characteristics and disease characteristics for significance in regard to survival. Results Our study found adjuvant radiotherapy and chemotherapy significantly improved survival, with modest benefits from neoadjuvant chemotherapy. Our findings also suggest age at diagnosis, disease grade, and suburban versus rural geographic locations may play key roles in patient prognosis. On multivariable analysis both disease Grade and surgical treatment were significant factors. Discussion MMMTs remain challenging, but appropriate treatment appears to enhance survival. The present findings suggest opportunities for improved outcomes and treatment strategies for patients with MMMTs.
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Affiliation(s)
- Neusha Zadeh
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Buies Creek, NC, United States
| | - Arjun Bhatt
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Vaishnavi Sripiparu
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Melisa Pasli
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - George Edwards
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Michael C Larkins
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - M Sean Peach
- Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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Yue XN, He XY, Wu JJ, Fan W, Zhang HJ, Wang CW. Endometrioid adenocarcinoma: combined multiparametric MRI and tumour marker HE4 to evaluate tumour grade and lymphovascular space invasion. Clin Radiol 2023; 78:e574-e581. [PMID: 37183140 DOI: 10.1016/j.crad.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/06/2022] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
AIM To assess the value of semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and quantitative diffusion-weighted imaging parameters combined with human epididymis protein 4 (HE4) in predicting the pathological grade and lymphovascular space invasion (LVSI) of endometrioid adenocarcinoma (EAC). MATERIALS AND METHODS Between October 2018 and December 2021, 60 women (mean age, 55 [range, 32-77] years) with EAC underwent preoperative pelvic MRI and HE4 level measurements. The positive enhancement integral (PEI), time to peak, maximum slope of increase (MSI), and maximum slope of decrease were measured by manually drawing a region of interest on the neoplastic tissue. The receiver operating characteristic curve was used to calculate the diagnostic efficiency of the single parameter and combined factors. RESULTS Lower apparent diffusion coefficients (ADCs) were observed in high-grade tumours (G3) than in low-grade tumours (G1/G2). PEI, MSI, and HE4 levels were higher in the high-grade tumours than in the low-grade tumours (p<0.05). The area under the curve (AUC) for G3 diagnosis using multiparametric MRI combined with HE4 was 0.929. ADC values were significantly lower in the EAC with LVSI than in those without LVSI. Tumours with LVSI showed higher PEI and HE4 levels than those without LVSI (p<0.05). The AUC for LVSI-positive diagnosis using multiparametric MRI combined with HE4 was 0.814. CONCLUSION Semi-quantitative DCE-MRI, ADC values, and serum HE4 levels can be used to predict tumour grade and LVSI, and the prediction efficiency of multiparametric MRI combined with serum HE4 is better than that of any single factor.
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Affiliation(s)
- X N Yue
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - X Y He
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - J J Wu
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - W Fan
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - H J Zhang
- Department of Pathology, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - C W Wang
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China.
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Kitajima K, Kihara T, Kawanaka Y, Kido A, Yoshida K, Mizumoto Y, Tomiyama A, Okuda S, Jinzaki M, Kato F, Takahama J, Takahata A, Fukukura Y, Nakamoto A, Tsujikawa T, Munechika J, Ohgiya Y, Kawai N, Goshima S, Ohya A, Fujinaga Y, Fukunaga T, Fujii S, Tanabe M, Ito K, Tsuboyama T, Kanie Y, Umeoka S, Ichikawa S, Motosugi U, Daido S, Kido A, Tamada T, Matsuki M, Yamashiro T, Yamakado K. Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis - Japan multicenter study. Oncotarget 2020; 11:3675-3686. [PMID: 33088427 PMCID: PMC7546756 DOI: 10.18632/oncotarget.27613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival. Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3–151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively. Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3). Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takako Kihara
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yusuke Kawanaka
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Aki Kido
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kotaro Yoshida
- Department of Radiology, Kanazawa University, Graduate School of Medicine Science, Kanazawa, Ichikawa, Japan
| | - Yasunari Mizumoto
- Department of Obstetrics and Gynecology, Kanazawa University, Graduate School of Medicine Science, Kanazawa, Ichikawa, Japan
| | - Akiko Tomiyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Junko Takahama
- Department of Radiology, Nara Medical University, Nara, Japan
| | - Akiko Takahata
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsushi Nakamoto
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Jiro Munechika
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitstu Ohgiya
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Satoshi Goshima
- Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ayumi Ohya
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takeru Fukunaga
- Division of Radiology, Department of Pathophysiological and Therapeutic Sciences, Tottori University, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Sciences, Tottori University, Tottori, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takahiro Tsuboyama
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yuichiro Kanie
- Department of Radiology, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan
| | - Shigeaki Umeoka
- Department of Radiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Sayaka Daido
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, Okayama, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Okayama, Japan
| | - Mitsuru Matsuki
- Department of Diagnostic Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Kitajima K, Kihara T, Kawanaka Y, Takahama J, Ueno Y, Murakami T, Yoshida K, Kato F, Takahata A, Fukukura Y, Munechika J, Fujinaga Y, Fukunaga T, Tanabe M, Kanie Y, Kido A, Tamada T, Yoshida R, Kamishima Y, Yamakado K. Characteristics of MR Imaging for Staging and Survival Analysis of Neuroendocrine Carcinoma of the Endometrium: A Multicenter Study in Japan. Magn Reson Med Sci 2020; 20:236-244. [PMID: 32713870 PMCID: PMC8424029 DOI: 10.2463/mrms.mp.2020-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: This study aimed to examine MRI features and staging of neuroendocrine carcinoma (NEC) of the endometrium and evaluate survival. Methods: Clinical data, pathological, and preoperative pelvic MRI findings in 22 patients with histologically surgery-proven endometrial NEC were retrospectively reviewed. Tumors were pure NEC (n = 10) or mixed histotype (n = 12), with 13 large and nine small cell type. Results: International Federation of Gynecology and Obstetrics (FIGO) staging was I, II, III, and IV in 6, 2, 12, and 2 patients, respectively. In 13 (76.4%) of 17 patients with pathological deep myometrial invasion, MRI showed abnormal diffusely infiltrative high T2 signal intensity throughout the myometrium with loss of normal uterine architecture. All tumors had restricted diffusion (apparent diffusion coefficient map low signal intensity, diffusion weighted imaging high signal intensity). Accuracy of T staging by MRI for all cases was 81.8%, with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for detecting metastatic pelvic lymph nodes was 60.0%, 100%, and 77.8%, respectively. Two intrapelvic peritoneal dissemination cases were detected by MRI. During follow-up (mean 30.4, range 3.3–138.4 months), 16 patients (72.7%) experienced recurrence and 12 (54.5%) died of disease. Two-year disease-free and overall survival rates for FIGO I, II, III, and IV were 66.7% and 83.3%, 50% and 100%, 10% and 33.3%, and 0% and 0%, respectively. Conclusion: Abnormal diffusely infiltrative high T2 signal intensity throughout the myometrium with normal uterine architecture loss and obvious restricted diffusion throughout the tumor are suggestive features of endometrial NEC. Pelvic MRI is reliable for intrapelvic staging of affected patients.
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Affiliation(s)
| | - Takako Kihara
- Department of Surgical Pathology, Hyogo College of Medicine
| | | | | | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine
| | | | - Kotaro Yoshida
- Department of Radiology, Graduate School of Medicine Science, Kanazawa University
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Akiko Takahata
- Department of Radiology, Kyoto Prefectural University of Medicine
| | - Yoshihiko Fukukura
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Jiro Munechika
- Department of Radiology, Showa University School of Medicine
| | | | - Takeru Fukunaga
- Department of Pathophysiological and Therapeutic Sciences, Tottori University
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine
| | - Yuichiro Kanie
- Department of Radiology, Japanese Red Cross Society Himeji Hospital
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School
| | | | - Rika Yoshida
- Department of Radiology, Faculty of Medicine, Shimane University
| | - Yuki Kamishima
- Department of Radiology, Nagoya City West Medical Center
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