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Erschienen in: Abdominal Radiology 2/2006

01.04.2006

Pitfalls in staging uterine neoplasm with imaging: a review

verfasst von: K. Kinkel

Erschienen in: Abdominal Radiology | Ausgabe 2/2006

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Abstract

This review analyzes current pitfalls in pretreatment staging of endometrial and cervical carcinoma with magnetic resonance imaging (MRI) based on a critical review of the literature. Technical, patient, and tumor-related characteristics were analyzed to improve further staging of uterine neoplasm with MRI. For endometrial carcinoma staging, contrast-enhanced dynamic imaging appears essential to avoid false-positive findings for deep myometrial invasion by better delineating tumor from normal myometrium. However, leiomyomas, adenomyosis, and grade 3 tumors provide difficulties in staging for pathologists and radiologists. Slice orientation perpendicular to the long axis of the cervical channel might improve false-negative findings for deep stromal invasion on T2-weighted images in endometrial and cervical cancer. Contrast-enhanced sequences do not improve diagnosis of parametrial or vaginal invasion in cervical cancer. Assessment of lymph node invasion by any imaging modality has limited sensitivity in detecting lymph node metastasis smaller than 5 mm. Knowledge of diagnostic criteria is critical to avoid false-negative findings for bladder wall invasion. Higher spatial resolution with dedicated multichannel pelvic phase array coils, smaller fields of view and section thickness, and careful comparison of T2-weighted and contrast-enhanced sequences are strategies that might avoid misinterpretation of pelvic MRI in staging uterine neoplasm.
Literatur
1.
Zurück zum Zitat Kinkel K, Kaji Y, Yu KK, et al. (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMed Kinkel K, Kaji Y, Yu KK, et al. (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMed
2.
Zurück zum Zitat Scheidler J, Hricak H, Yu KK, et al. (1997) Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA 278:1096–1101PubMedCrossRef Scheidler J, Hricak H, Yu KK, et al. (1997) Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA 278:1096–1101PubMedCrossRef
3.
Zurück zum Zitat Frei KA, Kinkel K, Bonel HM, et al. (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging—a meta-analysis and Bayesian analysis. Radiology 216:444–449PubMed Frei KA, Kinkel K, Bonel HM, et al. (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging—a meta-analysis and Bayesian analysis. Radiology 216:444–449PubMed
4.
Zurück zum Zitat Hricak H, Powell CB, Yu KK, et al. (1996) Invasive cervical carcinoma: role of MR imaging in pretreatment work-up—cost minimization and diagnostic efficacy analysis. Radiology 198:403–409PubMed Hricak H, Powell CB, Yu KK, et al. (1996) Invasive cervical carcinoma: role of MR imaging in pretreatment work-up—cost minimization and diagnostic efficacy analysis. Radiology 198:403–409PubMed
5.
Zurück zum Zitat Scoutt LM, McCarthy SM, Flynn SD, et al. (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology 194:567–572PubMed Scoutt LM, McCarthy SM, Flynn SD, et al. (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology 194:567–572PubMed
6.
Zurück zum Zitat Cunha TM, Felix A, Cabral I (2001) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and gross visual inspection. Int J Gynecol Cancer 11:130–136PubMedCrossRef Cunha TM, Felix A, Cabral I (2001) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and gross visual inspection. Int J Gynecol Cancer 11:130–136PubMedCrossRef
7.
Zurück zum Zitat Sheu MH, Chang CY, Wang JH, Yen MS (2001) Preoperative staging of cervical carcinoma with MR imaging: a reappraisal of diagnostic accuracy and pitfalls. Eur Radiol 11:1828–1833PubMedCrossRef Sheu MH, Chang CY, Wang JH, Yen MS (2001) Preoperative staging of cervical carcinoma with MR imaging: a reappraisal of diagnostic accuracy and pitfalls. Eur Radiol 11:1828–1833PubMedCrossRef
8.
Zurück zum Zitat Acs G (2002) Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol 19:237–254PubMed Acs G (2002) Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol 19:237–254PubMed
9.
Zurück zum Zitat Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855PubMedCrossRef Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855PubMedCrossRef
10.
Zurück zum Zitat Yamashita Y, Mizutani H, Torashima M, et al. (1993) Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR 161:595–599PubMed Yamashita Y, Mizutani H, Torashima M, et al. (1993) Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR 161:595–599PubMed
11.
Zurück zum Zitat Saez F, Urresola A, Larena JA, et al. (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466PubMedCrossRef Saez F, Urresola A, Larena JA, et al. (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466PubMedCrossRef
12.
Zurück zum Zitat Hricak H, Hamm B, Semelka RC, et al. (1991) Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imaging. Radiology 181:95–106PubMed Hricak H, Hamm B, Semelka RC, et al. (1991) Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imaging. Radiology 181:95–106PubMed
13.
Zurück zum Zitat Sironi S, Colombo E, Villa G, et al. (1992) Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. Radiology 185:207–212PubMed Sironi S, Colombo E, Villa G, et al. (1992) Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. Radiology 185:207–212PubMed
14.
Zurück zum Zitat Yamashita Y, Harada M, Sawada T, et al. (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501PubMed Yamashita Y, Harada M, Sawada T, et al. (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501PubMed
15.
Zurück zum Zitat Tanaka YO, Nishida M, Tsunoda H, et al. (2003) A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation. Eur Radiol 13:2038–2045PubMedCrossRef Tanaka YO, Nishida M, Tsunoda H, et al. (2003) A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation. Eur Radiol 13:2038–2045PubMedCrossRef
16.
Zurück zum Zitat Minderhoud-Bassie W, Treurniet FE, Koops W, et al. (1995) Magnetic resonance imaging (MRI) in endometrial carcinoma; preoperative estimation of depth of myometrial invasion. Acta Obstet Gynecol Scand 74:827–831PubMed Minderhoud-Bassie W, Treurniet FE, Koops W, et al. (1995) Magnetic resonance imaging (MRI) in endometrial carcinoma; preoperative estimation of depth of myometrial invasion. Acta Obstet Gynecol Scand 74:827–831PubMed
17.
Zurück zum Zitat Fanning J, Tsukada Y, Piver MS (1990) Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 37:47–50PubMedCrossRef Fanning J, Tsukada Y, Piver MS (1990) Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 37:47–50PubMedCrossRef
18.
Zurück zum Zitat Ohguri T, Aoki T, Watanabe H, et al. (2002) MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas. Eur Radiol 12:2737–2742PubMed Ohguri T, Aoki T, Watanabe H, et al. (2002) MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas. Eur Radiol 12:2737–2742PubMed
19.
Zurück zum Zitat Ben-Shachar I, Vitellas KM, Cohn DE (2004) The role of MRI in the conservative management of endometrial cancer. Gynecol Oncol 93:233–237PubMedCrossRef Ben-Shachar I, Vitellas KM, Cohn DE (2004) The role of MRI in the conservative management of endometrial cancer. Gynecol Oncol 93:233–237PubMedCrossRef
20.
Zurück zum Zitat Hricak H, Stern JL, Fisher MR, et al. (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305PubMed Hricak H, Stern JL, Fisher MR, et al. (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305PubMed
21.
Zurück zum Zitat Matsushita H, Kodama S, Kase H, et al. (1996) [Usefulness of magnetic resonance imaging in the determination of cervical involvement in endometrial cancer]. Nippon Sanka Fujinka Gakkai Zasshi 48:821–826PubMed Matsushita H, Kodama S, Kase H, et al. (1996) [Usefulness of magnetic resonance imaging in the determination of cervical involvement in endometrial cancer]. Nippon Sanka Fujinka Gakkai Zasshi 48:821–826PubMed
22.
Zurück zum Zitat Matsushita M, Kurata H, Kase H, et al. (2001) MR imaging underestimates stromal invasion in patients with adenocarcinoma of the uterine cervix. Eur J Gynaecol Oncol 22:201–203PubMed Matsushita M, Kurata H, Kase H, et al. (2001) MR imaging underestimates stromal invasion in patients with adenocarcinoma of the uterine cervix. Eur J Gynaecol Oncol 22:201–203PubMed
23.
Zurück zum Zitat Manfredi R, Mirk P, Maresca G, et al. (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378PubMed Manfredi R, Mirk P, Maresca G, et al. (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378PubMed
24.
Zurück zum Zitat Scheidler J, Heuck AF. Imaging of cancer of the cervix. Radiol Clin North Am 2002;40:577–590, viiPubMedCrossRef Scheidler J, Heuck AF. Imaging of cancer of the cervix. Radiol Clin North Am 2002;40:577–590, viiPubMedCrossRef
25.
Zurück zum Zitat Scheidler J, Heuck AF, Steinborn M, et al. (1998) Parametrial invasion in cervical carcinoma: evaluation of detection at MR imaging with fat suppression. Radiology 206:125–129PubMed Scheidler J, Heuck AF, Steinborn M, et al. (1998) Parametrial invasion in cervical carcinoma: evaluation of detection at MR imaging with fat suppression. Radiology 206:125–129PubMed
26.
Zurück zum Zitat Bipat S, Glas AS, van der Velden J, et al. (2003) Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol 91:59–66PubMedCrossRef Bipat S, Glas AS, van der Velden J, et al. (2003) Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol 91:59–66PubMedCrossRef
27.
Zurück zum Zitat Subak LL, Hricak H, Powell CB, et al. (1995) Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 86:43–50PubMedCrossRef Subak LL, Hricak H, Powell CB, et al. (1995) Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 86:43–50PubMedCrossRef
28.
Zurück zum Zitat Van Hoe L, Vanbeckevoort D, Oyen R, et al. (1999) Cervical carcinoma: optimized local staging with intravaginal contrast-enhanced MR imaging—preliminary results. Radiology 213:608–611PubMed Van Hoe L, Vanbeckevoort D, Oyen R, et al. (1999) Cervical carcinoma: optimized local staging with intravaginal contrast-enhanced MR imaging—preliminary results. Radiology 213:608–611PubMed
29.
Zurück zum Zitat Seki H, Azumi R, Kimura M, Sakai K. (1997) Stromal invasion by carcinoma of the cervix: assessment with dynamic MR imaging. AJR 168:1579–1585PubMed Seki H, Azumi R, Kimura M, Sakai K. (1997) Stromal invasion by carcinoma of the cervix: assessment with dynamic MR imaging. AJR 168:1579–1585PubMed
30.
Zurück zum Zitat Abe Y, Yamashita Y, Namimoto T, et al. (1998) Carcinoma of the uterine cervix. High-resolution turbo spin-echo MR imaging with contrast-enhanced dynamic scanning and T2-weighting. Acta Radiol 39:322–326PubMedCrossRef Abe Y, Yamashita Y, Namimoto T, et al. (1998) Carcinoma of the uterine cervix. High-resolution turbo spin-echo MR imaging with contrast-enhanced dynamic scanning and T2-weighting. Acta Radiol 39:322–326PubMedCrossRef
31.
Zurück zum Zitat Van Vierzen PB, Massuger LF, Ruys SH, Barentsz JO (1998) Fast dynamic contrast enhanced MR imaging of cervical carcinoma. Clin Radiol 53:183–192PubMed Van Vierzen PB, Massuger LF, Ruys SH, Barentsz JO (1998) Fast dynamic contrast enhanced MR imaging of cervical carcinoma. Clin Radiol 53:183–192PubMed
32.
Zurück zum Zitat Narayan K, McKenzie A, Fisher R, et al. (2003) Estimation of tumor volume in cervical cancer by magnetic resonance imaging. Am J Clin Oncol 26:E163–E168PubMed Narayan K, McKenzie A, Fisher R, et al. (2003) Estimation of tumor volume in cervical cancer by magnetic resonance imaging. Am J Clin Oncol 26:E163–E168PubMed
33.
Zurück zum Zitat Wagenaar HC, Trimbos JB, Postema S, et al. (2001) Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 82:474–482PubMedCrossRef Wagenaar HC, Trimbos JB, Postema S, et al. (2001) Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 82:474–482PubMedCrossRef
34.
Zurück zum Zitat Heuck A, Scheidler J, Kimmig R, et al. (1997) [Lymph node staging in cervix carcinomas: the results of high-resolution magnetic resonance tomography (MRT) with a phased-array body coil]. Rofo 166:210–214PubMed Heuck A, Scheidler J, Kimmig R, et al. (1997) [Lymph node staging in cervix carcinomas: the results of high-resolution magnetic resonance tomography (MRT) with a phased-array body coil]. Rofo 166:210–214PubMed
35.
Zurück zum Zitat Bellin MF, Roy C, Kinkel K, et al. (1998) Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles—initial clinical experience. Radiology 207:799–808PubMed Bellin MF, Roy C, Kinkel K, et al. (1998) Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles—initial clinical experience. Radiology 207:799–808PubMed
36.
Zurück zum Zitat Keller TM, Michel SC, Frohlich J, et al. (2004) USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results. Eur Radiol 14:937–944PubMed Keller TM, Michel SC, Frohlich J, et al. (2004) USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results. Eur Radiol 14:937–944PubMed
37.
Zurück zum Zitat Follen M, Levenback CF, Iyer RB, et al. (2003) Imaging in cervical cancer. Cancer 98:2028–2038PubMed Follen M, Levenback CF, Iyer RB, et al. (2003) Imaging in cervical cancer. Cancer 98:2028–2038PubMed
38.
Zurück zum Zitat Todo Y, Sakuragi N, Nishida R, et al. (2003) Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol 188:1265–1272PubMedCrossRef Todo Y, Sakuragi N, Nishida R, et al. (2003) Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol 188:1265–1272PubMedCrossRef
39.
Zurück zum Zitat Jhang H, Chuang L, Visintainer P, Ramaswamy G (2003) CA 125 levels in the preoperative assessment of advanced-stage uterine cancer. Am J Obstet Gynecol 188:1195–1197PubMedCrossRef Jhang H, Chuang L, Visintainer P, Ramaswamy G (2003) CA 125 levels in the preoperative assessment of advanced-stage uterine cancer. Am J Obstet Gynecol 188:1195–1197PubMedCrossRef
40.
Zurück zum Zitat Nicolet V, Carignan L, Bourdon F, Prosmanne O (2000) MR imaging of cervical carcinoma: a practical staging approach. Radiographics 20:1539–1549PubMed Nicolet V, Carignan L, Bourdon F, Prosmanne O (2000) MR imaging of cervical carcinoma: a practical staging approach. Radiographics 20:1539–1549PubMed
41.
Zurück zum Zitat Hawighorst H, Knapstein PG, Weikel W, et al. (1996) Cervical carcinoma: comparison of standard and pharmacokinetic MR imaging. Radiology 201:531–539PubMed Hawighorst H, Knapstein PG, Weikel W, et al. (1996) Cervical carcinoma: comparison of standard and pharmacokinetic MR imaging. Radiology 201:531–539PubMed
42.
Zurück zum Zitat Kim SH, Han MC (1997) Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging. AJR 168:393–397PubMed Kim SH, Han MC (1997) Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging. AJR 168:393–397PubMed
Metadaten
Titel
Pitfalls in staging uterine neoplasm with imaging: a review
verfasst von
K. Kinkel
Publikationsdatum
01.04.2006
Erschienen in
Abdominal Radiology / Ausgabe 2/2006
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-005-0383-8

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