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Liyanage A, Cardoza S, Kasabia D, Moore H. Accuracy of MRI in predicting deep myometrial invasion in endometrial cancer and the influence of leiomyoma, adenomyosis and the microcystic elongated and fragmented tumour pattern. J Med Imaging Radiat Oncol 2024; 68:235-242. [PMID: 38377045 DOI: 10.1111/1754-9485.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/29/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The most common form of endometrial cancer is Type 1 endometrioid adenocarcinoma. Depth of myometrial invasion is the most important prognostic factor correlating with overall patient survival. The objective was to investigate how accurate magnetic resonance imaging (MRI) is in predicting the depth of myometrial invasion in preoperative assessment, and the influence of leiomyoma and/or adenomyosis, or microcystic, elongated and fragmented (MELF) pattern of invasion on MRI diagnostic performance. METHOD Retrospective audit of 235 endometrial cancer patients from the regional Gynaecology Oncology multidisciplinary meeting at Auckland City Hospital, between January 2020 and January 2021. Radiologist assigned stage was compared to histopathology. Presence of leiomyoma, adenomyosis and MELF pattern evaluated followed by analysis under a Biostatistician's supervision. RESULTS Overall MRI diagnostic accuracy for depth of myometrial invasion was 86%. For deep myometrial invasion, MRI had a sensitivity of 72% and specificity 91%. Out of the misreported 32/235 cases, 16 demonstrated fibroids and/or adenomyosis leading to a sensitivity of 57% and specificity 93% for deep invasion, compared with 94% and 74% respectively in the population without, demonstrating statistical significance. Thirty seven cases with MELF pattern of invasion showed a sensitivity of 81% and specificity 80% for deep invasion, compared with 63% and 92% respectively in the group without, demonstrating no statistical significance. CONCLUSION MRI assessment of the depth of myometrial invasion in endometrial cancer has high accuracy. In the presence of background uterine fibroids/adenomyosis, pre-operative MRI accuracy of evaluating deep invasion shows a statistically significant reduction.
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Affiliation(s)
- Anuja Liyanage
- Department of Radiology, Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Supriya Cardoza
- Te Whatu Ora Counties Manukau Hospital, Auckland, New Zealand
| | - Darshna Kasabia
- Te Whatu Ora Counties Manukau Hospital, Auckland, New Zealand
| | - Helen Moore
- Te Whatu Ora Auckland City Hospital, Auckland Radiology Group, Auckland, New Zealand
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Fujii S, Gonda T, Yunaga H. Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging: Revisited. Invest Radiol 2024; 59:78-91. [PMID: 37493356 DOI: 10.1097/rli.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ABSTRACT Diffusion-weighted imaging (DWI) is an increasingly valuable sequence in daily clinical practice, providing both functional and morphological information. The use of DWI can help quantify diffusion using the apparent diffusion coefficient, which reflects the physiological features of the tissue and tumor microcirculation. This knowledge is crucial for understanding and interpreting gynecological imaging. This article reviews the clinical utility of DWI for gynecological imaging, highlighting its ability to aid in the detection of endometrial and cervical cancers, as well as tumor extension and metastasis. In addition, DWI can easily detect the solid components of ovarian cancer (including dissemination), assist in the diagnosis of adnexal torsion, and potentially show bone marrow status. Apparent diffusion coefficient measurement is useful for differentiating between endometrial lesions, uterine leiomyomas, and sarcomas, and may provide important information for predicting the prognosis of gynecological cancers.
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Affiliation(s)
- Shinya Fujii
- From the Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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Kido A, Himoto Y, Kurata Y, Minamiguchi S, Nakamoto Y. Preoperative Imaging Evaluation of Endometrial Cancer in FIGO 2023. J Magn Reson Imaging 2023. [PMID: 38146775 DOI: 10.1002/jmri.29161] [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: 06/14/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
The staging of endometrial cancer is based on the International Federation of Gynecology and Obstetrics (FIGO) staging system according to the examination of surgical specimens, and has revised in 2023, 14 years after its last revision in 2009. Molecular and histological classification has incorporated to new FIGO system reflecting the biological behavior and prognosis of endometrial cancer. Nonetheless, the basic role of imaging modalities including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography, as a preoperative assessment of the tumor extension and also the evaluation points in CT and MRI imaging are not changed, other than several point of local tumor extension. In the field of radiology, it has also undergone remarkable advancement through the rapid progress of computational technology. The application of deep learning reconstruction techniques contributes the benefits of shorter acquisition time or higher quality. Radiomics, which extract various quantitative features from the images, is also expected to have the potential for the quantitative prediction of risk factors such as histological types and lymphovascular space invasion, which is newly included in the new FIGO system. This article reviews the preoperative imaging diagnosis in new FIGO system and recent advances in imaging analysis and their clinical contributions in endometrial cancer. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Aki Kido
- Department Radiology, Toyama University Hospital, Toyama, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | | | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
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Cubo-Abert M, Rodríguez-Mías NL, Bradbury M, Pérez-Hoyos S, Vera M, García-Jiménez Á, Gómez-Cabeza JJ, Capell-Morell M, Pérez-Benavente MA, Díaz-Feijoo B, Gil-Moreno A. Can the microcystic, elongated and fragmented pattern of invasion influence the evaluation of the depth of myometrial invasion in low-grade endometrioid endometrial cancer using imaging techniques? ULTRASOUND (LEEDS, ENGLAND) 2023; 31:292-299. [PMID: 37929250 PMCID: PMC10621491 DOI: 10.1177/1742271x231157618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/28/2023] [Indexed: 11/07/2023]
Abstract
Objectives The microcystic, elongated and fragmented pattern of invasion can be associated with an underestimation of the depth of myometrial invasion by imaging techniques. We aimed to evaluate the influence of microcystic, elongated and fragmented pattern of invasion in the diagnostic performance of transvaginal ultrasound scan and magnetic resonance imaging for the prediction of the depth of myometrial invasion in low-grade endometrioid endometrial carcinomas. Methods Prospective and consecutive study including all low-grade (G1-G2) endometrioid endometrial carcinomas diagnosed between October 2013 and July 2018 in a tertiary hospital. Preoperative staging was performed with transvaginal ultrasound scan and/or magnetic resonance imaging followed by surgical staging. Final histology was considered as the reference standard. Sensitivity, specificity and diagnostic accuracy for the prediction of depth of myometrial invasion was calculated for both imaging techniques. The STARD 2015 guidelines were used. Results A total of 136 patients were consecutively included. Transvaginal ultrasound scan was performed in 132 patients and magnetic resonance imaging in 119 patients. The diagnostic accuracy of transvaginal ultrasound scan for the prediction of depth of myometrial invasion in the microcystic, elongated and fragmented negative group (82% (95% confidence interval = 73-88)) was higher compared to the microcystic, elongated and fragmented positive group (61% (95% confidence interval = 36-83)). The diagnostic accuracy of magnetic resonance imaging was also higher in the microcystic, elongated and fragmented negative group (80% (95% confidence interval = 71-87)) compared to the microcystic, elongated and fragmented positive (47% (95% confidence interval = 21-73)). Conclusions In low-grade endometrioid endometrial carcinomas with a positive microcystic, elongated and fragmented pattern of invasion, the evaluation of the depth of myometrial invasion using transvaginal ultrasound scan and magnetic resonance imaging may be underestimated.
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Affiliation(s)
- Montserrat Cubo-Abert
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Nuria-Laia Rodríguez-Mías
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melissa Bradbury
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Statistics and Bioinformatics Unit, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marta Vera
- Radiology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángel García-Jiménez
- Servicio de Anatomía Patológica, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan-José Gómez-Cabeza
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat Capell-Morell
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria-Assumpció Pérez-Benavente
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Berta Díaz-Feijoo
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Gynecology Service, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- CIBERONC, Barcelona, Spain
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Pergialiotis V, Zachariou E, Vlachos DE, Vlachos A, Goula K, Thomakos N, Rodolakis A, Haidopoulos D. Tumor free distance from serosa and survival rates of endometrial cancer patients: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 286:16-22. [PMID: 37167809 DOI: 10.1016/j.ejogrb.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
Myometrial invasion and its extent have been directly associated with the risk of relapse as well as the overall survival of endometrial cancer patients. Tumor free distance from the serosal surface of the uterine wall has been investigated the last years by several studies, however, to date, its importance remains unknown. The present meta-analysis is based on a systematic search of the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases and has been designed according to the PRISMA guidelines. Nine studies were included in the present systematic review that recruited pathology slides from 1,598 endometrial cancer patients and their meta-analysis indicated that TFD was significantly associated with the progression free survival of patients with endometrial cancer (OR 0.36, 95% CI 0.20, 0.65). The disease specific survival was not affected by the TFD (OR 0.30, 95% CI 0.09, 1.01). Sensitivity analyses revealed, however, that both the progression free and overall survival rates were associated with TFD. Significant discrepancies were observed in terms of histological subtypes and stage of the disease among included patients, hence, the actual importance of TFD in specific subgroups remains unknown. Future studies must evaluate the importance of this pathology marker particularly in patients with endometrioid subtypes and early-stage disease, as it is believed that in this group its importance will be more predictive as it will not be skewed by the presence of more important factors such as more aggressive histology and advanced stage disease.
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Affiliation(s)
- Vasilios Pergialiotis
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece.
| | - Eleftherios Zachariou
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Efthymios Vlachos
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Athanasios Vlachos
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | | | - Nikolaos Thomakos
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Alexandros Rodolakis
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Haidopoulos
- 1(st) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
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Qi X, Zhu L, Zhang B. Clinicopathologic association and prognostic impact of microcystic, elongated and fragmented pattern invasion, combined with tumor budding in endometrioid endometrial cancer. J Obstet Gynaecol Res 2022; 48:2431-2441. [PMID: 35769021 DOI: 10.1111/jog.15335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022]
Abstract
AIM As a special invasive pattern seen in low-grade endometrial carcinoma, microcystic, elongated and fragmented (MELF) pattern is related to lymph node metastasis. Tumor budding (TB) is another histological marker in many cancers associated with tumor aggressiveness. Herein, we evaluated the impact of MELF pattern combined with TB about clinicopathological features and prognosis in endometrioid endometrial cancer (EEC). To verify the relationship between the two morphological markers and microsatellite status in EEC, the primary mismatch repair (MMR) proteins were detected by immunohistochemistry. METHODS One hundred and seventy-two cases of ECC diagnosed between 2011 and 2016 were reviewed with a median follow up of 47.5 months. MELF pattern and TB were examined on all H&E-stained slides. Primary MMR proteins (MLH1, MSH2, MSH6, and PMS2) were also detected. RESULTS Based on MELF pattern and TB, 172 patients were divided into the following four groups: MELF(-)/TB(+) (n = 41), MELF(+)/TB(-) (n = 15), MELF(+)/TB(+) (n = 20), and MELF(-)/TB(-) (n = 96). Adverse pathological features were observed in the MELF(+)/TB(+) group: 70% presented deep muscular infiltration, 65% were lymphovascular space invasion, and 25% suffered lymph node metastasis. The proportion of MMR deficient in MELF(+)/TB(-) group was the highest (66.7%). The progression-free survival (PFS) and overall survival (OS) among the four groups were significantly different. MELF(+)/TB(+) group showed the worst PFS and OS. As univariate and multivariate survival analyses revealed, the combination of MELF pattern and TB was confirmed as an independent predictor of poor prognosis. CONCLUSIONS Our research demonstrates that MELF pattern combined with TB, as an independent predictor of adverse outcome, is associated with adverse pathological features, which facilitates better understanding of EEC tumor behavior and more precise prognosis without additional medical expense.
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Affiliation(s)
- Xiqin Qi
- Department of Obstetrics and Gynecology, Xuzhou Central Hospital affiliated to Nanjing University of Traditional Chinese Medicine, Xuzhou, China.,Department of Obstetrics and Gynecology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second Hospital, Huaian, China
| | - Lun Zhu
- Department of Pathology, The Affiliated Huaian Hospital of Xuzhou Medical University and Huaian Second Hospital, Huaian, China
| | - Bei Zhang
- Department of Obstetrics and Gynecology, Xuzhou Central Hospital affiliated to Nanjing University of Traditional Chinese Medicine, Xuzhou, China
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MRI and Adenomyosis: What Can Radiologists Evaluate? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105840. [PMID: 35627376 PMCID: PMC9140978 DOI: 10.3390/ijerph19105840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
Uterine adenomyosis is a common benign condition defined by the presence of heterotopic endometrial glands and stroma within the myometrium. Adenomyosis is often related to infertility and other adverse pregnancy outcomes. Modern imaging techniques allow the non-invasive diagnosis of adenomyosis and, in this framework, Magnetic Resonance Imaging (MRI) has assumed a central role due to its high diagnostic accuracy in the detection of adenomyosis. Currently, there is still a lack of international consensus on adenomyosis diagnostic criteria and classification, despite the fact that an agreed reporting system would promote treatment outcomes and research. This review aims to emphasize the important contribution of MRI to the diagnosis of adenomyosis and to highlight how, thanks to the great tissue differentiation provided by MRI, it is possible to identify the main direct (cystic component) and indirect (junctional zone features) signs of adenomyosis and to distinguish its various subtypes according to different MRI-based classifications. We also explored the main MRI criteria to identify the most common pitfalls and differential diagnoses of adenomyosis, whose features should be considered to avoid misdiagnosis.
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Motovilova E, Tan ET, Taracila V, Vincent JM, Grafendorfer T, Shin J, Potter HG, Robb FJL, Sneag DB, Winkler SA. Stretchable self-tuning MRI receive coils based on liquid metal technology (LiquiTune). Sci Rep 2021; 11:16228. [PMID: 34376703 PMCID: PMC8355233 DOI: 10.1038/s41598-021-95335-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/23/2021] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging systems rely on signal detection via radiofrequency coil arrays which, ideally, need to provide both bendability and form-fitting stretchability to conform to the imaging volume. However, most commercial coils are rigid and of fixed size with a substantial mean offset distance of the coil from the anatomy, which compromises the spatial resolution and diagnostic image quality as well as patient comfort. Here, we propose a soft and stretchable receive coil concept based on liquid metal and ultra-stretchable polymer that conforms closely to a desired anatomy. Moreover, its smart geometry provides a self-tuning mechanism to maintain a stable resonance frequency over a wide range of elongation levels. Theoretical analysis and numerical simulations were experimentally confirmed and demonstrated that the proposed coil withstood the unwanted frequency detuning typically observed with other stretchable coils (0.4% for the proposed coil as compared to 4% for a comparable control coil). Moreover, the signal-to-noise ratio of the proposed coil increased by more than 60% as compared to a typical, rigid, commercial coil.
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Affiliation(s)
- Elizaveta Motovilova
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA ,grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Ek Tsoon Tan
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Victor Taracila
- grid.418143.b0000 0001 0943 0267GE Healthcare, Aurora, OH USA
| | - Jana M. Vincent
- grid.418143.b0000 0001 0943 0267GE Healthcare, Aurora, OH USA
| | | | - James Shin
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA
| | - Hollis G. Potter
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | | | - Darryl B. Sneag
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Simone A. Winkler
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA
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