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Lee M, Andrieu PIC, Nougaret S, Russo L, Moufarrij S, Mueller JJ, Abu-Rustum NR, Menias CO, Lakhman Y. Role of MRI in Assessing the Feasibility of Fertility-Sparing Treatments for Early-Stage Endometrial and Cervical Cancers. AJR Am J Roentgenol 2025; 224:e2432157. [PMID: 39772587 DOI: 10.2214/ajr.24.32157] [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] [Indexed: 01/11/2025]
Abstract
Fertility-sparing treatment (FST) has become a key aspect of managing gynecologic cancers in reproductive-age patients who wish to preserve fertility. Several leading clinical societies, including the European Society of Gynecological Oncology, the European Society for Radiotherapy and Oncology, the European Society of Pathology, and the European Society of Human Reproduction and Embryology, have published evidence-based guidelines on fertility-sparing strategies and post-treatment surveillance of patients with early-stage gynecologic cancers, in particular endometrial and cervical cancers. These guidelines highlight MRI as essential to initial patient selection and follow-up. Properly tailored pelvic MRI protocols and clear MRI reports are key to performing accurate staging, assessing eligibility, and confirming the initial and ongoing feasibility of FST. Accordingly, radiologists, particularly those specializing in gynecologic imaging, play a critical role in the multidisciplinary approach to FST. They should be well-versed in FST eligibility criteria and key MRI findings before and after FST, ensuring these details are comprehensively communicated in structured MRI reports.
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Affiliation(s)
- Mihan Lee
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
- Department of Radiology, Weill Cornell Medical College, New York, NY
| | | | - Stephanie Nougaret
- Department of Radiology, PINKCC Laboratory, Montpellier Cancer Center, Montpellier, France
| | - Luca Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Sara Moufarrij
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer J Mueller
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Nadeem R Abu-Rustum
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | | | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
- Department of Radiology, Weill Cornell Medical College, New York, NY
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2
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Liu MM, Liang YT, Jin EH. Endometrial carcinoma with cervical stromal invasion: Three case reports. World J Clin Cases 2024; 12:5583-5588. [PMID: 39188595 PMCID: PMC11269997 DOI: 10.12998/wjcc.v12.i24.5583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Endometrial cancer is a kind of well-known tumors of female genitourinary system. Cervical stromal invasion is an adverse factor for poor prognosis of endometrial cancer. There is still controversy regarding the use of magnetic resonance imaging (MRI) in the diagnosis of cervical stromal invasion of endometrial cancer. The diagnosis of cervical stromal invasion varies significantly between different observers and institutions. We present a limited case series of the particular pattern of endometrial cancer, which infiltrates the cervical stroma and is often overlooked. CASE SUMMARY We present three cases of endometrial carcinoma with cervical stromal invasion with cancer-free uterine cavity. One patient, a reproductive-aged woman, exhibited irregular menstruation and was diagnosed with endometrial polyps by hysteroscopy and segmental curettage. A MRI scan revealed polypoid nodules within the internal cervical orifice. The other two cases were postmenopausal women who presented with abnormal vaginal bleeding. Hysteroscopy and segmental curettage suggested atypical hyperplasia of the endometrium. MRI scans did not detect any malignant signs in the endometrium. In one case, a non-thickened endometrium was observed, while in another, hyperplasia of the endometrium was seen. Notably, none of these patients had malignant tumors identified in the uterine cavity via MRI scans. However, postoperative pathological results following hysterectomy consistently indicated cervical stromal invasion. CONCLUSION Cervical stromal invasion is easily missed if no cancer is found in the uterine body on MRI. Immunohistochemistry of endoscopic curettage specimens should be conducted to avoid underestimation of the disease.
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Affiliation(s)
- Ming-Ming Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Yu-Ting Liang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
| | - Er-Hu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Liu M, Liang Y, Zheng X, Mo N, Jin E. Study on the value of MRI in locating the internal OS of the cervix and influencing factors. Sci Rep 2024; 14:17784. [PMID: 39090384 PMCID: PMC11294610 DOI: 10.1038/s41598-024-68735-7] [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: 12/10/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
The position of the internal os of the cervix reported in the literature was inconsistent on MRI images. Additionally, the practical impactful data influencing the internal os located by MRI is limited. We aimed to confirm the position of the internal os of the cervix on MRI images, and the influencing factors locating the the internal os by MRI. A single-center retrospective study was conducted. Data from 175 patients who underwent total hysterectomy for stage I endometrial cancer were collected. The internal os of the cervix is positioned as the starting point for measuring the length of the cervix on MRI images. On dynamic contrast-enhanced MRI (DCE-MRI), the section formed by the enhancement difference between the uterus and cervix, and on T2-weighted imaging(T2WI), the section formed by the physiological curvature of the uterus and the low signal intensity of the cervical stroma were used as starting points. The results showed no statistically significant difference compared with the removed uterus specimens (p = 0.208, p = 0.571, p = 0.804). A history of cesarean section(p < 0.001), irregular vaginal bleeding for more than three months(p < 0.001), cervical adenomyosis(p = 0.043), and premenopause(p = 0.001) were not conducive to locating the internal os of the cervix by MRI. Our findings provide valuable information and confirm the position of the internal os of the cervix on MRI images, and the several important infuencing factors. We hope that some patients will benefit from our study.
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Affiliation(s)
- Mingming Liu
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No.59 Yong'an Road, Xicheng District, Beijing, China
| | - Yuting Liang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xingzheng Zheng
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Na Mo
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No.59 Yong'an Road, Xicheng District, Beijing, China.
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4
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Van Damme A, Tummers P, De Visschere P, Van Dorpe J, Van de Vijver K, Vercauteren T, De Gersem W, Denys H, Naert E, Makar A, De Neve W, Vandecasteele K. Exclusion of non-Involved uterus from the target volume (EXIT-trial): An individualized treatment for locally advanced cervical cancer using modern radiotherapy and imaging techniques followed by completion surgery. Clin Transl Radiat Oncol 2024; 47:100793. [PMID: 38798749 PMCID: PMC11126536 DOI: 10.1016/j.ctro.2024.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background and purpose Chemoradiotherapy followed by brachytherapy is the standard of care for locally advanced cervical cancer (LACC). In this study, we postulate that omitting an iconographical unaffected uterus (+12 mm distance from the tumour) from the treatment volume is safe and that no tumour will be found in the non-targeted uterus (NTU) leading to reduction of high-dose volumes of surrounding organs at risk (OARs). Material and Methods In this single-arm phase 2 study, two sets of target volumes were delineated: one standard-volume (whole uterus) and an EXIT-volume (exclusion of non-tumour-bearing parts of the uterus with a minimum 12 mm margin from the tumour). All patients underwent chemoradiotherapy targeting the EXIT-volume, followed by completion hysterectomy. In 15 patients, a plan comparison between two treatment plans (PTV vs PTV_EXIT) was performed. The primary endpoint was the pathological absence of tumour involvement in the non-targeted uterus (NTU). Secondary endpoints included dosimetric impact of target volume reduction on OARs, acute and chronic toxicity, overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS). Results In all 21 (FIGO stage I: 2; II: 14;III: 3; IV: 2) patients the NTU was pathologically negative. Ssignificant reductions in Dmean in bladder, sigmoid and rectum; V15Gy in sigmoid and rectum, V30Gy in bladder, sigmoid and rectum; V40Gy and V45Gy in bladder, bowel bag, sigmoid and rectum; V50Gy in rectum were achieved. Median follow-up was 54 months (range 7-79 months). Acute toxicity was mainly grade 2 and 5 % grade 3 urinary. The 3y- OS, PFS and LRFS were respectively 76,2%, 64,9% and 81 %. Conclusion MRI-based exclusion of the non-tumour-bearing parts of the uterus at a minimum distance of 12 mm from the tumour out of the target volume in LACC can be done without risk of residual disease in the NTU, leading to a significant reduction of the volume of surrounding OARS treated to high doses.
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Affiliation(s)
- Axel Van Damme
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Tummers
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter De Visschere
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Departement of Radiology and Nuclear Medicine, Ghent University Hospital, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannelore Denys
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Gynaecology, Division of Gynecologic Oncology, ZNA Middelheim Antwerpen, Belgium
| | - Eline Naert
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Department of Gynaecology, Division of Gynecologic Oncology, ZNA Middelheim Antwerpen, Belgium
| | - Amin Makar
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Shinagare AB, Burk KS, Kilcoyne A, Akin EA, Chuang L, Hindman NM, Huang C, Rauch GM, Small W, Stein EB, Venkatesan AM, Kang SK. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Invasive Cancer of the Cervix: 2023 Update. J Am Coll Radiol 2024; 21:S249-S267. [PMID: 38823948 DOI: 10.1016/j.jacr.2024.02.026] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Cervical cancer is a common gynecological malignancy worldwide. Cervical cancer is staged based on the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was revised in 2018 to incorporate radiologic and pathologic data. Imaging plays an important role in pretreatment assessment including initial staging and treatment response assessment of cervical cancer. Accurate determination of tumor size, local extension, and nodal and distant metastases is important for treatment selection and for prognostication. Although local recurrence can be diagnosed by physical examination, imaging plays a critical role in detection and follow-up of local and distant recurrence and subsequent treatment selection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Kristine S Burk
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | - Aoife Kilcoyne
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | - Linus Chuang
- University of Vermont Larner College of Medicine Danbury Hospital, Burlington, Vermont; Gynecologic oncology expert
| | | | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Erica B Stein
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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Xiao ML, Qian T, Fu L, Wei Y, Ma FH, Gu WY, Li HM, Li YA, Qian ZX, Cheng JJ, Zhang GF, Qiang JW. Deep Learning Nomogram for the Identification of Deep Stromal Invasion in Patients With Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma: A Multicenter Study. J Magn Reson Imaging 2024; 59:1394-1406. [PMID: 37392060 DOI: 10.1002/jmri.28882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Deep stromal invasion (DSI) is one of the predominant risk factors that determined the types of radical hysterectomy (RH). Thus, the accurate assessment of DSI in cervical adenocarcinoma (AC)/adenosquamous carcinoma (ASC) can facilitate optimal therapy decision. PURPOSE To develop a nomogram to identify DSI in cervical AC/ASC. STUDY TYPE Retrospective. POPULATION Six hundred and fifty patients (mean age of 48.2 years) were collected from center 1 (primary cohort, 536), centers 2 and 3 (external validation cohorts 1 and 2, 62 and 52). FIELD STRENGTH/SEQUENCE 5-T, T2-weighted imaging (T2WI, SE/FSE), diffusion-weighted imaging (DWI, EPI), and contrast-enhanced T1-weighted imaging (CE-T1WI, VIBE/LAVA). ASSESSMENT The DSI was defined as the outer 1/3 stromal invasion on pathology. The region of interest (ROI) contained the tumor and 3 mm peritumoral area. The ROIs of T2WI, DWI, and CE-T1WI were separately imported into Resnet18 to calculate the DL scores (TDS, DDS, and CDS). The clinical characteristics were retrieved from medical records or MRI data assessment. The clinical model and nomogram were constructed by integrating clinical independent risk factors only and further combining DL scores based on primary cohort and were validated in two external validation cohorts. STATISTICAL TESTS Student's t-test, Mann-Whitney U test, or Chi-squared test were used to compare differences in continuous or categorical variables between DSI-positive and DSI-negative groups. DeLong test was used to compare AU-ROC values of DL scores, clinical model, and nomogram. RESULTS The nomogram integrating menopause, disruption of cervical stromal ring (DCSRMR), DDS, and TDS achieved AU-ROCs of 0.933, 0.807, and 0.817 in evaluating DSI in primary and external validation cohorts. The nomogram had superior diagnostic ability to clinical model and DL scores in primary cohort (all P < 0.0125 [0.05/4]) and CDS (P = 0.009) in external validation cohort 2. DATA CONCLUSION The nomogram achieved good performance for evaluating DSI in cervical AC/ASC. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mei Ling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ting Qian
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Le Fu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Wei
- Department of Automation, Zhejiang University of Technology, Hangzhou, China
| | - Feng Hua Ma
- Department of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Wei Yong Gu
- Department of Pathology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Hai Ming Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yong Ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zhao Xia Qian
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Jun Cheng
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guo Fu Zhang
- Department of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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7
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Manning-Geist B, Grace MA, Sonoda Y. Trachelectomy and fertility-sparing procedures for early-stage cervical cancer: A state of the science review. Gynecol Oncol 2024; 181:179-182. [PMID: 38271868 DOI: 10.1016/j.ygyno.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Beryl Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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8
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Avesani G, Perazzolo A, Amerighi A, Celli V, Panico C, Sala E, Gui B. The Utility of Contrast-Enhanced Magnetic Resonance Imaging in Uterine Cervical Cancer: A Systematic Review. Life (Basel) 2023; 13:1368. [PMID: 37374150 DOI: 10.3390/life13061368] [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: 05/04/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Correct staging of cervical cancer is essential to establish the best therapeutic procedure and prognosis for the patient. MRI is the best imaging modality for local staging and follow-up. According to the latest ESUR guidelines, T2WI and DWI-MR sequences are fundamental in these settings, and CE-MRI remains optional. This systematic review, according to the PRISMA 2020 checklist, aims to give an overview of the literature regarding the use of contrast in MRI in cervical cancer and provide more specific indications of when it may be helpful. Systematic searches on PubMed and Web Of Science (WOS) were performed, and 97 papers were included; 1 paper was added considering the references of included articles. From our literature review, it emerged that many papers about the use of contrast in cervical cancer are dated, especially about staging and detection of tumor recurrence. We did not find strong evidence suggesting that CE-MRI is helpful in any clinical setting for cervical cancer staging and detection of tumor recurrence. There is growing evidence that perfusion parameters and perfusion-derived radiomics models might have a role as prognostic and predictive biomarkers, but the lack of standardization and validation limits their use in a research setting.
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Affiliation(s)
- Giacomo Avesani
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Alessio Perazzolo
- Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Amerighi
- Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Veronica Celli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Camilla Panico
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Evis Sala
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Benedetta Gui
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
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9
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Wenzel HHB, Hardie AN, Moncada-Torres A, Høgdall CK, Bekkers RLM, Falconer H, Jensen PT, Nijman HW, van der Aa MA, Martin F, van Gestel AJ, Lemmens VEPP, Dahm-Kähler P, Alfonzo E, Persson J, Ekdahl L, Salehi S, Frøding LP, Markauskas A, Fuglsang K, Schnack TH. A federated approach to identify women with early-stage cervical cancer at low risk of lymph node metastases. Eur J Cancer 2023; 185:61-68. [PMID: 36965329 DOI: 10.1016/j.ejca.2023.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Lymph node metastases (pN+) in presumed early-stage cervical cancer negatively impact prognosis. Using federated learning, we aimed to develop a tool to identify a group of women at low risk of pN+, to guide the shared decision-making process concerning the extent of lymph node dissection. METHODS Women with cervical cancer between 2005 and 2020 were identified retrospectively from population-based registries: the Danish Gynaecological Cancer Database, Swedish Quality Registry for Gynaecologic Cancer and Netherlands Cancer Registry. Inclusion criteria were: squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma; The International Federation of Gynecology and Obstetrics 2009 IA2, IB1 and IIA1; treatment with radical hysterectomy and pelvic lymph node assessment. We applied privacy-preserving federated logistic regression to identify risk factors of pN+. Significant factors were used to stratify the risk of pN+. RESULTS We included 3606 women (pN+ 11%). The most important risk factors of pN+ were lymphovascular space invasion (LVSI) (odds ratio [OR] 5.16, 95% confidence interval [CI], 4.59-5.79), tumour size 21-40 mm (OR 2.14, 95% CI, 1.89-2.43) and depth of invasion>10 mm (OR 1.81, 95% CI, 1.59-2.08). A group of 1469 women (41%)-with tumours without LVSI, tumour size ≤20 mm, and depth of invasion ≤10 mm-had a very low risk of pN+ (2.4%, 95% CI, 1.7-3.3%). CONCLUSION Early-stage cervical cancer without LVSI, a tumour size ≤20 mm and depth of invasion ≤10 mm, confers a low risk of pN+. Based on an international privacy-preserving analysis, we developed a useful tool to guide the shared decision-making process regarding lymph node dissection.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Anna N Hardie
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arturo Moncada-Torres
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Claus K Høgdall
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Pernille T Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Frank Martin
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Anna J van Gestel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ligita P Frøding
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Katrine Fuglsang
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine H Schnack
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Gynaecology, Odense University Hospital, Odense, Denmark
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10
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Nguyen T, Nougaret S, Castillo P, Paspulati R, Bhosale P. Cervical cancer in the pregnant population. Abdom Radiol (NY) 2023; 48:1679-1693. [PMID: 37071123 DOI: 10.1007/s00261-023-03836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 04/19/2023]
Abstract
Cervical cancer is the second most encountered cancer in pregnant patients. The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer updated the staging of primary cervical carcinoma and disease process, with formal incorporation of imaging as a vital source of information in the management process to improve accuracy. Diagnosis and treatment of the pregnant population is a complex interplay of achieving adequate diagnostic information and optimal treatment while minimizing toxicity and risks to the mother and fetus. While novel imaging techniques and anticancer therapies are rapidly developed, much information on the safety and feasibility of different therapies is not yet available in the pregnant population. Therefore, managing pregnant patients with cervical cancer is complex and requires a multidisciplinary approach.
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Affiliation(s)
- Trinh Nguyen
- Billings Clinic Hospital, 2800 10th Ave N, Billings, MT, 95106, USA.
| | - Stephanie Nougaret
- Institute Regional du Cancer Montpellier, EU Euromedicine Park, 208 Av. des Apothicaires, 34090, Montpellier, France
| | - Patricia Castillo
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | | | - Priya Bhosale
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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11
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Fertility-sparing options for cancer patients. Abdom Radiol (NY) 2023; 48:1618-1628. [PMID: 36884058 DOI: 10.1007/s00261-023-03839-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/09/2023]
Abstract
Fertility preservation is becoming an integral part of cancer care among women of reproductive age. Despite advances in the treatment of pelvic malignancies, all the currently available treatment approaches, including radiotherapy, chemotherapy, and surgery, place women at high risk for future fertility impairment. With improved long-term survival rates associated with cancer, expanding the reproductive options available is of high priority. Several fertility preservation options are available today for women with gynecologic and non-gynecologic malignancies. Depending on the underlying oncological entity, these can include the following procedures whether alone or in combination: oocyte cryopreservation, embryo cryopreservation, ovarian tissue cryopreservation, ovarian transposition, and trachelectomy. The purpose of this review is to provide the most up-to-date information on the aforementioned fertility-preserving approaches and highlight the current challenges, drawbacks, and areas of research where more data are still very necessary to optimize outcomes in young female oncological patients desiring pregnancy in the future.
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12
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Pak T, Sadowski E, Patel-Lippmann K. MR Imaging in Cervical Cancer. Radiol Clin North Am 2023; 61:639-649. [PMID: 37169429 DOI: 10.1016/j.rcl.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Cervical cancer remains a significant contributor to morbidity and mortality for women globally despite medical advances in preventative medicine and treatment. The 2018 Internal Federation of Gynecology and Obstetrics committee modified their original 2009 staging scheme to incorporate advanced imaging modalities, where available, to increase the accuracy of staging and to guide evolving treatments. Having a robust understanding of the newest staging iteration, its consequences on treatment pathways, and common imaging pitfalls will aid the radiologist in generating valuable and practical reports to optimize treatment strategies.
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13
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Du P, Li G, Wu L, Huang M. Perspectives of ERCC1 in early-stage and advanced cervical cancer: From experiments to clinical applications. Front Immunol 2023; 13:1065379. [PMID: 36713431 PMCID: PMC9875293 DOI: 10.3389/fimmu.2022.1065379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Cervical cancer is a public health problem of extensive clinical importance. Excision repair cross-complementation group 1 (ERCC1) was found to be a promising biomarker of cervical cancer over the years. At present, there is no relevant review article that summarizes such evidence. In this review, nineteen eligible studies were included for evaluation and data extraction. Based on the data from clinical and experimental studies, ERCC1 plays a key role in the progression of carcinoma of the uterine cervix and the therapeutic response of chemoradiotherapy. The majority of the included studies (13/19, 68%) suggested that ERCC1 played a pro-oncogenic role in both early-stage and advanced cervical cancer. High expression of ERCC1 was found to be associated with the poor survival rates of the patients. ERCC1 polymorphism analyses demonstrated that ERCC1 might be a useful tool for predicting the risk of cervical cancer and the treatment-related toxicities. Experimental studies indicated that the biological effects exerted by ERCC1 in cervical cancer might be mediated by its associated genes and affected signaling pathways (i.e., XPF, TUBB3, and. To move towards clinical applications by targeting ERCC1 in cervical cancer, more clinical, in-vitro, and in-vivo investigations are still warranted in the future.
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14
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Abu-Rustum NR. Progress in surgical oncology: Gynecology perspective. J Surg Oncol 2022; 126:902-905. [PMID: 36087083 PMCID: PMC9472811 DOI: 10.1002/jso.27036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/06/2022]
Abstract
Since its founding in 1884, Memorial Sloan Kettering Cancer Center (MSK) has set standards of care in gynecologic oncology. Over time, the MSK treatment approach evolved into an effort of gynecologic oncology experts across disciplines. As the anatomic field of gynecologic oncology surgery expanded beyond the pelvis, experts in other fields of cancer care, including our hepatobiliary and thoracic colleagues, joined this interprofessional effort. Here, we describe recent, key contributions to surgical gynecologic oncology by the Gynecology Service at MSK.
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15
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ADC and kinetic parameter of primary tumor: Surrogate imaging markers for fertility-sparing vaginal radical trachelectomy in patients with stage IB cervical cancer. Eur J Radiol 2022; 155:110467. [PMID: 35970120 DOI: 10.1016/j.ejrad.2022.110467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/23/2022] [Accepted: 08/07/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the role of ADC and kinetic parameters derived from DCE-MRI in selecting eligible candidates for fertility-sparing vaginal radical trachelectomy (VRT). METHOD Female patients with FIGO stage IB cervical cancers between March 2019 and January 2022 were retrospectively included. All patients underwent hysterectomy and bilateral lymphadenectomy. According to the surgical pathology, the study population was divided into VRT-eligible group and VRT-ineligible group. ADC, semi-quantitative and quantitative kinetic parameters of the primary tumor were compared between the two groups. Logistic regression analysis was used to determine the independent predictors for VRT eligibility and ROC curve was used to evaluate the predictive performance. RESULTS 19 patients were deemed eligible for VRT and 50 were ineligible. Compared with VRT-eligible group, time to peak and ADC were significantly lower in VRT-ineligible group (P = 0.004 and 0.001, respectively) while volume fraction of plasma (Vp) was higher in VRT ineligible group (P = 0.001). ADC and Vp were independent predictors for VRT eligibility. Combining Vp and ADC yielded the highest area under the ROC curve of 0.853 compared with that of 0.766 for Vp and 0.764 for ADC, though marginal differences were found (P = 0.109 and 0.078, respectively). CONCLUSIONS ADC and the kinetic DCE-MRI parameter Vp can be used as surrogate markers to select eligible candidates for fertility-sparing VRT.
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16
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Baiocchi G, Tsunoda AT, Guitmann G, Vieira MA, Zanvettor PH, Silvestre JBCH, Santos MH, Sacramento RDMM, de Araujo EO, Lopes RH, Falcao D, Lopes A, Schmidt R, Lyra JS, Almeida HIB, Casteleins WA, Cintra GF, Zanini LAG, Reis RJ, Coelho EG, Fin FR, Rezende V, Pançan TDM, Vieira SC, Silva JS, de Andrade MR, Carneiro VCG, Foiato TF, Ritt GF, Ianaze GC, Moretti‐Marques R, Andrade CEMC, Maciel LF, Lira DL, Medeiros GM, Leite ALS, Cucolicchio GO, Tayeh MRA, Cruz RP, Guth GZ, Leal RMLV, Magno VA, Lopes FCO, Laporte GA, Pupo‐Nogueira A, Barros AV, da Cunha JR, Pessini SA, Braganca JF, Figueiredo HF, Loureiro CMB, Bocanegra RED, Affonso RJ, Fernandes PHDS, Ribeiro HSC, Batista TP, Oliveira AF, Ribeiro R. Brazilian Society of Surgical Oncology consensus on fertility‐sparing surgery for cervical cancer. J Surg Oncol 2022; 126:37-47. [DOI: 10.1002/jso.26899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andre Lopes
- Sao Paulo State Institute of Cancer Sao Paulo Brazil
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17
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Lura N, Wagner-Larsen KS, Forsse D, Trovik J, Halle MK, Bertelsen BI, Salvesen Ø, Woie K, Krakstad C, Haldorsen IS. What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer? Insights Imaging 2022; 13:105. [PMID: 35715582 PMCID: PMC9206052 DOI: 10.1186/s13244-022-01239-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Tumor size assessment by MRI is central for staging uterine cervical cancer. However, the optimal role of MRI-derived tumor measurements for prognostication is still unclear. Material and methods This retrospective cohort study included 416 women (median age: 43 years) diagnosed with cervical cancer during 2002–2017 who underwent pretreatment pelvic MRI. The MRIs were independently read by three radiologists, measuring maximum tumor diameters in three orthogonal planes and maximum diameter irrespective of plane (MAXimaging). Inter-reader agreement for tumor size measurements was assessed by intraclass correlation coefficients (ICCs). Size was analyzed in relation to age, International Federation of Gynecology and Obstetrics (FIGO) (2018) stage, histopathological markers, and disease-specific survival using Kaplan–Meier-, Cox regression-, and time-dependent receiver operating characteristics (tdROC) analyses. Results All MRI tumor size variables (cm) yielded high areas under the tdROC curves (AUCs) for predicting survival (AUC 0.81–0.84) at 5 years after diagnosis and predicted outcome (hazard ratios [HRs] of 1.42–1.76, p < 0.001 for all). Only MAXimaging independently predicted survival (HR = 1.51, p = 0.03) in the model including all size variables. The optimal cutoff for maximum tumor diameter (≥ 4.0 cm) yielded sensitivity (specificity) of 83% (73%) for predicting disease-specific death after 5 years. Inter-reader agreement for MRI-based primary tumor size measurements was excellent, with ICCs of 0.83–0.85. Conclusion Among all MRI-derived tumor size measurements, MAXimaging was the only independent predictor of survival. MAXimaging ≥ 4.0 cm represents the optimal cutoff for predicting long-term disease-specific survival in cervical cancer. Inter-reader agreement for MRI-based tumor size measurements was excellent. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01239-y.
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Affiliation(s)
- Njål Lura
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway. .,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Kari S Wagner-Larsen
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - David Forsse
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Mari K Halle
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Bjørn I Bertelsen
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Salvesen
- Clinical Research Unit, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kathrine Woie
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Camilla Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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18
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Xiao M, Li Y, Ma F, Zhang G, Qiang J. Multiparametric MRI radiomics nomogram for predicting lymph-vascular space invasion in early-stage cervical cancer. Br J Radiol 2022; 95:20211076. [PMID: 35312379 PMCID: PMC10996415 DOI: 10.1259/bjr.20211076] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To develop a radiomics nomogram based on multiparametric MRI (mpMRI) to pre-operatively predict lymph-vascular space invasion (LVSI) in patients with early-stage cervical cancer. METHODS This retrospective study included 233 consecutive patients with Stage IB-IIB cervical cancer. According to the ratio of 2:1, 154 patients and 79 patients were randomly assigned to the primary and validation cohorts, respectively. Features with intraclass and interclass correlation coefficient (ICCs) greater than 0.75 were selected for radiomics features. The significant features for predicting LVSI were selected using the least absolute shrinkage and selection operator (LASSO) algorithm based on the primary cohort. The rad-score for each patient was constructed via a linear combination of selected features that were weighted by their respective coefficients. The radiomics nomogram was developed using multivariable logistic regression analysis by incorporating the rad-score and clinical risk factors. RESULTS A total of 19 radiomics features and 3 clinical risk factors were selected. The rad-score exhibited a good performance in discriminating LVSI with a C-index of 0.76 and 0.81 in the primary and validation cohorts, respectively. The radiomics nomogram also exhibited a good discriminating performance in two cohorts (C-index of 0.78 and 0.82). The calibration curve of the radiomics nomogram demonstrated no significant differences was found between prediction and observation outcomes for the probability of LVSI in two cohorts (p = 0.86 and 0.98, respectively). The decision curve analysis indicated that clinician and patients could benefit from the use of radiomics nomogram and rad-score. CONCLUSION The nomogram and rad-score could be used conveniently and individually to predict LVSI in patients with early-stage cervical cancer and facilitate the treatment decision for clinician and patients. ADVANCES IN KNOWLEDGE The nomogram could pre-operatively predict LVSI in early-stage cervical cancer.
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Affiliation(s)
- Meiling Xiao
- Department of Radiology, Jinshan Hospital, Fudan
University, Shanghai,
China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan
University, Shanghai,
China
| | - Fenghua Ma
- Departments of Radiology, Obstetrics & Gynecology Hospital,
Fudan University, Shanghai,
China
| | - Guofu Zhang
- Departments of Radiology, Obstetrics & Gynecology Hospital,
Fudan University, Shanghai,
China
| | - Jin Qiang
- Department of Radiology, Jinshan Hospital, Fudan
University, Shanghai,
China
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19
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Ren J, Li Y, Yang JJ, Zhao J, Xiang Y, Xia C, Cao Y, Chen B, Guan H, Qi YF, Tang W, Chen K, He YL, Jin ZY, Xue HD. MRI-based radiomics analysis improves preoperative diagnostic performance for the depth of stromal invasion in patients with early stage cervical cancer. Insights Imaging 2022; 13:17. [PMID: 35092505 PMCID: PMC8800977 DOI: 10.1186/s13244-022-01156-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background The depth of cervical stromal invasion is one of the important prognostic factors affecting decision-making for early stage cervical cancer (CC). This study aimed to develop and validate a T2-weighted imaging (T2WI)-based radiomics model and explore independent risk factors (factors with statistical significance in both univariate and multivariate analyses) of middle or deep stromal invasion in early stage CC. Methods Between March 2017 and March 2021, a total of 234 International Federation of Gynecology and Obstetrics IB1-IIA1 CC patients were enrolled and randomly divided into a training cohort (n = 188) and a validation cohort (n = 46). The radiomics features of each patient were extracted from preoperative sagittal T2WI, and key features were selected. After independent risk factors were identified, a combined model and nomogram incorporating radiomics signature and independent risk factors were developed. Diagnostic accuracy of radiologists was also evaluated. Results The maximal tumor diameter (MTD) on magnetic resonance imaging was identified as an independent risk factor. In the validation cohort, the radiomics model, MTD, and combined model showed areas under the curve of 0.879, 0.844, and 0.886. The radiomics model and combined model showed the same sensitivity and specificity of 87.9% and 84.6%, which were better than radiologists (sensitivity, senior = 75.7%, junior = 63.6%; specificity, senior = 69.2%, junior = 53.8%) and MTD (sensitivity = 69.7%, specificity = 76.9%). Conclusion MRI-based radiomics analysis outperformed radiologists for the preoperative diagnosis of middle or deep stromal invasion in early stage CC, and the probability can be individually evaluated by a nomogram.
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20
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Multimodal MRI Analysis of Cervical Cancer on the Basis of Artificial Intelligence Algorithm. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:1673490. [PMID: 34858113 PMCID: PMC8592750 DOI: 10.1155/2021/1673490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study is to explore the application value of artificial intelligence algorithm in multimodal MRI image diagnosis of cervical cancer. Based on the traditional convolutional neural network (CNN), an artificial intelligence 3D-CNN algorithm is designed according to the characteristics of cervical cancer. 70 patients with cervical cancer were selected as the experimental group, and 10 healthy people were selected as the reference group. The 3D-CNN algorithm was applied to the diagnosis of clinical cervical cancer multimodal MRI images. The value of the algorithm was comprehensively evaluated by the image quality and diagnostic accuracy. The results showed that compared with the traditional CNN algorithm, the convergence rate of the loss curve of the artificial intelligence 3D-CNN algorithm was accelerated, and the segmentation accuracy of whole-area tumors (WT), core tumor areas (CT), and enhanced tumor areas (ET) was significantly improved. In addition, the clarity of the multimodal MRI image and the recognition performance of the lesion were significantly improved. Under the artificial intelligence 3D-CNN algorithm, the Dice values of WT, ET, and CT regions were 0.78, 0.71, and 0.64, respectively. The sensitivity values were 0.92, 0.91, and 0.88, respectively. The specificity values were 0.93, 0.92, and 0.9 l, respectively. The Hausdorff (Haus) distances were 0.93, 0.92, and 0.90, respectively. The data of various indicators were significantly better than those of the traditional CNN algorithm (P < 0.05). In addition, the diagnostic accuracy of the artificial intelligence 3D-CNN algorithm was 93.11 ± 4.65%, which was also significantly higher than that of the traditional CNN algorithm (82.45 ± 7.54%) (P < 0.05). In summary, the recognition and segmentation ability of multimodal MRI images based on artificial intelligence 3D-CNN algorithm for cervical cancer lesions were significantly improved, which can significantly enhance the clinical diagnosis rate of cervical cancer.
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21
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Diagnostic Accuracy of Magnetic Resonance Imaging for International Federation of Gynecology and Obstetrics 2018 IB to IIB Cervical Cancer Staging: Comparison Among Magnetic Resonance Sequences and Pathologies. J Comput Assist Tomogr 2021; 45:829-836. [PMID: 34407060 DOI: 10.1097/rct.0000000000001210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the most accurate magnetic resonance (MR) sequence for tumor detection, maximal tumor diameter, and parametrial invasion compared with histopathologic diagnoses. METHODS Fifty-one patients with International Federation of Gynecology and Obstetrics 2018 IB1 to IIB cervical cancer underwent preoperative MR imaging and surgical resection. Two radiologists independently evaluated the tumor detection, parametrial invasion, and tumor size in each of T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Results obtained for squamous cell carcinoma (SCC) and adenocarcinoma were also compared. RESULTS Neither the tumor detection rate nor parametrial invasion was found to be significantly different among sequences. Tumor size assessment using MR imaging with pathology showed good correlation: r = 0.63-0.72. The adenocarcinoma size tended to be more underestimated than SCC in comparison with the pathologic specimen. CONCLUSIONS Cervical cancer staging by MR images showed no significant difference among T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Adenocarcinoma was prone to be measured as smaller than the pathologic specimen compared with SCC.
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22
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Kido A, Nakamoto Y. Implications of the new FIGO staging and the role of imaging in cervical cancer. Br J Radiol 2021; 94:20201342. [PMID: 33989030 DOI: 10.1259/bjr.20201342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
International Federation of Gynecology and Obstetrics (FIGO) staging, which is the fundamentally important cancer staging system for cervical cancer, has changed in 2018. New FIGO staging includes considerable progress in the incorporation of imaging findings for tumour size measurement and evaluating lymph node (LN) metastasis in addition to tumour extent evaluation. MRI with high spatial resolution is expected for tumour size measurements and the high accuracy of positron emmision tomography/CT for LN evaluation. The purpose of this review is firstly review the diagnostic ability of each imaging modality with the clinical background of those two factors newly added and the current state for LN evaluation. Secondly, we overview the fundamental imaging findings with characteristics of modalities and sequences in MRI for accurate diagnosis depending on the focus to be evaluated and for early detection of recurrent tumour. In addition, the role of images in treatment response and prognosis prediction is given with the development of recent technique of image analysis including radiomics and deep learning.
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Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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23
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Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018. Eur Radiol 2021; 31:7802-7816. [PMID: 33852049 DOI: 10.1007/s00330-020-07632-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The recommendations cover indications for MRI examination including acquisition planes, patient preparation, imaging protocol including multi-parametric approaches such as diffusion-weighted imaging (DWI-MR), dynamic contrast-enhanced imaging (DCE-MR) and standardised reporting. The document also underscores the value of whole-body 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) and highlights potential future methods. METHODS In 2019, the ESUR female pelvic imaging working group reviewed the revised 2018 FIGO staging system, the up-to-date clinical management guidelines, and the recent imaging literature. The RAND-UCLA Appropriateness Method (RAM) was followed to develop the current ESUR consensus guidelines following methodological steps: literature research, questionnaire developments, panel selection, survey, data extraction and analysis. RESULTS The updated ESUR guidelines are recommendations based on ≥ 80% consensus among experts. If ≥ 80% agreement was not reached, the action was indicated as optional. CONCLUSIONS The present ESUR guidelines focus on the main role of MRI in the initial staging, response monitoring and evaluation of disease recurrence. Whole-body FDG-PET plays an important role in the detection of lymph nodes (LNs) and distant metastases. KEY POINTS • T2WI and DWI-MR are now recommended for initial staging, monitoring of response and evaluation of recurrence. • DCE-MR is optional; its primary role remains in the research setting. • T2WI, DWI-MRI and whole-body FDG-PET/CT enable comprehensive assessment of treatment response and recurrence.
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Quantitative kinetic parameters of primary tumor can be used to predict pelvic lymph node metastasis in early-stage cervical cancer. Abdom Radiol (NY) 2021; 46:1129-1136. [PMID: 32930831 DOI: 10.1007/s00261-020-02762-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate the role of kinetic parameters of primary tumor derived from dynamic contrast-enhanced MRI (DCE-MRI) in predicting pelvic lymph node metastasis (PLNM) in patients with cervical cancer. METHODS 66 women with newly diagnosed cervical cancer were included between July 2017 and August 2019. All patients had a FIGO stage IB-IIA cancer and treated with hysterectomy and bilateral lymphadenectomy. Kinetic parameters of the primary tumor were derived from DCE-MRI data. The tumor diameter, ADC value, kinetic parameters, and nodal short-axis diameter were compared between patients with or without PLNM. Logistic regression analysis was used to determine the independent predictors for PLNM and receiver operator characteristic curve was used to evaluate the predictive performance. RESULTS There were 20 patients with PLNM and 46 patients without PLNM. Tumor diameter, the efflux rate constant (Kep), and nodal short-axis diameter were significantly higher in patients with PLNM (P < 0.01). Multivariate logistic regression analysis showed that Kep and short-axis diameter were independent predictors for PLNM. Combining Kep and nodal short-axis diameter yielded the highest area under the curve (AUC) of 0.839. Combined with Kep, the sensitivity, specificity, negative predictive value, and positive predictive value of nodal short-axis diameter increased from 0.500, 0.957, 0.815, and 0.833 to 0.600, 0.978, 0.923, and 0.849, respectively. With 1.113 min-1 as threshold, the sensitivity and specificity values of Kep in predicting PLNM in patients with normal-sized lymph nodes were 0.909 and 0.667, respectively. CONCLUSIONS Kep of primary tumor can be used as a surrogate marker to predict PLNM in cervical cancer.
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Cottrell CM, Ohaegbulam GC, Smith JR, Del Priore G. Fertility-sparing treatment in cervical cancer: Abdominal trachelectomy. Best Pract Res Clin Obstet Gynaecol 2021; 75:72-81. [PMID: 33846052 DOI: 10.1016/j.bpobgyn.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
In the last two decades, great strides have been made to treat cancer while sparing fertility for young women. This is at least partly in response to changing demographics, including delayed childbearing and fewer historically traditional couples. The trachelectomy has become emblematic in this endeavor. With comparable outcomes to hysterectomy and successful conceptions, trachelectomy utilization has increased over time. It is now a standard of care for many situations. While there are several approaches, (vaginal, laparoscopic, and robotic), the abdominal trachelectomy allows surgeons to overcome several limitations, such as patient anatomy, surgical experience, and resources (i.e. no robot) to provide women everywhere this revolutionary operation. In this chapter, we outline surgical techniques, outcomes, and other aspects of the abdominal trachelectomy.
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Affiliation(s)
- Cyra M Cottrell
- Morehouse School of Medicine, 720 Westview Drive Atlanta, GA 30310, USA.
| | - Gail C Ohaegbulam
- Morehouse School of Medicine, 720 Westview Drive Atlanta, GA 30310, USA.
| | - J Richard Smith
- Consultant Gynaecological Surgeon, West London Gynaecological Cancer Centre, Imperial College, London, UK.
| | - Giuseppe Del Priore
- Morehouse School of Medicine, Department of Ob-Gyn, Gynecologic Oncology, 720 Westview Drive Atlanta, GA 30310, USA.
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Kohn JR, Katebi Kashi P, Acosta-Torres S, Beavis AL, Christianson MS. Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers. J Minim Invasive Gynecol 2020; 28:392-402. [PMID: 33373729 DOI: 10.1016/j.jmig.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers. TABULATION, INTEGRATION, AND RESULTS For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended-however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research. CONCLUSION Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.
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Affiliation(s)
- Jaden R Kohn
- Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis).
| | - Payam Katebi Kashi
- Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis)
| | | | - Anna L Beavis
- Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis)
| | - Mindy S Christianson
- Division of Reproductive Endocrinology and Infertility (Dr. Christianson), Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Moro F, Bonanno GM, Gui B, Scambia G, Testa AC. Imaging modalities in fertility preservation in patients with gynecologic cancers. Int J Gynecol Cancer 2020; 31:323-331. [PMID: 33139315 DOI: 10.1136/ijgc-2020-002109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Fertility preservation is an integral component of clinical decision-making and treatment design. However, the selection criteria on imaging for patients eligible for fertility preservation is still unclear. The present review aimed to summarize the main findings reported in both the literature and international guidelines on the role of imaging in the selection of patients for fertility preservation. A search strategy was developed and applied to PubMed, Scopus, Web of Science, and EMBASE to identify previous citations reporting imaging and fertility preservation in patients with gynecological cancer. We also retrieved the published guidelines on the eligibility criteria for fertility-sparing treatment of gynecological neoplasms. A description of the internal multidisciplinary guidelines, clinically in use in our institution, is provided with representative clinical cases. The literature review revealed 1291 articles and 18 of these were selected for the analysis. Both ultrasound and MRI represented the primary imaging methods for selecting patients for fertility preservation in cervical and endometrial cancers. Eligibility criteria of fertility-sparing management in patients with cervical cancer were: tumor size <2 cm, tumor distance from the internal os >1 cm, and no parametrium invasion. For patients with endometrial cancer, these included no myometrial and cervical stroma invasion. Both ultrasound and MRI play a key role in characterizing adnexal masses. These modalities provide a useful tool in identifying small ovarian lesions, thus key in the surveillance of patients after fertility sparing surgery. However, efficacy in excluding disease beyond the ovary remains limited. This review provides an update of the literature and schematic outline for the counseling and management of patients with the desire for fertility preservation.
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Affiliation(s)
- Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giulia Maria Bonanno
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Dipartimento Scienze della vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Centro di Ricerca e Studi sulla Salute Procreativa, Università Cattolica del Sacro Cuore, Rome, Italy
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Stein EB, Hansen JM, Maturen KE. Fertility-Sparing Approaches in Gynecologic Oncology. Radiol Clin North Am 2020; 58:401-412. [DOI: 10.1016/j.rcl.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Xiao M, Yan B, Li Y, Lu J, Qiang J. Diagnostic performance of MR imaging in evaluating prognostic factors in patients with cervical cancer: a meta-analysis. Eur Radiol 2019; 30:1405-1418. [PMID: 31776741 DOI: 10.1007/s00330-019-06461-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/08/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study aims to determine the diagnostic performance of conventional magnetic resonance imaging (MRI) in assessing the distance between the tumor and the internal os, stromal infiltration, lymph node metastasis, and parametrial invasion in patients with cervical cancer. METHODS A systematic English-language literature search of conventional MRI in the evaluation of human cervical cancer was performed in the PubMed, Cochrane Library, Embase, and Web of Science databases from 1995 to 2018. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratios (PLR and NLR) of all studies were calculated. The results were then plotted in a hierarchical summary receiver operating characteristic (HSROC) plot, and meta-regression and subgroup analyses of the parametrial invasion were also performed. RESULTS The pooled sensitivity, specificity, DOR, PLR, and NLR were 86%, 97%, 167.91, 24.74, and 0.15, respectively, in evaluating the internal os involvement (6 studies, 454 patients); 87%, 91%, 73.41, 10.22, and 0.14, respectively, in evaluating the stromal infiltration (11 studies, 672 patients); 51%, 89%, 8.63, 4.72, and 0.55, respectively, in evaluating the lymph node metastasis (15 studies, 997 patients); and 75%, 92%, 34.01, 9.38, and 0.28, respectively, in evaluating the parametrial invasion (19 studies, 1748 patients). The meta-regression of the parametrial invasion showed that the application of contrast enhancement was a significant factor affected the heterogeneity (p = 0.039). CONCLUSIONS Conventional MRI can accurately evaluate the distance between the tumor and the internal os, as well as stromal infiltration, and performs well in diagnosing the parametrial invasion. However, this method exhibited a limited ability in diagnosing the lymph node metastasis. KEY POINTS • MRI can help clinicians to accurately assess the distance between the tumor and the internal os, stromal infiltration, and parametrial invasion in patients with uterine cervical neoplasms. • MRI exhibits a limited ability in diagnosing the lymph node metastasis. • Management of patients with uterine cervical neoplasms becomes more appropriate.
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Affiliation(s)
- Meiling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
| | - Bicong Yan
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
| | - Jingjing Lu
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China.
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Kim SI, Lee M, Lee S, Suh DH, Kim HS, Kim K, Chung HH, No JH, Kim JW, Park NH, Song YS, Kim YB. Impact of laparoscopic radical hysterectomy on survival outcome in patients with FIGO stage IB cervical cancer: A matching study of two institutional hospitals in Korea. Gynecol Oncol 2019; 155:75-82. [PMID: 31383569 DOI: 10.1016/j.ygyno.2019.07.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare survival outcomes of primary laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in patients with FIGO stage IB cervical cancer. METHODS We retrospectively identified stage IB1-IB2 cervical cancer patients who received either LRH (n = 343) or ORH (n = 222) at two tertiary institutional hospitals between 2000 and 2018. To adjust for confounders, we conducted Mahalanobis distance-based sample matching for stage, histology, cervical mass size, parametrial invasion, and lymph node metastasis. Then, survival outcomes were compared between the matched groups. Through the independent matching processes, we narrowed the study population to stage IB1 patients and stage IB1 patients with tumor size ≤2 cm on pre-operative MRI. RESULTS After matching, LRH group showed poorer progression-free survival (PFS) than ORH group (3-year: 85.4% vs. 91.8%; P = 0.036), whereas no significant difference in overall survival (OS) was found. Regarding recurrence patterns, no significant differences in the incidences of pelvic, retroperitoneal lymph node and abdominal recurrences, or distant metastasis were observed between the two groups. Among the matched patients with stage IB1 who had cervical mass size ≤2 cm, the LRH and ORH groups showed similar PFS (3-year: 90.0% vs. 93.1%; P = 0.8) and OS (5-year: 98.6% vs. 96.4%; P = 0.6). CONCLUSIONS Despite the retrospective design, our matched cohort study suggests that ORH might be preferable for the surgical treatment of FIGO stage IB cervical cancer. However, in stage IB1 patients with tumor size ≤2 cm, LRH might be applicable, as equivalent outcomes were found regardless of the surgical approach. Further prospective studies are warranted.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungyoung Lee
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Sun J, Wu G, Shan F, Meng Z. The Value of IVIM DWI in Combination with Conventional MRI in Identifying the Residual Tumor After Cone Biopsy for Early Cervical Carcinoma. Acad Radiol 2019; 26:1040-1047. [PMID: 30385207 DOI: 10.1016/j.acra.2018.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in combination with conventional MRI in identifying the residual tumor after biopsy for early cervical carcinoma. MATERIALS AND METHODS Eighty patients with histologically proven early cervical carcinoma were enrolled into this study. MRI sequences included two sets of MRI sequences including conventional MRI (T1WI, T2WI, and dynamic contrast-enhanced MRI) and IVIM DWI/conventional MRI combinations. The patients were classified into residual tumor and nonresidual tumor group after biopsy. IVIM parameters were quantitatively analyzed and compared between two groups. The diagnostic ability of two sets of MRI sequences were calculated and compared. RESULTS The mean D and f values were significantly lower in residual tumor group than in nonresidual tumor group (p < 0.05). The areas under receiver operating characteristic curves of D and f for discriminating between residual tumor and nonresidual tumor group were 0.848 and 0.767, respectively. The sensitivity and accuracy of conventional MRI/IVIM DWI combinations for the detection of residual tumor were 82.7% and 83.8%, respectively, while the sensitivity and accuracy of conventional MRI were 52.4% and 53.8%, respectively. CONCLUSION The addition of IVIM DWI to conventional MRI considerably improves the sensitivity and accuracy of the detection of residual tumor after biopsy for early cervical carcinoma.
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Affiliation(s)
- Junqi Sun
- Department of Radiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Guangyao Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China.
| | - Feifei Shan
- Department of Ultrasound, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Zhihua Meng
- Department of Radiology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
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Kim SI, Cho JH, Seol A, Kim YI, Lee M, Kim HS, Chung HH, Kim JW, Park NH, Song YS. Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1–IIA2 cervical cancer. Gynecol Oncol 2019; 153:3-12. [DOI: 10.1016/j.ygyno.2019.01.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/30/2018] [Accepted: 01/05/2019] [Indexed: 11/30/2022]
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He Y, Li Y, Lin C, Qi Y, Wang X, Zhou H, Yang J, Xiang Y, Xue H, Jin Z. Three‐dimensional turbo‐spin‐echo amide proton transfer‐weighted mri for cervical cancer: A preliminary study. J Magn Reson Imaging 2019; 50:1318-1325. [DOI: 10.1002/jmri.26710] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yong‐Lan He
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Yuan Li
- Department of OB&GYN, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Cheng‐Yu Lin
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Ya‐Fei Qi
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | | | - Hai‐Long Zhou
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Jun‐Jun Yang
- Department of OB&GYN, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Yang Xiang
- Department of OB&GYN, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Hua‐Dan Xue
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Zheng‐Yu Jin
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
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Early Cervical Cancer: Predictive Relevance of Preoperative 3-Tesla Multiparametric Magnetic Resonance Imaging. Int J Surg Oncol 2018; 2018:9120753. [PMID: 30155294 PMCID: PMC6092969 DOI: 10.1155/2018/9120753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/25/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
Objective We assess the predictive significance of preoperative 3-Tesla multiparametric MRI findings. Methods A total of 260 patients with FIGO IA2-IIA cervical cancer underwent primary surgical treatment between 2007 and 2016. Univariable and multivariable logistic regression analyses were used to assess the incremental prognostic significance. Results The clinical predictive factors associated with pT2b disease were MRI parametrial invasion (PMI) (adjusted odds ratio (AOR) 3.77, 95% confidence interval(CI) 1.62-8.79; P=0.02) and MRI uterine corpus invasion (UCI) (AOR 9.99, 95% CI 4.11-24.32; P<0.0001). In multivariable analysis, for underdiagnoses, histologically squamous carcinoma versus adenocarcinoma and adenosquamous carcinoma (AOR 2.07, 95% CI 1.06-4.07; P=0.034) and MRI tumor size (AOR 0.76, 95% CI 0.63-0.92; P=0.005) were significant predictors; for overdiagnoses, these results were MRI tumor size (AOR 1.51, 95% CI 1.06-2.16; P=0.023), MRI PMI (AOR 71.73, 95% CI 8.89-611.38; P<0.0001) and MRI UCI (AOR 0.19, 95% CI 0.01-1.01; P=0.051). Conclusion PMI and UCI on T2-weighted images through preoperative 3T MRI are useful coefficients for accurate prediction of the pT2b stage; however, careful surveillance is required. Therefore, preoperative decision-making for early cervical cancer patients based on MRI diagnosis should be considered carefully, particularly in the presence of factors that are known to increase the likelihood of misdiagnosis.
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The Value of Diffusion-Weighted Imaging in Combination With Conventional Magnetic Resonance Imaging for Improving Tumor Detection for Early Cervical Carcinoma Treated With Fertility-Sparing Surgery. Int J Gynecol Cancer 2018; 27:1761-1768. [PMID: 28930805 DOI: 10.1097/igc.0000000000001113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the value of diffusion-weighted imaging (DWI) in combination with conventional magnetic resonance imaging (MRI) for improving tumor detection in young patients treated with fertility-sparing surgery because of early cervical carcinoma. METHODS Fifty-four patients with stage Ia or Ib1 cervical carcinoma were enrolled into this study. Magnetic resonance examinations were performed for these patients using conventional MRI (including T1-weighted imaging, T2-weighted imaging, and dynamic contrast-enhanced MRI) and DWI. The apparent diffusion coefficient (ADC) values of cervical carcinoma were analyzed quantitatively and compared with that of adjacent epithelium. Sensitivity, positive predictive value, and accuracy of 2 sets of MRI sequences were calculated on the basis of histologic results, and the diagnostic ability of conventional MRI/DWI combinations was compared with that of conventional MRI. RESULTS The mean ADC value from cervical carcinoma (mean, 786 × 10 mm/s ± 100) was significantly lower than that from adjacent epithelium (mean, 1352 × 10 mm/s ± 147) (P = 0.01). When the threshold ADC value set as 1010 × 10 mm/s, the sensitivity and specificity for differentiating cervical carcinoma from nontumor epithelium were 78.2% and 67.2%, respectively. The sensitivity and accuracy of conventional MRI for tumor detection were 76.0% and 70.4%, whereas the sensitivity and accuracy of conventional MRI/DWI combinations were 91.7% and 90.7%, respectively. Conventional MRI/DWI combinations revealed a positive predictive value of 97.8% and only 4 false-negative findings. CONCLUSIONS The addition of DWI to conventional MRI considerably improves the sensitivity and accuracy of tumor detection in young patients treated with fertility-sparing surgery, which supports the inclusion quantitative analysis of ADC value in routine MRI protocol before fertility-sparing surgery.
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Is fertility-preservation safe for adult non-metastatic gynecologic rhabdomyosarcoma patients? Systematic review and pooled survival analysis of 137 patients. Arch Gynecol Obstet 2017; 297:559-572. [DOI: 10.1007/s00404-017-4591-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Rockall AG, Qureshi M, Papadopoulou I, Saso S, Butterfield N, Thomassin-Naggara I, Farthing A, Smith JR, Bharwani N. Role of Imaging in Fertility-sparing Treatment of Gynecologic Malignancies. Radiographics 2017; 36:2214-2233. [PMID: 27831834 DOI: 10.1148/rg.2016150254] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Treatments for gynecologic cancer usually result in loss of fertility due to surgery or radical radiation therapy in the pelvis. In countries with an established screening program for cervical cancer, the majority of gynecologic malignancies occur in postmenopausal women. However, a substantial number of affected women are of childbearing age and have not completed their families. In these younger women, consideration of fertility preservation may be important. This article describes the fertility-sparing treatment options that are currently available and outlines the role of imaging in the selection of eligible patients on the basis of a review of the literature. In the setting of cervical cancer, magnetic resonance (MR) imaging is used to delineate the size, position, and stage of the tumor for selection of patients who are suitable for radical trachelectomy. In patients with solitary complex adnexal masses, diffusion- and perfusion-weighted MR imaging sequences are used to categorize the likelihood of invasive or borderline malignancy for consideration of unilateral ovarian resection, with fertility preservation when possible. In patients with endometrial cancer, MR imaging is used to rule out signs of invasive disease before hormone therapy is considered. Imaging is also used at patient follow-up to detect recurrent disease; however, evidence to support this application is limited. In conclusion, imaging is an essential tool in the care of patients with gynecologic malignancies who are considering fertility-preserving treatment options. ©RSNA, 2016.
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Affiliation(s)
- Andrea G Rockall
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Mahrukh Qureshi
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Ioanna Papadopoulou
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Srdjan Saso
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Nicholas Butterfield
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Isabelle Thomassin-Naggara
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Alan Farthing
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - J Richard Smith
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Nishat Bharwani
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
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Tsuyoshi H, Yoshida Y. Diagnostic imaging using positron emission tomography for gynecological malignancy. J Obstet Gynaecol Res 2017; 43:1687-1699. [DOI: 10.1111/jog.13436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/28/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology; University of Fukui; Fukui Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology; University of Fukui; Fukui Japan
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Saadi J, Minig L, Noll F, Saraniti G, Cárdenas-Rebollo JM, Perrotta M. Four Surgical Approaches to Cervical Excision During Laparoscopic Radical Trachelectomy for Early Cervical Cancer. J Minim Invasive Gynecol 2017; 24:869-875. [PMID: 28461178 DOI: 10.1016/j.jmig.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To compare the clinical and oncological outcomes of four different approaches of cervical excision (CE) during radical trachelectomy (RT) for early cervical cancer. DESIGN A retrospective comparative observational study was performed at Gynecology Department of the Hospital Italiano de Buenos Aires in Buenos Aires, Argentine. The study was composed of all consecutive women who had undergone laparoscopic RT for early cervical cancer between May 2011 and July 2016. They were divided in four groups according with different surgical approaches to perform the CE during RT; which are also detailed. (Canadian Task Force Classification III). SETTING Tertiary care hospital. INTERVENTION CE during radical trachelectomy for early cervical cancer. MEASUREMENT AND MAIN RESULTS A total of 7, 6, 6 and 3 patients undergone Type A, B, C and D cervical excision during RT, respectively. No significant differences in terms of age, BMI, surgical time and length of hospital stay were found according with different types of CE. Patients in Type D had, however, a significantly higher EBL, p =.006. Similar histology characteristics in terms of histology type, tumor grade and size, as well as lymph node count were observed among groups. Only grade 1-2 postoperative complications were noted in 9 patients. One local recurrence after Type B CE was treated with radical surgery plus chemoradiaton; while other patient after Type A CE relapsed with peritoneal carcinomatosis managed with chemotherapy. CONCLUSION Different types of cervical excision that are here described should be used according to each case based on specific clinical factors.
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Affiliation(s)
- José Saadi
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Lucas Minig
- Gynecology Department, Valencian Institute of Oncology, Valencia, Spain
| | - Florencia Noll
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Saraniti
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Myriam Perrotta
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Sato S, Itamochi H, Sugiyama T. Fertility-sparing surgery for uterine cervical cancer. Future Oncol 2016; 12:2345-55. [DOI: 10.2217/fon-2016-0260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The standard treatment for early cervical cancer of the uterus (CC) is radical hysterectomy with resection of the parametrium and pelvic lymphadenectomy. At least 40% of patients develop early-stage CC during child-bearing age, therefore preserving the uterus to maintain fertility has been an important consideration. Several surgical procedures including conization and vaginal or abdominal radical trachelectomy have been reported. These procedures are safe for removing lymph node negative CC tumors with <2 cm diameter. Recently, less radical surgical procedures that maintain fertility, such as conization, simple trachelectomy, minimally invasive surgery and neoadjuvant chemotherapy, have been indicated for tumors greater than 2 cm in diameter. In this review, we discuss the currently accepted surgical approaches for treating CC while maintaining fertility.
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Affiliation(s)
- Seiya Sato
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Hiroaki Itamochi
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Toru Sugiyama
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
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43
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Woo S, Kim HS, Chung HH, Kim SY, Kim SH, Cho JY. Early stage cervical cancer: role of magnetic resonance imaging after conization in determining residual tumor. Acta Radiol 2016; 57:1268-76. [PMID: 26671305 DOI: 10.1177/0284185115620948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although magnetic resonance imaging (MRI) is currently indispensable in the management of cervical cancer, its role in determining residual tumor in patients with cervical cancer after conization is not well known. PURPOSE To evaluate the value of MRI after conization in determining residual tumor in patients with FIGO stage IA-IB1 cervical cancer. MATERIAL AND METHODS In this retrospective study, 55 patients underwent conization followed by preoperative MRI and definitive surgery. Two radiologists evaluated the presence of residual tumor on MRI. MRI and preoperative clinical variables were compared between patients with and without residual tumor at final pathology using Student's t-test or Chi-square test. Association between variables and the presence of residual tumor was assessed using logistic regression analyses and receiver operating characteristic (ROC) curves. RESULTS Residual tumor at final pathology was found in 30 (54.5%) patients. Patients with residual tumor were older, had greater SCC antigen, and more frequently had positive conization margins and identifiable tumor on MRI (P < 0.008). Multivariate analysis showed that age (P = 0.008; odds ratio [OR] = 1.140), positive conization margin (P = 0.016; OR = 11.919), and identifiable tumor on MRI (P = 0.038; OR = 6.926) were independently predictive of residual tumor. Areas under the curve (AUCs) calculated with age (0.693), SCC antigen (0.755), and identifiable tumor on MRI (0.727) were greater than lymphovascular space invasion (0.517) and histological subtype (0.520, P ≤ 0.049). Otherwise, there were no significant differences in the AUCs derived from different variables (P = 0.053-0.970). CONCLUSION Identifiable tumor on MRI after conization in patients with early stage cervical cancer was an independent predictor of residual tumor at final pathology.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Sung Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Jiamset I, Hanprasertpong J. Risk Factors for Parametrial Involvement in Early-Stage Cervical Cancer and Identification of Patients Suitable for Less Radical Surgery. Oncol Res Treat 2016; 39:432-8. [DOI: 10.1159/000447335] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/02/2016] [Indexed: 11/19/2022]
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Bentivegna E, Gouy S, Maulard A, Chargari C, Leary A, Morice P. Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. Lancet Oncol 2016; 17:e240-e253. [DOI: 10.1016/s1470-2045(16)30032-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 12/16/2022]
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Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol 2016; 8:342-354. [PMID: 27158421 PMCID: PMC4840192 DOI: 10.4329/wjr.v8.i4.342] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/15/2016] [Accepted: 01/31/2016] [Indexed: 02/06/2023] Open
Abstract
Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.
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Downey K, Attygalle AD, Morgan VA, Giles SL, MacDonald A, Davis M, Ind TEJ, Shepherd JH, deSouza NM. Comparison of optimised endovaginal vs external array coil T2-weighted and diffusion-weighted imaging techniques for detecting suspected early stage (IA/IB1) uterine cervical cancer. Eur Radiol 2016; 26:941-50. [PMID: 26162579 PMCID: PMC4778155 DOI: 10.1007/s00330-015-3899-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare sensitivity and specificity of endovaginal versus external-array coil T2-W and T2-W + DWI for detecting and staging small cervical tumours. METHODS Optimised endovaginal and external array coil MRI at 3.0-T was done prospectively in 48 consecutive patients with stage Ia/Ib1 cervical cancer. Sensitivity/specificity for detecting tumour and parametrial extension against histopathology for a reading radiologist were determined on coronal T2-W and T2W + DW images. An independent radiologist also scored T2-W images without and with addition of DWI for the external-array and endovaginal coils on separate occasions >2 weeks apart. Cohen's kappa assessed inter- and intra-observer agreement. RESULTS Median tumour volume in 19/38 cases positive on subsequent histology was 1.75 cm(3). Sensitivity, specificity, PPV, NPV were: reading radiologist 91.3 %, 89.5 %, 91.3 %, 89.5 %, respectively; independent radiologist T2-W 82.6 %, 73.7 %, 79.1 %, 77.8 % for endovaginal, 73.9 %, 89.5 %, 89.5 %, 73.9 % for external-array coil. Adding DWI improved sensitivity and specificity of endovaginal imaging (78.2 %, 89.5 %); adding DWI to external-array imaging improved specificity (94.7 %) but reduced sensitivity (66.7 %). Inter- and intra-observer agreement on T2-W + DWI was good (kappa = 0.67 and 0.62, respectively). CONCLUSION Endovaginal coil T2-W MRI is more sensitive than external-array coil for detecting tumours <2 cm(3); adding DWI improves specificity of endovaginal imaging but reduces sensitivity of external-array imaging. KEY POINTS • Endovaginal more accurate than external-array T2-W MRI for detecting small cervical cancers. • Addition of DWI improves sensitivity and specificity of endovaginal T2-W imaging. • Addition of DWI substantially reduces sensitivity of external-array T2-W imaging.
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Affiliation(s)
- Kate Downey
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Veronica A Morgan
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Sharon L Giles
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - A MacDonald
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - M Davis
- Department of Gynaecology, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey, KT2 7QB, UK
| | - Thomas E J Ind
- Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - John H Shepherd
- Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nandita M deSouza
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
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Bhosale PR, Iyer RB, Ramalingam P, Schmeler KM, Wei W, Bassett RL, Ramirez PT, Frumovitz M. Is MRI helpful in assessing the distance of the tumour from the internal os in patients with cervical cancer below FIGO Stage IB2? Clin Radiol 2016; 71:515-22. [PMID: 27012496 DOI: 10.1016/j.crad.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/09/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
AIM To determine the ability of magnetic resonance imaging (MRI) in detecting tumour-free margins from the internal os (IO). MATERIALS AND METHODS A database search yielded 79 women with early-stage cervical cancer who underwent radical hysterectomy and preoperative MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI in assessment of ≤5 and >5 mm IO involvement were calculated with histopathological surgical specimen findings considered to be the reference standard. A main and subset analysis was performed. The subset analysis included only those patients who would have been considered for radical trachelectomy. RESULTS For predicting a distance between the tumour and the IO of ≤5 mm, MRI had a sensitivity of 73%, a specificity of 98.3%, a PPV of 95%, a NPV of 88.1%, and an accuracy of 89.8% for the main analysis, and sensitivity of 81.8%, a specificity of 93.2% a PPV of 69.2% a NPV of 96.5% and an accuracy of 91.4% for the subset analysis. CONCLUSION MRI has high specificity, NPV, and accuracy in detecting tumour from the IO, making MRI suitable for treatment planning in patients desiring trachelectomy to preserve fertility.
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Affiliation(s)
- P R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - R B Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Schmeler
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P T Ramirez
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Frumovitz
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lakhman Y, D'Anastasi M, Miccò M, Scelzo C, Vargas HA, Nougaret S, Sosa RE, Chi DS, Abu-Rustum NR, Hricak H, Sala E. Second-Opinion Interpretations of Gynecologic Oncologic MRI Examinations by Sub-Specialized Radiologists Influence Patient Care. Eur Radiol 2015; 26:2089-98. [PMID: 26494640 DOI: 10.1007/s00330-015-4040-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine if second-opinion review of gynaecologic oncologic (GynOnc) magnetic resonance imaging (MRI) by sub-specialized radiologists impacts patient care. METHODS 469 second-opinion MRI interpretations rendered by GynOnc radiologists were retrospectively compared to the initial outside reports. Two gynaecologic surgeons, blinded to the reports' origins, reviewed all cases with discrepancies between initial and second-opinion MRI reports and recorded whether these discrepancies would have led to a change in patient management defined as a change in treatment approach, counselling, or referral. Histopathology or minimum 6-month imaging follow-up were used to establish the diagnosis. RESULTS Second-opinion review of GynOnc MRIs would theoretically have affected management in 94/469 (20 %) and 101/469 (21.5 %) patients for surgeons 1 and 2, respectively. Specifically, second-opinion review would have theoretically altered treatment approach in 71/469 (15.1 %) and 60/469 (12.8 %) patients for surgeons 1 and 2, respectively. According to surgeons 1 and 2, these treatment changes would have prevented unnecessary surgery in 35 (7.5 %) and 31 (6.6 %) patients, respectively, and changed surgical procedure type/extent in 19 (4.1 %) and 12 (2.5 %) patients, respectively. Second-opinion interpretations were correct in 103 (83 %) of 124 cases with clinically relevant discrepancies between initial and second-opinion reports. CONCLUSIONS Expert second-opinion review of GynOnc MRI influences patient care. KEY POINTS • Outside gynaecologic oncologic MRI examinations are often submitted for a second-opinion review. • One-fifth of MRIs had important discrepancies between initial and second-opinion interpretations. • Second-opinion review of gynaecologic oncologic MRI is a valuable clinical service.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.
| | - Melvin D'Anastasi
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA.,Institute for Clinical Radiology, University Hospitals Munich - Campus Grosshadern, Munich, Germany
| | - Maura Miccò
- Department of Bioimaging and Radiological Science, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Chiara Scelzo
- Surgery Department, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy
| | - Hebert Alberto Vargas
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| | - Stephanie Nougaret
- Department of Imaging, CHU Montpellier, St. Eloi Hospital, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France
| | - Ramon E Sosa
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| | - Dennis S Chi
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, USA
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