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Prediction of disease progression following concurrent chemoradiotherapy for uterine cervical cancer: value of post-treatment diffusion-weighted imaging. Eur Radiol 2015; 26:3272-9. [DOI: 10.1007/s00330-015-4156-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
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Rauch GM, Kaur H, Choi H, Ernst RD, Klopp AH, Boonsirikamchai P, Westin SN, Marcal LP. Optimization of MR imaging for pretreatment evaluation of patients with endometrial and cervical cancer. Radiographics 2015; 34:1082-98. [PMID: 25019443 DOI: 10.1148/rg.344140001] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endometrial and cervical cancer are the most common gynecologic malignancies in the world. Accurate staging of cervical and endometrial cancer is essential to determine the correct treatment approach. The current International Federation of Gynecology and Obstetrics (FIGO) staging system does not include modern imaging modalities. However, magnetic resonance (MR) imaging has proved to be the most accurate noninvasive modality for staging endometrial and cervical carcinomas and often helps with risk stratification and making treatment decisions. Multiparametric MR imaging is increasingly being used to evaluate the female pelvis, an approach that combines anatomic T2-weighted imaging with functional imaging (ie, dynamic contrast material-enhanced and diffusion-weighted imaging). MR imaging helps guide treatment decisions by depicting the depth of myometrial invasion and cervical stromal involvement in patients with endometrial cancer and tumor size and parametrial invasion in those with cervical cancer. However, its accuracy for local staging depends on technique and image quality, namely thin-section high-resolution multiplanar T2-weighted imaging with simple modifications, such as double oblique T2-weighting supplemented by diffusion weighting and contrast enhancement.
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Affiliation(s)
- Gaiane M Rauch
- From the Departments of Diagnostic Radiology (G.M.R., H.K., H.C., R.D.E., P.B., L.P.M.), Radiation Oncology (A.H.K.), and Gynecologic Oncology and Reproductive Medicine (S.N.W.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Mail Unit 1473, Houston, TX 77030-4009
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Xu-Welliver M, Yuh WTC, Fielding JR, Macura KJ, Huang Z, Ayan AS, Backes FJ, Jia G, Moshiri M, Zhang J, Mayr NA. Imaging across the life span: innovations in imaging and therapy for gynecologic cancer. Radiographics 2015; 34:1062-81. [PMID: 25019442 DOI: 10.1148/rg.344130099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The focus of this article is radiation therapy for gynecologic cancers, with emphasis on imaging-based treatment planning and delivery. For the various gynecologic cancers, radiation oncologists rely on essential clinical information to triage treatment options, and various imaging studies are performed for treatment planning and radiation therapy delivery. A practical approach is provided to help radiologists tailor their reports for the needs of their radiation oncology and gynecologic oncology colleagues, to optimize multidisciplinary care for patients with gynecologic cancer. Template radiology reports are proposed to address the specific information needs of oncologists at each phase-before, during, and after treatment. Fueled by the rapid progress in engineering and computer sciences during the past 2 decades, remarkable advances have been made in anatomic, functional, and molecular imaging and in radiation treatment planning and delivery in patients with gynecologic cancer. Radiation therapy has evolved from a nontargeted approach to a precisely targeted, highly conformal treatment modality, to further improve treatment outcomes and reduce morbidity. High-quality imaging has become essential for staging of the disease, delineation of tumor extent for treatment planning and delivery, and monitoring therapy response. Anatomic and functional imaging has also been shown to provide prognostic information that allows clinicians to tailor therapy on the basis of personalized patient information. This field is an area of active research, and future clinical trials are warranted to validate preliminary results in the field.
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Affiliation(s)
- Meng Xu-Welliver
- From the Departments of Radiation Oncology (M.X., A.S.A.), Radiology (G.J., J.Z.), and Obstetrics and Gynecology (F.J.B.), Ohio State University, Columbus, Ohio; Department of Radiology, University of North Carolina, Chapel Hill, NC (J.R.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (K.J.M.); Department of Radiation Oncology, East Carolina University, Greenville, NC (Z.H.); and Departments of Radiology (W.T.C.Y., M.M.) and Radiation Oncology (N.A.M.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195-6043
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Bourgioti C, Chatoupis K, Rodolakis A, Antoniou A, Tzavara C, Koutoulidis V, Moulopoulos LA. Incremental prognostic value of MRI in the staging of early cervical cancer: a prospective study and review of the literature. Clin Imaging 2015; 40:72-8. [PMID: 26459788 DOI: 10.1016/j.clinimag.2015.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/03/2015] [Accepted: 09/12/2015] [Indexed: 12/14/2022]
Abstract
This is to evaluate the predictive ability of clinical examination and preoperative magnetic resonance imaging (MRI) for the staging of early cervical cancer. We prospectively evaluated 115 patients with cervical cancer, International Federation of Gynecologic and Obstetrics (FIGO) stage <IIB; receiver operating characteristic (ROC) analysis determined the predictive ability of MRI, clinical assessment, and their combination for tumor staging. Surgery was the standard of reference. MRI was more accurate than clinical examination for tumor estimate, parametrial or internal os involvement. When combined with MRI, the predictive ability of clinical examination for overall staging [area under the curve (AUC)=0.59, P>.05) increased significantly (AUC=0.84, P<.05). Our results support the official incorporation of MRI into FIGO classification system.
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Affiliation(s)
- Charis Bourgioti
- Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vas. Sofias Ave., Athens, Greece, 11528.
| | - Konstantinos Chatoupis
- Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vas. Sofias Ave., Athens, Greece, 11528.
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Alexandra Hospital, Medical School, University of Athens, 80 Vas. Sofias Ave., Greece, 11528.
| | - Aristeidis Antoniou
- Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vas. Sofias Ave., Athens, Greece, 11528.
| | - Chara Tzavara
- Department of Health, Epidemiology and Medical Statistics, Medical School, University of Athens, 25 Alexandroupoleos Str., Athens, Greece, 11527.
| | - Vassilis Koutoulidis
- Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vas. Sofias Ave., Athens, Greece, 11528.
| | - Lia Angela Moulopoulos
- Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vas. Sofias Ave., Athens, Greece, 11528.
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Leursen G, Gardner CS, Sagebiel T, Patnana M, de CastroFaria S, Devine CE, Bhosale PR. Magnetic Resonance Imaging of Benign and Malignant Uterine Neoplasms. Semin Ultrasound CT MR 2015; 36:348-60. [PMID: 26296485 DOI: 10.1053/j.sult.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Benign and malignant uterine masses can be seen in the women. Some of these are asymptomatic and incidentally discovered, whereas others can be symptomatic. With the soft tissue contrast resolution magnetic resonance imaging can render a definitive diagnosis, which can further help streamline patient management. In this article we show magnetic resonance imaging examples of benign and malignant masses of the uterus and their treatment strategies.
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Affiliation(s)
- Gustavo Leursen
- Department of Abdominal Radiology, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Tara Sagebiel
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | - Madhavi Patnana
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | | | | | - Priya R Bhosale
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX.
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Makino H, Kato H, Furui T, Hayasaki Y, Morishige KI, Kanematsu M. Assessment of uterine enhancement rate after abdominal radical trachelectomy using dynamic contrast-enhanced magnetic resonance imaging. Arch Gynecol Obstet 2015; 293:625-32. [DOI: 10.1007/s00404-015-3842-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 08/07/2015] [Indexed: 12/18/2022]
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MR imaging in the management of trachelectomy. Diagn Interv Imaging 2015; 97:129-32. [PMID: 26119867 DOI: 10.1016/j.diii.2014.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/03/2014] [Accepted: 07/07/2014] [Indexed: 11/23/2022]
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Magnetic resonance appearance of gastric-type adenocarcinoma of the uterine cervix in comparison with that of usual-type endocervical adenocarcinoma: a pitfall of newly described unusual subtype of endocervical adenocarcinoma. Int J Gynecol Cancer 2015; 24:1474-9. [PMID: 25188888 DOI: 10.1097/igc.0000000000000229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the characteristics of gastric-type adenocarcinoma (GAS) of the uterine cervix, compared with usual-type endocervical adenocarcinoma (UEA) and squamous cell carcinoma (SCC), using magnetic resonance (MR) imaging. MATERIALS AND METHODS A total of 15 histopathologically defined GASs, 12 UEAs, and 40 SCCs were retrieved from archive files and were included for evaluation. Microscopic features, as well as topography and tumor growth pattern, and presence or absence of coexistence of cystic cavities were evaluated. Accuracy of evaluation for parametrial tissue and vaginal wall invasion was also evaluated by 2 diagnostic radiologists, independently, without clinical information on cases. RESULTS Thirteen (86.70%) of the 15 cases of GAS exhibited tumors in the higher portion of cervical canal or the entire cervix. On the other hand, SCCs and UEAs were mainly located in the lower portion of cervical canal, at a frequency of 21 of 40 (52.5%) and 9 of 12 (75.0%), respectively. Involvement of the corpus was observed more frequently in cases of GAS with an occurrence of 8 of 15 (53.3%), whereas in all cases of UEA and in 5 of the 40 cases of SCC, the corpus was free of tumor. In GAS cases, the predominant pattern of growth was highly infiltrating and endophytic (14/15, 93.3%), whereas an exophytic growth pattern was observed in 31 (77.5%) of the 40 SCC cases and 11 (91.7%) of the 12 UEA cases. Cystic cavities associated with tumors were identified in only 1 case of SCC but occurred in 12 (80.0%) of the 15 GASs and 4 (33.3%) of the 12 UEAs. Diagnostic accuracies of more than 70% and more than 60% were reached in parametrial invasion and vaginal invasion, respectively, in GAS. CONCLUSION Distinctive MR imaging features of GAS were infiltrating mass of endophytic growth, location in the upper cervical canal, and association with tiny cysts. This characteristic appearance can be a clue for the evaluation of extent of tumor based on MR imaging.
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Fischerova D, Cibula D. Ultrasound in Gynecological Cancer: Is It Time for Re-evaluation of Its Uses? Curr Oncol Rep 2015; 17:28. [DOI: 10.1007/s11912-015-0449-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nougaret S, Reinhold C, Alsharif SS, Addley H, Arceneau J, Molinari N, Guiu B, Sala E. Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade. Radiology 2015; 276:797-808. [PMID: 25928157 DOI: 10.1148/radiol.15141212] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. MATERIALS AND METHODS The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. RESULTS No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P < .0001). There was no significant difference in the ADCs between grades 1 and 2 tumors (P > .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P < .02). CONCLUSION The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.
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Affiliation(s)
- Stephanie Nougaret
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Caroline Reinhold
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Shaza S Alsharif
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Helen Addley
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Jocelyne Arceneau
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Nicolas Molinari
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Boris Guiu
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Evis Sala
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
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Comparison of contrast-enhanced isotropic 3D-GRE-T1WI sequence versus conventional non-isotropic sequence on preoperative staging of cervical cancer. PLoS One 2015; 10:e0122053. [PMID: 25799021 PMCID: PMC4370849 DOI: 10.1371/journal.pone.0122053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To compare contrast-enhanced isotropic 3D-GRE-T1WI sequence vs. conventional non-isotropic sequence in terms of image quality, estimated signal-to-noise ratio (eSNR), relative tumor contrast and performance of cervical cancer staging. Methods This retrospective study was approved by the institutional review board, and informed consent was waived. Seventy-one patients (47 ± 9.4 years), with pathologically-confirmed cervical cancer underwent axial contrast-enhanced 1mm3 isotropic 3D-GRE-T1WI sequence (herein referred to Isotropy), and 3-mm-thick non-isotropic sagittal and coronal sequences. Image quality score, eSNR and relative contrast between tumor to myometrium, gluteal muscle, and fat respectively, were compared between 3-mm-thick reconstructed images from Isotropy and directly scanned non-isotropic images by paired t-test. Difference in tumor staging obtained from Isotropy and combined Three-planes including reconstructed axial images, directly scanned sagittal and coronal sequence were compared by McNemar test. Results Both sequences showed similar image quality. Reconstructed images demonstrated higher eSNR, equal or lower relative tumor contrast compared with non-isotropic images. Compared with performing diagnosis on Three-planes, both reviewers showed higher accuracy when diagnosing vaginal invasion on Isotropy (p = 0.039 and 0.003, respectively). Conclusion Compared with non-isotropic sequence, 3.0T MR isotropic 3D-GRE-T1WI sequence exhibited better eSNR, providing more reliable clinical information for preoperative staging of cervical cancer.
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Abstract
OBJECTIVE To review the outcomes of those women who underwent hysterectomy because of an abnormal cervical smear where local excision was considered technically not possible. MATERIALS AND METHODS A retrospective chart review was performed for all women who had hysterectomy at a university-affiliated hospital, carried out during the period between January 2000 and June 2012, because of cervical neoplasia. RESULTS Fifty-six women were identified. The mean (standard deviation [SD]) age of the women at the time of hysterectomy was 61.4 (8.2) years. Two women (3.6%) had cervical carcinoma, and adjuvant treatment was required in both cases. Being postmenopausal and older than 50 years and having a history of previous local excisional procedure were associated with a higher risk of high-grade cervical intraepithelial neoplasia found during hysterectomy (p > .005). During a mean (SD) follow-up of 42.3 (30.8) months after hysterectomy, 35.7% of women had persistent cytologic abnormality after hysterectomy, with 19.6% having subsequent histologically proven vaginal intraepithelial neoplasia (VAIN). Women's age, route of hysterectomy, previous local excision, degree of cytologic abnormality before hysterectomy, presence of VAIN before hysterectomy, and final histology of the hysterectomy specimen could not predict subsequent VAIN after hysterectomy. CONCLUSIONS Hysterectomy seems to be an appropriate option in management, but further surgery or adjuvant therapy may be needed. Women should also be aware of the possibilities of persistent cytologic abnormalities including VAIN, but unfortunately, no predictive factor for its occurrence can be identified.
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Kato T, Takashima A, Kasamatsu T, Nakamura K, Mizusawa J, Nakanishi T, Takeshima N, Kamiura S, Onda T, Sumi T, Takano M, Nakai H, Saito T, Fujiwara K, Yokoyama M, Itamochi H, Takehara K, Yokota H, Mizunoe T, Takeda S, Sonoda K, Shiozawa T, Kawabata T, Honma S, Fukuda H, Yaegashi N, Yoshikawa H, Konishi I, Kamura T. Clinical tumor diameter and prognosis of patients with FIGO stage IB1 cervical cancer (JCOG0806-A). Gynecol Oncol 2015; 137:34-9. [PMID: 25662625 DOI: 10.1016/j.ygyno.2015.01.548] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In order to determine indications for less radical surgery such as modified radical hysterectomy, the risk of pathological parametrial involvement and prognosis of FIGO stage IB1 cervical cancer patients undergoing standard radical hysterectomy with pre-operatively assessed tumor diameter≤2 cm were investigated. METHODS We conducted a retrospective multi-institutional chart review of patients with FIGO stage IB1 cervical cancer who underwent primary surgical treatment between 1998 and 2002. The eligibility criteria for the analyses were (i) histologically-proven squamous cell carcinoma, adenocarcinoma or, adenosquamous cell carcinoma, (ii) radical hysterectomy performed, (iii) clinical tumor diameter data available by MR imaging or specimens by cone biopsy, and (iv) age between 20 and 70. Based on the clinical tumor diameter, patients were stratified into those with the following tumors: i) 2 cm or less (cT≤2 cm) and ii) greater than 2 cm (cT>2 cm). We expected 5-year OS of ≥95% and parametrial involvement<2-3% for patients with cT≤2 cm who underwent radical hysterectomy. RESULTS Of the 1269 patients enrolled, 604 were eligible for the planned analyses. Among these, 571 underwent radical hysterectomy (323 with cT≤2 cm and 248 with cT>2 cm). Parametrial involvement was present in 1.9% (6/323) with cT≤2 cm and 12.9% (32/248) with cT>2 cm. Five-year overall survivals were 95.8% (95% CI 92.9-97.6%) in cT≤2 cm and 91.9% (95% CI 87.6-94.8%) in cT>2 cm patients. CONCLUSION Patients with cT≤2 cm had lower risk of parametrial involvement and more favorable 5-year overall survival. They could therefore be good candidates for receiving less radical surgery.
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Affiliation(s)
- Tomoyasu Kato
- Department of Gynecologic Oncology, National Cancer Center Hospital, Japan.
| | - Atsuo Takashima
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Takahiro Kasamatsu
- Department of Gynecologic Oncology, National Cancer Center Hospital, Japan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Toru Nakanishi
- Department of Gynecologic Oncology, Aichi Cancer Center, Japan
| | | | - Shoji Kamiura
- Department of Gynecology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
| | - Takashi Onda
- Department of Obstetrics and Gynecology, Kitasato University, Japan
| | - Toshiyuki Sumi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Japan
| | | | - Toshiaki Saito
- Gynecologic Service, National Kyushu Cancer Center, Japan
| | | | | | - Hiroaki Itamochi
- Department of Obstetrics and Gynecology, Tottori University, Japan
| | | | - Harushige Yokota
- Department of Gynecologic Oncology, Saitama Cancer Center, Japan
| | - Tomoya Mizunoe
- Department of Gynecologic Oncology, Kure Medical Center, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Japan
| | - Kenzo Sonoda
- Department of Obstetrics and Gynecology, Kyushu University, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University, Japan
| | - Takayo Kawabata
- Department of Obstetrics and Gynecology, Kagoshima City Hospital, Japan
| | - Shigeru Honma
- Department of Gynecology, Niigata Cancer Center Hospital, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University, Japan
| | | | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University, Japan
| | - Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University, Japan
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Schreuder SM, Lensing R, Stoker J, Bipat S. Monitoring treatment response in patients undergoing chemoradiotherapy for locally advanced uterine cervical cancer by additional diffusion-weighted imaging: A systematic review. J Magn Reson Imaging 2014; 42:572-94. [PMID: 25346470 DOI: 10.1002/jmri.24784] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/03/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To determine the role of diffusion-weighted imaging (DWI) in evaluating response to chemoradiotherapy in patients with uterine cervical cancer. MATERIALS AND METHODS A search was performed in MEDLINE and EMBASE from January 2005 to April 2014 using search terms related to uterine cervical cancer and magnetic resonance imaging. Two reviewers independently checked the studies for inclusion criteria, patient population, magnetic resonance imaging (MRI) parameters and analysis, follow-up for treatment response, apparent diffusion coefficient (ADC) values, and quality assessment. RESULTS Nine studies with 231 patients were included. International Federation of Gynecology and Obstetrics (FIGO) staging varied from Ib1 to IVb and mean age from 42 to 67 years. When baseline and after treatment pooled mean ADC values were compared, complete responders showed higher increase (0.88 × 10(-3) mm(2) /s to 1.50 × 10(-3) mm(2) /s; Δ0.62 × 10(-3) mm(2) /s) compared to partial responders (1.03 × 10(-3) mm(2) /s to 1.42 × 10(-3) mm(2) /s; Δ0.39 × 10(-3) mm(2) /s) and to nonresponders (0.87 × 10(-3) mm(2) /s to 1.18 × 10(-3) mm(2) /s; Δ0.31 × 10(-3) mm(2) /s). Individual studies also showed that an ADC of ≤0.31 was only seen in nonresponders and an increase of ADC of ≥0.62 was only seen in complete responders. The number of datasets for monitoring early response (at 2 or 4 weeks of therapy) were low and comparable increases in pooled mean ADC values between complete responders, partial responders, and nonresponders were seen. Data on quality assessment showed high risk of bias concerning patient selection, DWI evaluation, and flow and timing. CONCLUSION DWI can be used for monitoring treatment response after treatment, but not for the early response monitoring.
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Affiliation(s)
- Sanne M Schreuder
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Rutger Lensing
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
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Shirazi AS, Razi T, Cheraghi F, Rahim F, Ehsani S, Davoodi M. Diagnostic Accuracy of Magnetic Resonance Imaging versus Clinical Staging in Cervical Cancer. Asian Pac J Cancer Prev 2014; 15:5729-32. [DOI: 10.7314/apjcp.2014.15.14.5729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Noël P, Dubé M, Plante M, St-Laurent G. Early Cervical Carcinoma and Fertility-sparing Treatment Options: MR Imaging as a Tool in Patient Selection and a Follow-up Modality. Radiographics 2014; 34:1099-119. [DOI: 10.1148/rg.344130009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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168
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MRI findings before and after abdominal radical trachelectomy (ART) for cervical cancer: A prospective study and review of the literature. Clin Radiol 2014; 69:678-86. [DOI: 10.1016/j.crad.2014.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 12/14/2022]
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Siepe B, Hoilund-Carlsen PF, Gerke O, Weber WA, Motschall E, Vach W. The move from accuracy studies to randomized trials in PET: current status and future directions. J Nucl Med 2014; 55:1228-34. [PMID: 24914059 DOI: 10.2967/jnumed.113.127076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 04/28/2014] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED Since the influential study by van Tinteren et al. published in The Lancet in 2002, there have been an increasing number of diagnostic randomized controlled trials (RCTs) investigating the benefit of PET. If they provide valid and useful information on the benefit, these studies can play an important role in informing guideline developers and policy makers. Our aim was to investigate how far the nuclear medicine community has come on its way from accuracy studies to RCTs and which issues we have to take into account in planning future studies. METHODS We conducted a systematic review of diagnostic randomized trials, in which PET was applied in only one arm. We covered published studies as well as registered unpublished and planned studies. We considered 3 quality indicators related to the usefulness of a trial to generate evidence for a clinical benefit: use of patient-important outcome, sufficient sample size, and current standard as comparator. RESULTS Fourteen published and 15 planned studies were identified. Five of the published studies and 12 of the planned studies did not use a patient-important outcome. Sample sizes were often so small that a significant result could be expected only under the assumption of a substantial reduction in the event rate. Comparators typically reflected the current standard. CONCLUSION If we consider the traditional areas of primary diagnosis, staging, and follow-up, then the number and quality of RCTs on PET is currently not sufficient to provide a major source for evidence-based decisions on the clinical benefit of PET. There will also be a future need in these traditional areas to deduce the clinical benefit of PET from the results of accuracy studies. The situation may be more favorable for the areas of treatment planning and response evaluation. Choice of patient-important outcomes and sufficient sample sizes are crucial issues in planning RCTs to demonstrate the clinical benefit of using PET.
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Affiliation(s)
- Bettina Siepe
- Department of Anesthesiology, Freiburg University Medical Center, Freiburg, Germany
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark Department of Business and Economics, Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | | | - Edith Motschall
- Department of Medical Biometry and Medical Informatics, Freiburg University Medical Center, Freiburg, Germany; and
| | - Werner Vach
- Clinical Epidemiology, Department of Medical Biometry and Medical Informatics Freiburg University Medical Center, Freiburg, Germany
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Testa AC, Di Legge A, De Blasis I, Moruzzi MC, Bonatti M, Collarino A, Rufini V, Manfredi R. Imaging techniques for the evaluation of cervical cancer. Best Pract Res Clin Obstet Gynaecol 2014; 28:741-68. [PMID: 24861248 DOI: 10.1016/j.bpobgyn.2014.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 02/07/2023]
Abstract
Improvements in the treatment of cervical carcinoma have made it possible to offer optimal and personalised treatment. Cervical cancer staging is based on clinical examination and histological findings. Many diagnostic methods are used in clinical practice. Magnetic resonance imaging is considered the optimal method for staging cervical carcinoma because of its high accuracy in assessing local extension of disease and distant metastases. Ultrasound has gained increased attention in recent years; it is faster, cheaper, and more widely available than other imaging techniques, and is highly accurate in detecting tumour presence and evaluating local extension of disease. Magnetic resonance imaging and ultrasound are often used together with computed tomography or positron emission tomography combined with computed tomography to assess the whole body, a more accurate detection of pathological lymph nodes and metabolic information of the disease.
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Affiliation(s)
- Antonia Carla Testa
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessia Di Legge
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Ilaria De Blasis
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Cristina Moruzzi
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Bonatti
- Department of Radiology, University of Verona, "G.B. Rossi" Hospital, Verona, Italy
| | - Angela Collarino
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, University of Verona, "G.B. Rossi" Hospital, Verona, Italy
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Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, Ebina Y, Yamada H, Takahashi S, Sugimura K. Fusion of PET and MRI for staging of uterine cervical cancer: comparison with contrast-enhanced (18)F-FDG PET/CT and pelvic MRI. Clin Imaging 2014; 38:464-469. [PMID: 24642250 DOI: 10.1016/j.clinimag.2014.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/03/2013] [Accepted: 02/09/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the fusion of pelvic magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (PET) for assessment of locoregional extension and nodal staging of cervical cancer. METHODS PET/computed tomography (CT), MRI, and non-fused and fusion of PET and MRI for assessing the extent of the primary tumor and metastasis to nodes were evaluated. RESULTS Accuracy for T-status was 83.3% for fused and non-fused PET/MRI and MRI proved significantly more accurate than PET/CT (53.3%) (P=.0077). Sensitivity, specificity, and accuracy for nodal metastasis were 92.3%, 88.2%, and 90.0% for fused PET/MRI and PET/contrast-enhanced CT; 84.6%, 94.1%, and 90.0% for non-fused PET/MRI; and 69.2%, 100%, and 86.7% for MRI. CONCLUSION Fused PET/MRI combines the individual advantages of MRI and PET.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology and of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yuko Suenaga
- Department of Radiology and of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiko Ueno
- Department of Radiology and of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomonori Kanda
- Department of Radiology, Hyogo Cancer Center, Hyogo, Japan
| | - Tetsuo Maeda
- Department of Radiology and of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Yasuhiko Ebina
- Department of Radiology, Hyogo Cancer Center, Hyogo, Japan
| | - Hideto Yamada
- Department of Radiology, Hyogo Cancer Center, Hyogo, Japan
| | - Satoru Takahashi
- Department of Radiology and of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuro Sugimura
- Department of Radiology and of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan
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Rizzo S, Calareso G, Maccagnoni S, Angileri SA, Landoni F, Raimondi S, Pasquali E, Lazzari R, Bellomi M. Pre-operative MR evaluation of features that indicate the need of adjuvant therapies in early stage cervical cancer patients. A single-centre experience. Eur J Radiol 2014; 83:858-64. [PMID: 24581810 DOI: 10.1016/j.ejrad.2014.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/24/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study compared the MR measurement of minimum uninvolved cervical stroma and maximum stromal invasion, and the detection of positive lymph nodes with the pathological results. In addition, tumour type and grade were correlated with nodal status and apparent diffusion coefficient (ADC) values. METHODS Patients who underwent surgery and MR at our centre for early stage cervical cancer (FIGO IA1-IIB) were included. Data recorded included: age, date of MR, clinical FIGO (International Federation of Gynacology and Obstetrics) stage, histological type and grade, adjuvant therapy, pre-surgical conisation. MR evaluation included: measurement of the minimum uninvolved stroma, maximum thickness of stromal involvement, presence and site of positive pelvic lymph nodes, calculation of ADC values. Statistical analysis was performed to compare MR and pathological results. The agreement between MR and pathology in measuring depth of stromal invasion was analysed by Bland-Altman plot, calculating the limits of agreement (LoA). RESULTS 113/217 patients underwent adjuvant therapies. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MR in evaluation of minimum thickness of uninvolved cervical stroma were 88%, 75%, 70%, 90% and 80%; the same values in evaluation of pelvic positive lymph nodes were 64%, 85%, 65%, 84% and 78%. The mean difference between MR and pathological results in measuring maximum depth of stromal invasion was -0.65mm (95% LoA: -9.37mm; 8.07mm). Depth of stromal invasion was strongly related to positive nodal status (p<0.001). ADC values (available in 51/217 patients) were not associated with the features assessed. CONCLUSIONS Pre-surgical MR is accurate (80%) in evaluating the minimum thickness of uninvolved cervical stroma; MR measurements of maximum depth of stromal invasion differed ±9mm from the pathological results in 95% of cases. Furthermore, a strong association was found between the depth of stromal invasion and the presence of positive lymph nodes, suggesting that inclusion of these measurements in the MR report might guide the choice of the best treatment option for early cervical cancer patients.
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Affiliation(s)
- Stefania Rizzo
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
| | - Giuseppina Calareso
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Sara Maccagnoni
- Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy
| | | | - Fabio Landoni
- Division of Gynecology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Sara Raimondi
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Elena Pasquali
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy; Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy
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Rizzo S, Calareso G, De Maria F, Zanagnolo V, Lazzari R, Cecconi A, Bellomi M. Gynecologic tumors: how to communicate imaging results to the surgeon. Cancer Imaging 2013; 13:611-25. [PMID: 24434038 PMCID: PMC3894699 DOI: 10.1102/1470-7330.2013.0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Gynecologic cancers are a leading cause of morbidity and mortality for female patients, with an estimated 88,750 new cancer cases and 29,520 deaths in the United States in 2012. To offer the best treatment options to patients it is important that the radiologist, surgeon, radiation oncologist, and gynecologic oncologist work together with a multidisciplinary approach. Using the available diagnostic imaging modalities, the radiologist must give appropriate information to the surgeon in order to plan the best surgical approach and its timing.
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Affiliation(s)
- Stefania Rizzo
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy
| | - Federica De Maria
- Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy
| | - Vanna Zanagnolo
- Department of Gynecology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy
| | - Roberta Lazzari
- Department of Radiotherapy, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy
| | - Agnese Cecconi
- Department of Radiotherapy, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy; Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy
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Horváth K, Pete I, Vereczkey I, Dudnyikova A, Gődény M. Evaluation of the Accuracy of Preoperative MRI in Measuring Myometrial Infiltration in Endometrial Carcinoma. Pathol Oncol Res 2013; 20:327-33. [DOI: 10.1007/s12253-013-9699-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022]
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175
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Current Concepts in the Diagnosis and Management of Endometrial and Cervical Carcinomas. Radiol Clin North Am 2013; 51:1087-110. [DOI: 10.1016/j.rcl.2013.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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176
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Marnitz S, Köhler C, Rauer A, Schneider A, Budach V, Tsunoda A, Mangler M. Patterns of care in patients with cervical cancer 2012: results of a survey among German radiotherapy departments and out-patient health care centers. Strahlenther Onkol 2013; 190:34-40. [PMID: 23887709 DOI: 10.1007/s00066-013-0403-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/03/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Platinum-based primary or adjuvant chemoradiation is the treatment of choice for patients with cervical cancer. However, despite national guidelines and international recommendations, many aspects in diagnosis, therapy, and follow-up of patients with cervical cancer are not based on valid data. METHODS To evaluate the current patterns of care for patients with cervical cancer in Germany, a questionnaire with 25 items was sent to 281 radiooncologic departments and out-patient health care centers. RESULTS The response rate was 51%. While 87% of institutions treat 0-25 patients/year, 12 % treat between 26 and 50 and only 1% treat more than 50 patients/year. In 2011, the stage distribution of 1,706 treated cervical cancers were IB1, IB2, IIA, IIB, IIIA/IIIB, and IV in 11, 12, 11, 22, 28, and 16%, respectively. CT (90%) and MRI (86%) are mainly used as staging procedures in contrast to PET-CT with 14%. Interestingly, 27% of institutions advocate surgical staging prior to chemoradiation. In the majority of departments 3D-based (70%) and intensity-modulated radiotherapy (76%) are used for percutaneous radiation, less frequently volumetric arc techniques (26%). Nearly all colleagues (99.3%) apply conventional fractioning of 1.8-2 Gy for external-beam radiotherapy, in 19% combined with a simultaneous integrated boost. Cisplatinum mono is used as a radiosensitizer with 40 mg/m(2) weekly by 90% of radiooncologists. For boost application in the primary treatment, HDR (high-dose rate) brachytherapy is the dominant technique (84%). In patients after radical hysterectomy pT1B1/1B2, node negative and resection in sound margins adjuvant chemoradiation is applied due to the occurrence of 1-4 other risk factors in 16-97%. There is a broad spectrum of recommended primary treatment strategies in stages IIB and IVA. CONCLUSION Results of the survey underline the leading role but also differences in the use of chemoradiation in the treatment of cervical cancer patients in Germany.
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Affiliation(s)
- S Marnitz
- Department of Radiooncology, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany,
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Brandão AC, Silva AO. Diseases of the female pelvis: advances in imaging evaluation. Magn Reson Imaging Clin N Am 2013; 21:447-69. [PMID: 23642562 DOI: 10.1016/j.mric.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Magnetic resonance (MR) imaging has been widely accepted as a powerful imaging modality for the evaluation of the pelvis because of its intrinsic superior soft tissue contrast compared with that of computed tomography. In certain cases, however, the morphologic study provided by MR imaging may not be enough. Functional evaluation with perfusion and diffusion, which allow estimation of the microvascular characteristics and cellularity of the lesions, favors the differentiation of benign from malignant lesions. This article focuses on new magnetic resonance techniques and their contribution to the differentiation and characterization of pelvic pathologies.
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Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 2013; 266:717-40. [PMID: 23431227 DOI: 10.1148/radiol.12120315] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many treatment options are available to patients with endometrial, cervical, or ovarian cancer. Magnetic resonance (MR) imaging plays an important role in the patient journey from the initial evaluation of the extent of the disease to appropriate treatment selection and follow-up. The purpose of this review is to highlight the added role of MR imaging in the treatment stratification and overall care of patients with endometrial, cervical, or ovarian cancer. Several MR imaging techniques used in evaluation of patients with gynecologic malignancies are described, including both anatomic MR imaging sequences (T1- and T2-weighted sequences) and pulse sequences that characterize tissue on the basis of physiologic features (diffusion-weighted MR imaging), dynamic contrast agent-enhanced MR imaging, and MR spectroscopy. MR imaging findings corresponding to the 2009 revised International Federation of Gynecology and Obstetrics staging of gynecologic malignancies are also described in detail, highlighting possible pearls and pitfalls of staging. With the growing role of the radiologist as a core member of the multidisciplinary treatment planning team, it is crucial for imagers to recognize that MR imaging has become central in tailoring treatment options and therapy in patients with gynecologic malignancies.
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Affiliation(s)
- Evis Sala
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, England, UK.
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Mangler M, Zech N, Schneider A, Köhler C, Marnitz S. Aspects of Therapy for Cervical Cancer in Germany 2012 - Results from a Survey of German Gynaecological Hospitals. Geburtshilfe Frauenheilkd 2013; 73:227-238. [PMID: 24771915 DOI: 10.1055/s-0032-1328302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/24/2013] [Accepted: 02/01/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction: In spite of the existence of guidelines and international recommendations, many aspects in the diagnosis, therapy and follow-up of patients with cervical cancer are not based on validated data. A broad spectrum of different opinions and procedures concerning the therapy for patients with cervical cancer is under controversial discussion by the responsible gynaecologists in German hospitals. Methods: The present study is intended to picture the current treatment situation for cervical cancer in Germany. For this purpose a specially developed questionnaire with questions divided into 19 subsections was sent to all 688 gynaecological hospitals in Germany. Results: The response rate to the questionnaire was 34 %. 91 % of the hospitals treated between 0 and 25 patients with cervical cancer per year. 7.5 % treated between 26 and 50 and 1.4 % of the hospitals more than 50 patients per year. The bimanual examination was the most frequently used staging method (98 %); PET-CT was the least used staging method (2.3 %). Interestingly 48 % of the hospitals used surgical staging. The great majority of the hospitals (71 %) used abdominal radical hysterectomy (Wertheim-Meigs operation) to treat their patients. TMMR via laparotomy was used by 13 %. 16 % of the hospitals performed laparoscopic or robot-assisted radical hysterectomies. The sentinel concept was hardly used even in the early stages. It must be emphasised that in 74 % of the hospitals radical hysterectomies were performed even in cases with positive pelvic lymph nodes and in 43 % also in cases with positive paraaortic lymph nodes. The therapy of choice for FIGO IIB cancers is primary radiochemotherapy (RCTX) in 21 % of the hospitals; operative staging followed by radiochemotherapy in 24 % and treatment by radical hysterectomy followed by adjuvant RCTX was employed in this situation by 46 % of the hospitals. In 15-97 % of the hospitals for node-negative and in sano resected patients in stage pT1B1/1B2 after radical hysterectomy, an adjuvant RCTX is recommended when further risk factors exist (LVSI, tumour > 4 cm, age < 40 years, adenocarcinoma, S3). Conclusion: A broad spectrum of differing staging and therapy concepts is in use for patients with cervical cancer in Germany. A standardisation of therapy is needed. An update of national guidelines could help to achieve more transparency and a standardisation of treatment for patients with cervical cancer.
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Affiliation(s)
| | - N Zech
- Gynäkologie, Charité, Berlin
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Pearls and pitfalls in MRI of gynecologic malignancy with diffusion-weighted technique. AJR Am J Roentgenol 2013; 200:261-76. [PMID: 23345345 DOI: 10.2214/ajr.12.9713] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Developments in MRI techniques have increased the role of MRI in assessment of the pelvis in women. The aims of this review are a short overview of pelvic MRI with an emphasis on diffusion-weighted MRI (DWI) and presentation of a practical approach that includes the pearls and pitfalls of DWI. CONCLUSION DWI provides indispensable information in the evaluation of gynecologic malignancies. Prudent application of this technique requires knowledge of the optimal protocols and pitfalls in interpretation.
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Abstract
OBJECTIVE Functional MR techniques report on a variety of biologic features of tumors: dynamic contrast-enhanced, diffusion-weighted, and intrinsic susceptibility-weighted MRI and MR spectroscopy reflect, at a simplistic level, vascularity, cellularity, hypoxic status, and metabolism, respectively. This article reviews the evidence for each of the functional MR readouts to determine these clinical end points and thus influence the management of ovarian, endometrial, and cervical cancer. CONCLUSION These techniques may be implemented in gynecologic malignancies to detect, characterize, and stage tumors as well as potentially to predict the outcome and measure response to treatment.
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Epstein E, Testa A, Gaurilcikas A, Di Legge A, Ameye L, Atstupenaite V, Valentini AL, Gui B, Wallengren NO, Pudaric S, Cizauskas A, Måsbäck A, Zannoni GF, Kannisto P, Zikan M, Pinkavova I, Burgetova A, Dundr P, Nemejcova K, Cibula D, Fischerova D. Early-stage cervical cancer: Tumor delineation by magnetic resonance imaging and ultrasound — A European multicenter trial. Gynecol Oncol 2013; 128:449-53. [DOI: 10.1016/j.ygyno.2012.09.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/21/2012] [Accepted: 09/21/2012] [Indexed: 11/24/2022]
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Routine pelvic MRI using phased-array coil for detection of extraprostatic tumour extension: accuracy and clinical significance. Eur Radiol 2012; 23:1158-66. [PMID: 23114883 PMCID: PMC3599204 DOI: 10.1007/s00330-012-2669-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/20/2012] [Accepted: 09/04/2012] [Indexed: 11/21/2022]
Abstract
Objectives To determine the accuracy and assess the clinical significance of surface-coil 1.5-T magnetic resonance imaging (MRI) for the detection of locally advanced prostate cancer (PCa). Methods Between December 2007 and January 2010, we examined 209 PCa patients (mean age = 62.5 years) who were consecutively treated with robot-assisted laparoscopic prostatectomy and prospectively staged by MRI. One hundred and thirty-five patients (64.6 %) had locally advanced disease. Conventional clinical tumour stage and MRI-assessed tumour stage were compared with histopathological tumour stage (pT). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) were calculated using pT as the “gold standard”. Overstaged and understaged cases at MRI were reviewed. Results Sensitivity, specificity, PPV, NPV and OA for the detection of locally advanced disease were 25.9, 95.9, 92.1, 41.2 and 50.5 % and 56.3, 82.2, 85.4, 50.4 and 65.4 % for clinical staging and MRI, respectively. Among patients understaged at MRI, the resection margins were free in 64.4 % of the cases (38/59). Conclusions Although the accuracy was limited, the detection of locally advanced disease improved substantially when MRI was added to routine clinical staging. The majority of the understaged patients nevertheless achieved free margins. When assessing the clinical significance of MRI staging the extent of extraprostatic extension has to be considered. Key Points • MRI substantially improves detection of locally advanced prostate cancer • MRI has limited overall staging accuracy • Most T3 cancers unrecognised at MRI still achieved free resection margins • Assessing the true clinical contribution of MRI remains challenging
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Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E. The Revised FIGO Staging System for Uterine Malignancies: Implications for MR Imaging. Radiographics 2012; 32:1805-27. [DOI: 10.1148/rg.326125519] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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