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Fang Y, Wang K, Xiao M, Cheng J, Lin Z, Qiang J, Li Y. Multiparametric MRI-based radiomics nomogram for identifying cervix-corpus junction cervical adenocarcinoma from endometrioid adenocarcinoma. Abdom Radiol (NY) 2024; 49:1557-1568. [PMID: 38441631 DOI: 10.1007/s00261-024-04214-x] [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: 11/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To developed a magnetic resonance imaging (MRI) radiomics nomogram to identify adenocarcinoma at the cervix-corpus junction originating from the endometrium or cervix in order to better guide clinical treatment. METHODS Between February 2011 and September 2021, the clinicopathological data and MRI in 143 patients with histopathologically confirmed cervical adenocarcinoma (CAC, n = 86) and endometrioid adenocarcinoma (EAC, n = 57) were retrospectively analyzed at the cervix-corpus junction. Radiomics features were extracted from fat-suppressed T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, and delayed phase contrast-enhanced T1-weighted imaging (CE-T1WI) sequences. A radiomics nomogram was developed integrating radscore with independent clinical risk factors. The area under the curve (AUC) was used to evaluate the diagnostic efficacy of the radscore, nomogram and two different experienced radiologists in differentiating CAC from EAC at the cervix-corpus junction, and Delong test was applied to compare the differences of their diagnostic performance. RESULTS In the training cohort, the AUC was 0.93 for radscore; 0.97 for radiomics nomograms; 0.85 and 0.86 for radiologists 1 and 2, respectively. Delong test showed that the differential efficacy of nomogram was significant better than those of radiologists in the training cohort (both P < 0.05). CONCLUSIONS The nomogram based on radscore and clinical risk factors could better differentiate CAC from EAC at the cervix-corpus junction than radiologists, and preoperatively and non-invasively identify the origin of adenocarcinoma at the cervix-corpus junction, which facilitates clinicians to make individualized treatment decision.
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Affiliation(s)
- Yuhan Fang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Keying Wang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Meiling Xiao
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jiejun Cheng
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Zijing Lin
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China.
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
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Lakhman Y, Aherne EA, Jayaprakasam VS, Nougaret S, Reinhold C. Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET. AJR Am J Roentgenol 2023; 221:633-648. [PMID: 37459457 PMCID: PMC467038 DOI: 10.2214/ajr.23.29003] [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] [Indexed: 09/15/2023]
Abstract
This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Emily A Aherne
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France
- Pinkcc Lab, IRCM, Montpellier, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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Ai C, Zhang L, Ding W, Zhong S, Li Z, Li M, Zhang H, Zhang L, Zhang L, Hu H. A nomogram-based optimized Radscore for preoperative prediction of lymph node metastasis in patients with cervical cancer after neoadjuvant chemotherapy. Front Oncol 2023; 13:1117339. [PMID: 37655103 PMCID: PMC10466037 DOI: 10.3389/fonc.2023.1117339] [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: 12/06/2022] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Purpose To construct a superior single-sequence radiomics signature to assess lymphatic metastasis in patients with cervical cancer after neoadjuvant chemotherapy (NACT). Methods The first half of the study was retrospectively conducted in our hospital between October 2012 and December 2021. Based on the history of NACT before surgery, all pathologies were divided into the NACT and surgery groups. The incidence rate of lymphatic metastasis in the two groups was determined based on the results of pathological examination following lymphadenectomy. Patients from the primary and secondary centers who received NACT were enrolled for radiomics analysis in the second half of the study. The patient cohorts from the primary center were randomly divided into training and test cohorts at a ratio of 7:3. All patients underwent magnetic resonance imaging after NACT. Segmentation was performed on T1-weighted imaging (T1WI), T2-weighted imaging, contrast-enhanced T1WI (CET1WI), and diffusion-weighted imaging. Results The rate of lymphatic metastasis in the NACT group (33.2%) was significantly lower than that in the surgery group (58.7%, P=0.007). The area under the receiver operating characteristic curve values of Radscore_CET1WI for predicting lymph node metastasis and non-lymphatic metastasis were 0.800 and 0.797 in the training and test cohorts, respectively, exhibiting superior diagnostic performance. After combining the clinical variables, the tumor diameter on magnetic resonance imaging was incorporated into the Rad_clin model constructed using Radscore_CET1WI. The Hosmer-Lemeshow test of the Rad_clin model revealed no significant differences in the goodness of fit in the training (P=0.594) or test cohort (P=0.748). Conclusions The Radscore provided by CET1WI may achieve a higher diagnostic performance in predicting lymph node metastasis. Superior performance was observed with the Rad_clin model.
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Affiliation(s)
- Conghui Ai
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lan Zhang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, China
| | - Wei Ding
- 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Suixing Zhong
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Miaomiao Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Huimei Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lan Zhang
- Department of Radiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Lei Zhang
- Department of Gynecology, Yunnan Tumor Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hongyan Hu
- Department of Pathology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Center), Kunming, China
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Moreira ASL, Ribeiro V, Aringhieri G, Fanni SC, Tumminello L, Faggioni L, Cioni D, Neri E. Endometrial Cancer Staging: Is There Value in ADC? J Pers Med 2023; 13:jpm13050728. [PMID: 37240898 DOI: 10.3390/jpm13050728] [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: 03/21/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To assess the ability of apparent diffusion coefficient (ADC) measurements in predicting the histological grade of endometrial cancer. A secondary goal was to assess the agreement between MRI and surgical staging as an accurate measurement. METHODS Patients with endometrial cancers diagnosed between 2018-2020 and having received both MRI and surgical staging were retrospectively enrolled. Patients were characterized according to histology, tumor size, FIGO stage (MRI and surgical stage), and functional MRI parameters (DCE and DWI/ADC). Statistical analysis was performed to determine if an association could be identified between ADC variables and histology grade. Secondarily, we assessed the degree of agreement between the MRI and surgical stages according to the FIGO classification. RESULTS The cohort included 45 women with endometrial cancer. Quantitative analysis of ADC variables did not find a statistically significant association with histological tumor grades. DCE showed higher sensitivity than DWI/ADC in the assessment of myometrial invasion (85.00% versus 65.00%) with the same specificity (80.00%). A good agreement between MRI and histopathology for the FIGO stage was found (kappa of 0.72, p < 0.01). Differences in staging between MRI and surgery were detected in eight cases, which could not be justified by the interval between MRI and surgery. CONCLUSIONS ADC values were not useful for predicting endometrial cancer grade, despite the good agreement between MRI interpretation and histopathology of endometrial cancer staging at our center.
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Affiliation(s)
| | - Vera Ribeiro
- Gynaecology Department, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal
| | - Giacomo Aringhieri
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Salvatore Claudio Fanni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Tumminello
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Dania Cioni
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
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Gui B, Lupinelli M, Russo L, Miccò M, Avesani G, Panico C, Di Paola V, Rodolfino E, Autorino R, Ferrandina G, Fanfani F, Scambia G, Manfredi R. MRI in uterine cancers with uncertain origin: Endometrial or cervical? Radiological point of view with review of the literature. Eur J Radiol 2022; 153:110357. [DOI: 10.1016/j.ejrad.2022.110357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/24/2022] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
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Amado Cabana S, Gallego Ojea J, Félez Carballada M. Usefulness of dynamic contrast-enhanced magnetic resonance imaging in characterizing ovarian tumors classified as indeterminate at ultrasonography. RADIOLOGIA 2022; 64:110-118. [DOI: 10.1016/j.rxeng.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/20/2020] [Indexed: 10/18/2022]
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Dhamija E, Gulati M, Manchanda S, Singhal S, Sharma D, Kumar S, Bhatla N. Imaging in Carcinoma Cervix and Revised 2018 FIGO Staging System: Implications in Radiology Reporting. Indian J Radiol Imaging 2021; 31:623-634. [PMID: 34790308 PMCID: PMC8590564 DOI: 10.1055/s-0041-1735502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) staging system of carcinoma cervix saw a radical change in 2018 with the inclusion of cross-sectional imaging tools for the assessment of disease extent and staging. One of the major revisions is the inclusion of lymph node status, detected either on imaging or pathological evaluation, in the staging system. The changes were based on long-term patient follow-up and survival rates reported in literature. Thus, it becomes imperative for a radiologist to be well versed with the recent staging system, its limitations, and implications on the patient management.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Malvika Gulati
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dayanand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Lin Y, Hsieh CY, Huang YL, Chen K, Huang YT, Wu RC, Huang HJ, Chou HH, Chao A, Lai CH, Lin G. Magnetic Resonance Spectroscopy for Risk Stratification of Sonographically Indeterminate Ovarian Neoplasms: Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11101847. [PMID: 34679545 PMCID: PMC8534853 DOI: 10.3390/diagnostics11101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms. A total of 21 patients with diagnosed adnexal masses between 2014 and 2017 were divided into malignant (four serous cystadenocarcinomas, four endometrioid carcinomas, three clear cell carcinomas, and one carcinosarcoma) and benign (four cystadenomas, two teratomas, one fibroma, one endometrioma, and one corpus luteal cyst) groups. An apparent diffusion coefficient (ADC) value of 1.27 × 10-3 mm2/s was considered as the optimal threshold in distinguishing malignant from benign ovarian tumors (sensitivity and specificity: 100% and 77.8%, respectively). Choline peaks were detected in six of seven O-RADS (Ovarian-Adnexal Imaging-Reporting Data System) 4 lesions and corrected all of the DWI false-negative clear cell carcinoma. Based on the presence of the choline peaks, the diagnostic performance of MRS showed a sensitivity of 77.8%, a specificity of 100%, and an accuracy of 85.7%, respectively. In conclusion, MRS could potentially play a complementary role for DWI in tumor characterization, particularly for O-RADS 4 tumors or clear cell carcinomas.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Ching-Yi Hsieh
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Taoyuan 33382, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33382, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Diagnostic Radiology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Ren-Chin Wu
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Angel Chao
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33382, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200
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Rao S, Smith DA, Guler E, Kikano EG, Rajdev MA, Yoest JM, Ramaiya NH, Tirumani SH. Past, Present, and Future of Serum Tumor Markers in Management of Ovarian Cancer: A Guide for the Radiologist. Radiographics 2021; 41:1839-1856. [PMID: 34597221 DOI: 10.1148/rg.2021210005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The ability to accurately detect early ovarian cancer and subsequently monitor treatment response is essential to improving survival for patients with ovarian malignancies. Several serum tumor markers (STMs)-including cancer antigen 125 (CA-125), human epididymis protein 4 (HE4), cancer antigen 19-9 (CA 19-9), and carcinoembryonic antigen (CEA)-have been used as a noninvasive method of identifying ovarian cancer in conjunction with imaging. Although current guidelines do not recommend use of STMs as screening tools for ovarian cancer, these markers have clinical utility in both diagnosis and surveillance for women with ovarian cancer. CA-125 is the most commonly used STM; its level may be elevated in several types of ovarian cancer, including epithelial cell tumors, carcinosarcoma, teratomas, and secondary ovarian malignancies. An elevated level of CA 19-9 is associated with clear cell tumors, teratomas, and secondary malignancies. CEA is most commonly associated with mucinous ovarian cancers. Finally, HE4 is being increasingly used to identify certain subtypes of epithelial ovarian cancers, particularly serous and endometrioid tumors. Diagnosis of ovarian cancers relies on a combination of CA-125 levels and US findings, which include a large adnexal mass or high-risk features, including septa and increased vascularity. CT is preferred for staging and is used along with PET and STM monitoring for surveillance. Increasingly, MRI is being used to characterize ovarian lesions that are indeterminate at US or CT. The future of STM testing involves development of "liquid biopsies," in which plasma samples are analyzed for evidence of tumors, including circulating tumor DNA or tumor cells and tumor micro-RNA. When combined with traditional imaging techniques, liquid biopsies may lead to earlier diagnosis and improved survival. An invited commentary by Shinagare is available online. ©RSNA, 2021.
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Affiliation(s)
- Sanjay Rao
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Daniel A Smith
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Ezgi Guler
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Elias G Kikano
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Maharshi A Rajdev
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Jennifer M Yoest
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Nikhil H Ramaiya
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Sree Harsha Tirumani
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
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Zheng T, Yang L, Du J, Dong Y, Wu S, Shi Q, Wang X, Liu L. Combination Analysis of a Radiomics-Based Predictive Model With Clinical Indicators for the Preoperative Assessment of Histological Grade in Endometrial Carcinoma. Front Oncol 2021; 11:582495. [PMID: 34235069 PMCID: PMC8255911 DOI: 10.3389/fonc.2021.582495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Histological grade is one of the most important prognostic factors of endometrial carcinoma (EC) and when selecting preoperative treatment methods, conducting accurate preoperative grading is of great significance. PURPOSE To develop a magnetic resonance imaging (MRI) radiomics-based nomogram for discriminating histological grades 1 and 2 (G1 and G2) from grade 3 (G3) EC. METHODS This was a retrospective study included 358 patients with histologically graded EC, stratified as 250 patients in a training cohort and 108 patients in a test cohort. T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and a dynamic contrast-enhanced three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) were performed via 1.5-Tesla MRI. To establish ModelADC, the region of interest was manually outlined on the EC in an apparent diffusion coefficient (ADC) map. To establish the radiomic model (ModelR), EC was manually segmented by two independent radiologists and radiomic features were extracted. The Radscore was calculated based on the least absolute shrinkage and selection operator regression. We combined the Radscore with carbohydrate antigen 125 (CA125) and body mass index (BMI) to construct a mixed model (ModelM) and develop the predictive nomogram. Receiver operator characteristic (ROC) and calibration curves were assessed to verify the prediction ability and the degree of consistency, respectively. RESULTS All three models showed some amount of predictive ability. Using ADC alone to predict the histological risk of EC was limited in both the cohort [area under the curve (AUC), 0.715; 95% confidence interval (CI), 0.6509-0.7792] and test cohorts (AUC, 0.621; 95% CI, 0.515-0.726). In comparison with ModelADC, the discrimination ability of ModelR showed improvement (Delong test, P < 0.0001 for both the training and test cohorts). ModelM, established based on the combination of radiomic and clinical indicators, showed the best level of predictive ability in both the training (AUC, 0.925; 95% CI, 0.898-0.951) and test cohorts (AUC, 0.915; 95% CI, 0.863-0.968). Calibration curves suggested a good fit for probability (Hosmer-Lemeshow test, P = 0.673 and P = 0.804 for the training and test cohorts, respectively). CONCLUSION The described radiomics-based nomogram can be used to predict EC histological classification preoperatively.
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Affiliation(s)
- Tao Zheng
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Linsha Yang
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Juan Du
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Yanchao Dong
- Department of Intervention, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Shuo Wu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Qinglei Shi
- Scientific Clinical Specialist, Siemens Ltd., Beijing, China
| | - Xiaohan Wang
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Lanxiang Liu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
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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: 65] [Impact Index Per Article: 21.7] [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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Amado Cabana S, Gallego Ojea JC, Félez Carballada M. Usefulness of dynamic contrast-enhanced magnetic resonance imaging in characterizing ovarian tumors classified as indeterminate at ultrasonography. RADIOLOGIA 2020; 64:S0033-8338(20)30073-4. [PMID: 32650993 DOI: 10.1016/j.rx.2020.05.006] [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: 01/14/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether there is a significant relationship between the shape of the time-intensity curve on dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of ovarian tumors classified as indeterminate at ultrasonography and the type of lesion (benign, borderline, or malignant) to enable an accurate presurgical diagnosis. MATERIAL AND METHODS We used dynamic contrast-enhanced MRI to study 68 ovarian tumors that were classified as indeterminate at ultrasonography. We included only cases for which a definitive diagnosis (histologic diagnosis or ≥1 year stability on imaging tests) was available. Each case was classified as benign, borderline, or malignant. To analyze the MRI studies, we marked regions of interest in the lesion and in the myometrium (as a reference). We obtained a curve defined by the relation between the intensity of enhancement and time and classified each tumor according to four predefined curve types. We also analyzed semiquantitative parameters. Finally, we compared the results for each of the three groups of tumors. RESULTS We found significant associations (p <0.001) between the curves without early enhancement and benign and borderline lesions as well as between the curves with early enhancement and malignant lesions. Malignant lesions were significantly associated with the semiquantitative enhancement parameters: maximum (p=0.002), maximum relative (p=0.006), and relative (p=0.018). CONCLUSIONS In ovarian tumors classified as indeterminate at ultrasonography, dynamic contrast-enhanced MRI can be useful for classification as benign, borderline, or malignant because the malignant lesions are significantly associated with early enhancement curves.
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Affiliation(s)
- S Amado Cabana
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España.
| | - J C Gallego Ojea
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - M Félez Carballada
- Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
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Giles SL, Imseeh G, Rivens I, ter Haar GR, Taylor A, deSouza NM. MR guided high intensity focused ultrasound (MRgHIFU) for treating recurrent gynaecological tumours: a pilot feasibility study. Br J Radiol 2019; 92:20181037. [PMID: 31084495 PMCID: PMC6592075 DOI: 10.1259/bjr.20181037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/07/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the feasibility of targeting recurrent gynaecological tumours with MR guided high intensity focused ultrasound (MRgHIFU). METHODS 20 patients with recurrent gynaecological tumours were prospectively scanned on a Philips/Profound 3 T Achieva MR/ Sonalleve HIFU system. Gross tumour volume (GTV) and planning target volume (PTV) were delineated on T 2W and diffusion-weighted imaging (DWI). Achievable treatment volumes that (i) assumed bowel and/or urogenital tract preparation could be used to reduce risk of damage to organs-at-risk (TVoptimal), or (ii) assumed no preparations were possible (TVno-prep) were compared with PTV on virtual treatment plans. Patients were considered treatable if TVoptimal ≥ 50 % PTV. RESULTS 11/20 patients (55%) were treatable if preparation strategies were used: nine had central pelvic recurrences, two had tumours in metastatic locations. Treatable volume ranged from 3.4 to 90.3 ml, representing 70 ± 17 % of PTVs. Without preparation, 6/20 (30%) patients were treatable (four central recurrences, two metastatic lesions). Limiting factors were disease beyond reach of the HIFU transducer, and bone obstructing tumour access. DWI assisted tumour outlining, but differences from T 2W imaging in GTV size (16.9 ± 23.0%) and PTV location (3.8 ± 2.8 mm in phase-encode direction) limited its use for treatment planning. CONCLUSIONS Despite variation in size and location within the pelvis, ≥ 50 % of tumour volumes were considered targetable in 55 % patients while avoiding adjacent critical structures. A prospective treatment study will assess safety and symptom relief in a second patient cohort. ADVANCES IN KNOWLEDGE Target size, location and access make MRgHIFU a viable treatment modality for treating symptomatic recurrent gynaecological tumours within the pelvis.
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Affiliation(s)
- Sharon L Giles
- The CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Georgios Imseeh
- Department of Gynae-Oncology, The Royal Marsden Hospital, London, United Kingdom
| | - Ian Rivens
- Therapeutic Ultrasound, The Institute of Cancer Research, London, United Kingdom
| | - Gail R ter Haar
- Therapeutic Ultrasound, The Institute of Cancer Research, London, United Kingdom
| | - Alexandra Taylor
- Department of Gynae-Oncology, The Royal Marsden Hospital, London, United Kingdom
| | - Nandita M deSouza
- The CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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Otero-García MM, Mesa-Álvarez A, Nikolic O, Blanco-Lobato P, Basta-Nikolic M, de Llano-Ortega RM, Paredes-Velázquez L, Nikolic N, Szewczyk-Bieda M. Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers. Insights Imaging 2019; 10:19. [PMID: 30758678 PMCID: PMC6375059 DOI: 10.1186/s13244-019-0696-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.
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Affiliation(s)
- María Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain.
| | - Alicia Mesa-Álvarez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Olivera Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Patricia Blanco-Lobato
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Marijana Basta-Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | | | - Laura Paredes-Velázquez
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Nikola Nikolic
- Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Magda Szewczyk-Bieda
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
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Qu Y, He Y, Li Z, Chen X, Liu Q, Zou S, Kong C, Liu Y, Gao C, Zhang G, Zhu W. Constructing an ovarian cancer metastasis index by dissecting medical records. Oncotarget 2017; 8:102212-102222. [PMID: 29254237 PMCID: PMC5731947 DOI: 10.18632/oncotarget.22336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/22/2017] [Indexed: 01/16/2023] Open
Abstract
Globally, ovarian cancer (OC) is the leading cause of gynecological cancer-associated deaths. Metastasis, especially multi-organ metastasis, determines the speed of disease progression. A multicenter retrospective study was performed to identify the factors that drive metastasis, from medical records of 534 patients with OC. The average number of target organs per patient was 3.66, indicating multi-organ metastasis. The most common sites of metastasis were large intestine and greater omentum, which were prone to co-metastasis. Results indicated that ascites and laterality, rather than age and menopausal status, were the potential drivers for multi-organ metastasis. Cancer antigen (CA) 125 (CA-125) and nine other blood indicators were found to show a significant, but weak correlation with multi-organ metastasis. A neural network cascade-multiple linear regression hybrid model was built to create an ovarian cancer metastasis index (OCMI) by integration of six multi-organ metastasis drivers including CA-125, blood platelet count, lymphocytes percentage, prealbumin, ascites, and laterality. In an independent set of 267 OC medical records, OCMI showed a moderate correlation with multi-organ metastasis (Spearman ρ = 0.67), the value being 0.72 in premenopausal patients, and good performance in identifying multi-organ metastasis (area under the receiver operating characteristic curve = 0.832), implying a potential prognostic marker for OC.
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Affiliation(s)
- Yanjun Qu
- Department of Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanan He
- Department of Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhangming Li
- Department of Pharmacy, Guangdong Hospital of Integrated Chinese and Western Medicine, Foshan, China
| | - Xiuwei Chen
- Department of Gynecology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qian Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuangshuang Zou
- Department of Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Congcong Kong
- Department of Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yixiu Liu
- Department of Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ce Gao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guangmei Zhang
- Department of Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenliang Zhu
- Department of Pharmacy, The Second Affiliated Hospital of Harbin Medical University, Institute of Clinical Pharmacy, The Heilongjiang Key Laboratory of Drug Research, Harbin Medical University, Harbin, China
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Fotopoulou C, Hall M, Cruickshank D, Gabra H, Ganesan R, Hughes C, Kehoe S, Ledermann J, Morrison J, Naik R, Rolland P, Sundar S. British Gynaecological Cancer Society (BGCS) epithelial ovarian/fallopian tube/primary peritoneal cancer guidelines: recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2017; 213:123-139. [DOI: 10.1016/j.ejogrb.2017.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
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Predicting and Early Monitoring Treatment Efficiency of Cervical Cancer Under Concurrent Chemoradiotherapy by Intravoxel Incoherent Motion Magnetic Resonance Imaging. J Comput Assist Tomogr 2017; 41:422-429. [DOI: 10.1097/rct.0000000000000550] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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