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Gul P, Gul K, Altaf MO, Javaid A, Ashraf J. The Accuracy of MRI in the Local Staging of Endometrial Cancer: An Experience From a Tertiary Care Oncology Institute in Pakistan. Cureus 2022; 14:e31053. [DOI: 10.7759/cureus.31053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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2
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Daix M, Angeles MA, Migliorelli F, Kakkos A, Martinez Gomez C, Delbecque K, Mery E, Tock S, Gabiache E, Decuypere M, Goffin F, Martinez A, Ferron G, Kridelka F. Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology in early-stage endometrial cancer. J Gynecol Oncol 2021; 32:e48. [PMID: 33908709 PMCID: PMC8192240 DOI: 10.3802/jgo.2021.32.e48] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate the concordance between preoperative European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO)-European SocieTy for Radiotherapy and Oncology (ESTRO) risk classification in early-stage endometrial cancer (EC) assessed by biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen. Methods This bicentric retrospective study included women diagnosed with early-stage EC (≤stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into 3 degrees of risk of lymph node (LN) involvement based on biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with weighted Cohen's kappa coefficient. Results A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to biopsy in 18% and in 7% to both (p<0.001). Kappa coefficient for concordance was 0.25 for MRI and 0.73 for biopsy. Conclusion Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low-risk patients to decrease the indication of second surgery for re-staging and/or to avoid toxicity of adjuvant radiotherapy.
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Affiliation(s)
- Manon Daix
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium.,Department of Gynecology, Centre Hospitalier Chrétien - Mont Légia, Liège, Belgium.
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology, Centre Hospitalier Intercommunal des Vallées de l'Ariège, Saint Jean de Verges, France
| | - Athanasios Kakkos
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Carlos Martinez Gomez
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Katty Delbecque
- Department of Pathology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Eliane Mery
- Department of Pathology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | - Stéphanie Tock
- Department of Gynecology, Centre Hospitalier Chrétien - Mont Légia, Liège, Belgium
| | - Erwan Gabiache
- Department of Medical Imaging, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | | | - Frédéric Goffin
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Frédéric Kridelka
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
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Bi Q, Bi G, Wang J, Zhang J, Li H, Gong X, Ren L, Wu K. Diagnostic Accuracy of MRI for Detecting Cervical Invasion in Patients with Endometrial Carcinoma: A Meta-Analysis. J Cancer 2021; 12:754-764. [PMID: 33403033 PMCID: PMC7778546 DOI: 10.7150/jca.52797] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative assessment of cervical invasion and to analyse the influence of different imaging protocols in patients with endometrial carcinoma. Methods: An extensive search of articles about MRI for assessing cervical invasion in patients with endometrial carcinoma was performed on PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials from January 2000 to July 2020. Two reviewers independently evaluated the methodological quality of each study by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Diagnostic accuracy results and additional useful information were extracted. The pooled estimation data was obtained by statistical analysis. Results: A total of 42 eligible studies were included in the meta-analysis. Significant evidence of heterogeneity was found for detecting cervical invasion (I2 = 74.1%, P = 0.00 for sensitivity and I2 = 56.2%, P = 0.00 for specificity). The pooled sensitivity and specificity of MRI were 0.58 and 0.95 respectively. The use of higher field strength (3.0 T) demonstrated higher pooled sensitivity (0.74). Using diffusion weighted imaging (DWI) alone presented higher pooled sensitivity (0.86) than using other sequences. The studies that used dynamic contrast-enhanced MRI (DCE-MRI) alone showed higher sensitivity (0.80) and specificity (0.96) than those that used T2-weighted imaging (T2WI) alone. Conclusions: MRI shows high specificity for detecting cervical infiltration in endometrial carcinoma. Using DWI or a 3.0-T device may improve the pooled sensitivity. DCE-MRI demonstrates higher pooled sensitivity and specificity than T2WI.
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Affiliation(s)
- Qiu Bi
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Guoli Bi
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Junna Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan, China
| | - Jie Zhang
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Hongliang Li
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Xiarong Gong
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Lixiang Ren
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Kunhua Wu
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
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Kuwahara R, Kido A, Yajima R, Nishio N, Nakao K, Kurata Y, Tanaka S, Minamiguchi S, Baba T, Mandai M, Togashi K. Microcystic, Elongated and Fragmented Pattern Invasion Can Adversely Influence Preoperative Staging for Low-grade Endometrial Carcinoma. Magn Reson Med Sci 2020; 20:20-27. [PMID: 32074591 PMCID: PMC7952211 DOI: 10.2463/mrms.mp.2019-0153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To investigate the influence of microcystic, elongated and fragmented (MELF) pattern invasion on preoperative evaluation of lymph node (LN) metastasis and myometrial invasion in patients with low-grade endometrial carcinoma. Methods: The study included 192 consecutive patients with low-grade endometrial carcinoma who underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI), followed by surgery. One hundred sixty one of 192 patients underwent LN dissection and were analyzed for LN metastasis. All patients were analyzed for myometrial invasion. Presence of enlarged LN was evaluated by using size criteria on CT. Depth of myometrial invasion was evaluated on MRI using T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted imaging comprehensively. Sensitivity and specificity for LN metastasis and deep myometrial invasion were evaluated for MELF group and non-MELF group. The difference of sensitivity between two groups was compared using Chi-square and Fisher’s exact test. Results: MELF pattern invasion was identified in 43/192 patients (22%). LN metastases were observed in 18/39 patients in MELF group and 6/122 patients in non-MELF group for pelvic LN and 11/29 patients in MELF group and 4/57 patients in non-MELF group for para-aortic LN. Sensitivity for the detection of pelvic LN metastasis in MELF group was significantly lower than in non-MELF group (16.7% vs 66.7%). As for the assessment of the deep myometiral invasion, pathological deep myometrial invasion were found in 31/43 patients in MELF group and 32/149 patients in non-MELF group. Sensitivity in MELF group showed lower values than in non-MELF group (54.8% vs 78.1% for reader 1, 54.8% vs 62.5% for reader 2), although there was no statistically significant difference (P = 0.09 for reader 1 and P = 0.72 for reader 2). Conclusion: In case of low-grade endometrial carcinoma with MELF pattern invasion, preoperative staging by CT and MRI have a risk for underestimation.
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Affiliation(s)
- Ryo Kuwahara
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Ryo Yajima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Naoko Nishio
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Kyoko Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
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Xu X, Li N, Chen Y, Ouyang H, Zhao X, Zhou J. Diagnostic efficacy of MRI for pre-operative assessment of ovarian malignancy in endometrial carcinoma: A decision tree analysis. Magn Reson Imaging 2018; 57:285-292. [PMID: 30580078 DOI: 10.1016/j.mri.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/17/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022]
Abstract
AIM Accurate preoperative assessment of ovarian malignancy in endometrial carcinoma helps in determining the decision to preserve the ovaries in individualized treatment. This study adopted decision tree method to evaluate the diagnostic efficiency of pelvic MRI and clinical data of patients for preoperative identification of endometrial carcinoma-combined ovarian malignancy (EC-OM). MATERIAL AND METHODS This retrospective study included a total of 801 patients, and postoperative pathological examinations identified 58 EC-OM group and 743 endometrial carcinoma cases without ovarian malignancy (EC group). Diagnostic efficiency of pelvic MRI in EC-OM was calculated by comparing the clinical data and imaging features of patients in the two groups. Decision tree analysis was performed to screen out associative indexes and establish a diagnostic model for EC-OM. RESULTS Pelvic MRI showed that, EC-OM group showed deeper invasion into the myometrium, and higher percentages of patients with cervical or cornual involvement, or metastasis of lymph nodes or peritoneum than EC group (P = 0.00). Preoperative pelvic MRI showed a sensitivity of 51.72% and a specificity of 99.87% when detecting ovarian malignancy in endometrial carcinoma. Decision tree model obtained a sensitivity of 89.66%, with an AUC (area under ROC curve) of 0.949 (95% CI 0.906, 0.993, P < 0.001). CONCLUSION Decision tree analysis based on pelvic MRI and clinical data of patients showed that the detection rate of ovarian malignancy could be increased for patients with endometrial carcinoma.
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Affiliation(s)
- Xiaojuan Xu
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yan Chen
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Ouyang
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhou
- Department of Gynecology, The Central Hospital of Karamay, Xinjiang, Uyghur Autonomous Region, China.
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Ribeiro JR, Gaudet HM, Khan M, Schorl C, James NE, Oliver MT, DiSilvestro PA, Moore RG, Yano N. Human Epididymis Protein 4 Promotes Events Associated with Metastatic Ovarian Cancer via Regulation of the Extracelluar Matrix. Front Oncol 2018; 7:332. [PMID: 29404274 PMCID: PMC5786890 DOI: 10.3389/fonc.2017.00332] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/26/2017] [Indexed: 01/06/2023] Open
Abstract
Human epididymis protein 4 (HE4) has received much attention recently due to its diagnostic and prognostic abilities for epithelial ovarian cancer. Since its inclusion in the Risk of Ovarian Malignancy Algorithm (ROMA), studies have focused on its functional effects in ovarian cancer. Here, we aimed to investigate the role of HE4 in invasion, haptotaxis, and adhesion of ovarian cancer cells. Furthermore, we sought to gain an understanding of relevant transcriptional profiles and protein kinase signaling pathways mediated by this multifunctional protein. Exposure of OVCAR8 ovarian cancer cells to recombinant HE4 (rHE4) promoted invasion, haptotaxis toward a fibronectin substrate, and adhesion onto fibronectin. Overexpression of HE4 or treatment with rHE4 led to upregulation of several transcripts coding for extracellular matrix proteins, including SERPINB2, GREM1, LAMC2, and LAMB3. Gene ontology indicated an enrichment of terms related to extracellular matrix, cell migration, adhesion, growth, and kinase phosphorylation. LAMC2 and LAMB3 protein levels were constitutively elevated in cells overexpressing HE4 and were upregulated in a time-dependent manner in cells exposed to rHE4 in the media. Deposition of laminin-332, the heterotrimer comprising LAMC2 and LAMB3 proteins, was increased in OVCAR8 cells treated with rHE4 or conditioned media from HE4-overexpressing cells. Enzymatic activity of matriptase, a serine protease that cleaves laminin-332 and contributes to its pro-migratory functional activity, was enhanced by rHE4 treatment in vitro. Proteomic analysis revealed activation of focal adhesion kinase signaling in OVCAR8 cells treated with conditioned media from HE4-overexpressing cells. Focal adhesions were increased in cells treated with rHE4 in the presence of fibronectin. These results indicate a direct role for HE4 in mediating malignant properties of ovarian cancer cells and validate the need for HE4-targeted therapies that will suppress activation of oncogenic transcriptional activation and signaling cascades.
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Affiliation(s)
- Jennifer R. Ribeiro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
| | - Hilary M. Gaudet
- Department of Chemistry, Wheaton College, Norton, MA, United States
| | - Mehreen Khan
- Department of Chemistry, Wheaton College, Norton, MA, United States
| | - Christoph Schorl
- Center for Genomics and Proteomics, Genomics Core Facility, Brown University, Providence, RI, United States
| | - Nicole E. James
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, United States
| | - Matthew T. Oliver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
| | - Paul A. DiSilvestro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
| | - Richard G. Moore
- Department of Obstetrics and Gynecology, Wilmot Cancer Institute, Division of Gynecologic Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Naohiro Yano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
- Roger Williams Medical Center, Department of Surgery, Boston University Medical School, Providence, RI, United States
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7
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Misdiagnosis of a Giant Uterine Leiomyosarcoma: Clinic and Image Challenges. Case Rep Oncol Med 2017; 2017:3568328. [PMID: 28804663 PMCID: PMC5540456 DOI: 10.1155/2017/3568328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022] Open
Abstract
A 41-year-old woman (G3P2L2Ab1) was referred to gynecology clinic with chief complaints of abdominal distension and localized abdominal wall pruritus for three months. She was misdiagnosed with gastrointestinal disorder and ultimately had undergone imaging. Ultrasonography and computed tomography (CT) scan disclosed a huge solid-cystic mass originating from the ovary. On clinical examination the patient had no pain or tenderness and no gynecologic complaints. Laboratory tests showed normal tumor markers and hemoglobin at 8 g/dl. Laparotomy was carried out as diagnosis of ovarian serous cyst adenoma, but a huge tumor with attachment to uterus and ovaries and extension to pelvic floor, peripheral tissues of ureter, and upper abdomen was found. Hysterectomy with bilateral salpingooophorectomy was done. Pathology report demonstrated uterine leiomyosarcoma measuring 40 centimeters and weighing 10 kilograms. In conclusion, as pelvic masses even in a large size may present unspecific symptoms misdiagnosis may occur which lead to overgrowth, local invasion, or other complications. So, it is rather to suggest ultrasonography in patients with persistent abdominal or pelvic symptoms and if needed, more exact diagnostic modalities like magnetic resonance imaging (MRI) could be offered to avoid misdiagnosis and mismanagement.
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8
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Teixeira AMS, Ribeiro R, Schmeler KM, Herzog TJ, Nicolau SM, Marques RM. A preoperative and intraoperative scoring system to predict nodal metastasis in endometrial cancer. Int J Gynaecol Obstet 2017; 137:78-85. [PMID: 28093726 DOI: 10.1002/ijgo.12103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/28/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop a scoring system that guides surgical decision-making regarding the need to perform lymphadenectomy. METHODS A retrospective study was performed of patients who underwent complete surgical staging of endometrial cancer between 2003 and 2014 at three centers in Brazil. Preoperative and intraoperative risk factors were used to develop a scoring system to predict lymph node metastasis. RESULTS Among 329 patients included, 71 (21.6%) had positive lymph nodes and 259 (78.4%) had negative lymph nodes. The characteristics associated with nodal metastasis in univariate analysis included the level of cancer antigen 125 (P<0.001), preoperative histological grade (P<0.001), endometrial thickness (P=0.012), and pathologic features including tumor size (P<0.001), tumor extension (P<0.001), and lower uterine segment involvement (P<0.001). On multivariate logistic regression analysis, tumor grade, tumor extension, and lower uterine segment involvement remained significantly associated. The resulting scoring system showed good accuracy as demonstrated by an area under the receiver operating characteristic curve of 0.858 (95% confidence interval 0.804-0.913). CONCLUSION A highly accurate scoring system for the prediction of lymph node metastasis was developed on the basis of three preoperative and intraoperative risk factors. After validation, this model could greatly aid clinicians in the surgical management of endometrial cancer.
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Affiliation(s)
| | - Reitan Ribeiro
- Surgical Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - Sergio M Nicolau
- Gynecology Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Marques
- Gynecology Department, Universidade Federal de São Paulo, São Paulo, Brazil.,Oncology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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9
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Gangadhar K, Mahajan A, Sable N, Bhargava P. Magnetic Resonance Imaging of Pelvic Masses: A Compartmental Approach. Semin Ultrasound CT MR 2016; 38:213-230. [PMID: 28705369 DOI: 10.1053/j.sult.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.
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Affiliation(s)
- Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Nilesh Sable
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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10
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Body N, Lavoué V, De Kerdaniel O, Foucher F, Henno S, Cauchois A, Laviolle B, Leblanc M, Levêque J. Are preoperative histology and MRI useful for classification of endometrial cancer risk? BMC Cancer 2016; 16:498. [PMID: 27430321 PMCID: PMC4950781 DOI: 10.1186/s12885-016-2554-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background The 2010 guidelines of the French National Cancer Institute (INCa) classify patients with endometrial cancer into three risk groups for lymph node invasion and recurrence on the basis of MRI and histological analysis of an endometrial specimen obtained preoperatively. The classification guides therapeutic choices, which may include pelvic and/or para-aortic lymphadenectomy. The purpose of this study was to evaluate the diagnostic performance of preoperative assessment to help identify intermediate- or high-risk patients requiring lymphadenectomy. Methods The study included all patients who underwent surgery for endometrial cancer between January 2010 and December 2013 at either Rennes University Hospital or Vannes Regional Hospital. The criteria for eligibility included a preoperative assessment with MRI and histological examination of an endometrial sample. A histological comparison was made between the preoperative and surgical specimens. Results Among the 91 patients who underwent a full preoperative assessment, the diagnosis of intermediate- or high-risk endometrial cancer was established by MRI and histology with a sensitivity of 70 %, specificity of 82 %, positive predictive value (PPV) of 87 %, negative predictive value (NPV) of 61 %, positive likelihood ratio (LR+) of 3.8 and negative likelihood ratio (LR-) of 0.3. The risk group was underestimated in 32 % of patients and overestimated in 7 % of patients. MRI underestimated endometrial cancer stage in 20 % of cases, while endometrial sampling underestimated the histological type in 4 % of cases and the grade in 9 % of cases. Conclusion The preoperative assessment overestimated or underestimated the risk of recurrence in nearly 40 % of cases, with errors in lesion type, grade or stage. Erroneous preoperative risk assessment leads to suboptimal initial surgical management of patients with endometrial cancer.
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Affiliation(s)
- Noemie Body
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France
| | - Vincent Lavoué
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France. .,Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France. .,University of Rennes 1, Faculty of Medicine, Rennes, France.
| | | | - Fabrice Foucher
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.,Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France
| | - Sébastien Henno
- Pathology Department, CHU Pontchaillou, Rennes University Hospital, Rennes, France
| | - Aurélie Cauchois
- Pathology Department, CHU Pontchaillou, Rennes University Hospital, Rennes, France
| | - Bruno Laviolle
- Clinical Pharmacology Department, Rennes University Hospital, CIC Inserm 0203, Hôpital Pontchaillou, Rennes, France
| | - Marc Leblanc
- Gynaecology Department, Bretagne Atlantique Hospital, Vannes, France
| | - Jean Levêque
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.,Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France.,University of Rennes 1, Faculty of Medicine, Rennes, France
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11
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Boaventura CS, Galvão JLS, Soares GMB, Bitencourt AGV, Chojniak R, Bringel SLR, Brot LD. Synchronous gynecologic cancer and the use of imaging for diagnosis. Rev Assoc Med Bras (1992) 2016; 62:116-9. [PMID: 27167539 DOI: 10.1590/1806-9282.62.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.
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12
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Liu P, Long P, Huang Y, Sun F, Wang Z. CXCL12/CXCR4 axis induces proliferation and invasion in human endometrial cancer. Am J Transl Res 2016; 8:1719-1729. [PMID: 27186295 PMCID: PMC4859900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Since that we have previously found CXCL12/CXCR4, an important biological axis is highly transcribed in several cancer cells. We aim to investigate whether CXCL12/CXCR4 axis regulates critical processes in neoplastic transformation that affects endometrial cancer cell biology. METHODS The expression levels of CXCR4 were analyzed in human normal endometrial tissue, simple hyperplasia, atypical hyperplasia and endometrial cancer cells by immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR). Serum CXCL12 was measured by Enzyme-Linked Immunosorbent Assay (ELISA) in Ishikawa endometrial cancer cell line. To study the biological function of CXCL12/CXCR4 in endometrial cancer, short interfering RNA silencing of CXCR4 was established to analyze the roles of CXCL12/CXCR4 in proliferation, migration, invasion and apoptosis of Ishikawa cells in vitro. RESULTS The expression level of CXCR4 in endometrial cancer tissue was higher as compared to atypical hyperplasia, simple hyperplasia and normal cycling endometrium cells. Ishikawa cells secreted CXCL12 spontaneously and continuously for 96 hrs in culture. The proliferation, migration and invasion of Ishikawa cells was significantly induced, and the apoptosis was significantly reduced by CXCL12 in combination with CXCR4. Moreover, CXCR4 silencing could significantly antagonize all these functions. CONCLUSIONS CXCL12/CXCR4 axis plays an important role in the proliferation, invasion and metastasis of endometrial cancer, indicating that CXCR4 could be the target for the treatment of endometrial cancer.
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Affiliation(s)
- Pingping Liu
- Department of Gynecology, The Affiliated Hospital of Qingdao University Qingdao 266003, P.R. China
| | - Ping Long
- Department of Gynecology, The Affiliated Hospital of Qingdao University Qingdao 266003, P.R. China
| | - Yu Huang
- Department of Gynecology, The Affiliated Hospital of Qingdao University Qingdao 266003, P.R. China
| | - Fengyi Sun
- Department of Gynecology, The Affiliated Hospital of Qingdao University Qingdao 266003, P.R. China
| | - Zhenyan Wang
- Department of Gynecology, The Affiliated Hospital of Qingdao University Qingdao 266003, P.R. China
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Yin XH, Jia HY, Shi M, Wu H, Li YM. Magnetic resonance imaging for detection of depth of myometrial invasion and cervical invasion in patients with endometrial carcinoma. Int J Clin Exp Med 2015; 8:19501-19505. [PMID: 26770600 PMCID: PMC4694500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
AIMS The aim of this study was to evaluate clinical significance of depth of myometrial invasion and cervical invasion by magnetic resonance imaging (MRI) in patients with endometrial carcinoma. METHODS Between September 2011 and October 2014 on 98 patients who were diagnosed with and treated for endometrial carcinoma at Subei People's Hospital in China included in this study. Main outcome measure was the correlation between the depth of myometrial invasion and cervical invasion by preoperative MRI, transvaginal sonography, hysteroscopy with directed biopsy study and the subsequent histopathological findings following examination of the hysterectomy specimen. RESULTS The mean age was 54.6 years old and the most common histological subtype was the endometrioid type of endometrial adenocarcinoma (87.8%). In the evaluation of deep myometrial invasion (>50%), sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratios of MRI were 70.00%, 94.87%, 77.78%, 92.50%, 13.65, 0.316, respectively. For cervical invasion, these values were 72.73%, 98.85%, 88.89%, 96.63%, 63.27, 0.30, respectively. CONCLUSION MRI is the superior diagnostic method to detect the myometrial invasion and cervical invasion.
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Affiliation(s)
- Xiang-Hua Yin
- Department of Obstetrics and Gynecology, Clinical Medical College of Yangzhou University98 W Nantong Rd, Yangzhou 225001, Jiangsu, China
| | - Hong-Yan Jia
- Department of Obstetrics and Gynecology, Clinical Medical College of Yangzhou University98 W Nantong Rd, Yangzhou 225001, Jiangsu, China
| | - Min Shi
- Department of Obstetrics and Gynecology, Clinical Medical College of Yangzhou University98 W Nantong Rd, Yangzhou 225001, Jiangsu, China
| | - Huan Wu
- Department of Obstetrics and Gynecology, Clinical Medical College of Yangzhou University98 W Nantong Rd, Yangzhou 225001, Jiangsu, China
| | - Yun-Mo Li
- Department of Respiratory Medicine, Clinical Medical College of Yangzhou University98 W Nantong Rd, Yangzhou 225001, Jiangsu, China
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Minar L, Klabenesova I, Jandakova E, Zlamal F, Bienertova-Vasku J. Prognostic value of human epididymis protein 4 in endometrial cancer and its utility for surgical staging. J Obstet Gynaecol Res 2015. [PMID: 26223178 DOI: 10.1111/jog.12764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM An optimal surgical staging in the group of patients with the high-risk type of endometrial cancer is often limited by age and serious internal comorbidities. Therefore, in this study we focused on human epididymis protein 4 and its contribution to the preoperative differentiation of prognostically distinct groups of patients and to individualized surgical treatment as compared with cancer antigen (CA) 125 and imaging methods. MATERIAL AND METHODS The study included 115 patients with endometrioid adenocarcinoma diagnosed through endometrial biopsy. Before the final operation, blood sampling was performed for the determination of human epididymis protein 4 (HE4) and CA125 levels. Serum levels of both biomarkers were analyzed in relation to individual prognostic factors (stage of disease, depth of myometrial invasion, tumor grade, risk type of disease). RESULTS In the case of HE4, we demonstrated a statistically significant difference (P < 0.001) between patients with low and high risk of the disease. In our model, achieving the maximum sum of sensitivity and specificity, HE4 shows a sensitivity of 72.4% and a specificity of 75.4% for the cut-off 76.5 pmol/L and is a better predictor in distinguishing the high-risk patients than CA125 (area under the curve 0.77 for HE vs 0.71 for CA125). CONCLUSION HE4 is a marker that could complement the findings of imaging techniques and that may be useful in decision-making on how to individualize surgical staging. The possibility of its introduction as an independent marker in routine practice remains, at the moment however, limited. The optimal cut-off for HE4 has not been established yet and further studies are needed.
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Affiliation(s)
- Lubos Minar
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Masaryk University Brno and Faculty Hospital Brno, Brno, Czech Republic
| | | | - Eva Jandakova
- Department of Pathology, Faculty Hospital Brno, Brno, Czech Republic
| | - Filip Zlamal
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Julie Bienertova-Vasku
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
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Application of Combined Two-Dimensional and Three-Dimensional Transvaginal Contrast Enhanced Ultrasound in the Diagnosis of Endometrial Carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:292743. [PMID: 26090396 PMCID: PMC4450230 DOI: 10.1155/2015/292743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
Objective. The goal of this study was to explore the clinical value of combining two-dimensional (2D) and three-dimensional (3D) transvaginal contrast-enhanced ultrasounds (CEUS) in diagnosis of endometrial carcinoma (EC). Methods. In this prospective diagnostic study, transvaginal 2D and 3D CEUS were performed on 68 patients with suspected EC, and the results of the obtained 2D-CEUS and 3D-CEUS images were compared with the gold standard for statistical analysis. Results. 2D-CEUS benign endometrial lesions showed the normal uterine perfusion phase while EC cases showed early arrival and early washout of the contrast agent and nonuniform enhancement. The 3D-CEUS images differed in central blood vessel manifestation, blood vessel shape, and vascular pattern between benign and malignant endometrial lesions (P < 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of transvaginal 2D-CEUS and 2D-CEUS combined with 3D-CEUS for diagnosis of benign and malignant endometrial lesions were 76.9%, 73.8%, 64.5%, 83.8%, and 75.0% and 84.6%, 83.3%, 75.9%, 89.7%, and 83.8%, respectively. Conclusion. 3D-CEUS is a useful supplement to 2D-CEUS and can clearly reveal the angioarchitecture spatial relationships between vessels and depth of myometrial invasion in EC. The combined use of 2D and 3D-CEUS can offer direct, accurate, and comprehensive diagnosis of early EC.
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Abstract
The endometrial cancer is the most frequent gynecological cancer. To improve and homogenize the professional practices of endometrial cancer, guidelines were developed in November 2010. The aim of this study is to estimate the implementation of these recommendations. This is a retrospective multicentre study, using the databases of three French centers made between November 2010 and December 2012: the university hospital in Reims, the Tenon hospital in Paris and the Cancer Center Georges-François-Leclerc in Dijon. This study consists in the evaluation of the diagnoses and therapeutic assessment modalities for women with endometrial cancer and the concordance with the INCa guidelines. During this study, 161 patients were treated for an endometrial cancer. A histological and radiological preoperative assessment was respectively made in 92.5% and 73.3% of the cases. It revealed an agreement between anatomo-radiologic pre- and postoperative in 62.3% and 53.4% of the cases for myometrial invasion and the International Federation of Gynecology and Obstetric classification. The surgical modalities were in agreement with the guidelines in 64.6% (n = 104) and 60.3% (n = 97) of the cases. The discrepancy of the guidelines resulted from the absence or the excess realization of a lymphadenectomy. An adjuvant therapy was administered in 67.1% (n = 108) of the cases and was in agreement with the guidelines in 62.3% of the cases. s The pre- and postoperative discordance between histological and radiological results are at the origin of a default in treatment for certain patients. This discordance leads to excess or lack of nodes exploration.
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