Diagnostic value and clinical significance of MRI and CT in detecting lymph node metastasis of early cervical cancer

Magnetic Resonance Imaging Radiomics-Based Model for Prediction of Lymph Node Metastasis in Cervical Cancer

Background

Cervical cancer remains a major cause of mortality among women globally, with lymph node metastasis (LNM) being a critical determinant of patient prognosis.

Methods

In this study, MRI scans from 153 cervical cancer patients between January 2018 and January 2024 were analyzed. The patients were assigned to two groups: 103 in the training cohort; 49 in the validation cohort. Radiomic features were extracted from T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps. The ITK-SNAP software enabled three-dimensional manual segmentation of the tumor regions in cervical cancer to identify regions of interest (ROIs). The collected data was divided for the training and validation of the Support Vector Machine (SVM) model.

Results

The combined T2WI and ADC-based radiomics model exhibited robust diagnostic capabilities, achieving an area under the curve (AUC) of 0.804 (95% CI [0.712-0.890]) in the training cohort and an AUC of 0.811 (95% CI [0.721-0.902]) in the validation cohort. The nomogram that includes radiomic features, International Federation of Gynecology and Obstetrics (FIGO) stage, and LNM has a C-index of 0.895 (95% CI [0.821-0.962]) in the training cohort and a C-index of 0.916 (95% CI [0.825-0.987]) in the validation cohort. The C-statistics are all above 0.80, and the predicted variables are nearly aligned with the 45-degree line, consistent with the results shown in the calibration plot. This indicates that our model demonstrates good discrimination ability and satisfactory calibration.

Conclusion

The MRI radiomics model, leveraging T2WI combined with ADC maps, offers an effective method for predicting LNM in cervical cancer patients.

Autocrine and paracrine effects of MDK promote lymph node metastasis of cervical squamous cell carcinoma

Lymph node metastasis (LNM) is the main metastatic pathway of cervical cancer, which is closely related to 5-year survival rate of cervical squamous cell carcinoma (CSCC), yet the underlying mechanism remains unconfirmed. In this study, we show that midkine (MDK) was highly expressed in CSCC and overexpression of MDK was associated with CSCC LNM. Functional investigations demonstrated that MDK promoted LNM by enhancing proliferation, migration and invasion capacity of cervical cancer cells, facilitating lymphangiogenesis and down-regulating the expression of tight junction proteins of human lymphatic endothelial cells (HLECs). MDK exerted these biological effects by interacting with Syndecan-1 and activating PI3K/AKT and p38 MAPK pathways. A retrospective study showed that s-MDK was related to LNM. s-MDK combined with serum-squamous cell carcinoma antigen(s-SCCA) improved the diagnostic accuracy of CSCC LNM. These findings established a new mechanism of LNM and highlighted MDK as a candidate tumor biomarker and therapeutic target in CSCC.

Circular RNA circIL21R promotes cervical cancer cells proliferation and migration by sponging the miR-1205/PTBP1 axis

Increasing research has shown that the abnormal expression of circRNAs is closely related to tumorigenesis, apoptosis, and patient prognosis in cervical cancer. This study aimed to reveal the procancer role of circIL21R in cervical cancer and investigate its related molecular mechanisms. Bioinformatics analysis revealed that circIL21R promotes the progression of cervical cancer via the miR-1205/PTBP1 axis. CircIL21R expression was significantly greater in tumor tissue than in adjacent normal tissue, and higher circIL21R expression indicated shorter survival. We applied MTS assays, EdU assays, and Transwell assays to show that the overexpression of circIL21R promoted cervical cancer cell proliferation and invasion. Mechanistically, circIL21R promoted the expression of PTBP1 by sponging miR-1205. Moreover, rescue assays confirmed that regulating the expression of miR-1205 or PTBP1 could reverse the tumorigenic effect caused by circIL21R overexpression. In addition, circIL21R promoted the tumorigenesis of cervical cancer in vivo. In summary, our study demonstrated that circIL21R was highly expressed in cervical cancer and upregulated PTBP1 expression by acting as a ceRNA for miR-1205, making outstanding contributions to several malignant biological processes in cervical cancers, such as growth, proliferation, and invasion. CircIL21R is a potential biomarker for the diagnosis and treatment of cervical cancer.

Comparison of the diagnostic value of [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in patients with T stage ≤ 2a2 uterine cervical cancer: a prospective study

PURPOSE

To compare the diagnostic value of [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in patients with T stage ≤ 2a2 uterine cervical cancer patients.

METHODS

Patients pathologically diagnosed with cervical cancer and with a T stage ≤ T2a2 were prospectively enrolled. All patients underwent whole-body [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT within 2 weeks, and surgical treatment was performed within 10 days after PET.

RESULTS

Twenty-five patients were enrolled. Twenty patients underwent radical hysterectomy, among which all of them underwent pelvic lymphadenectomy, and 10 patients underwent para-aortic lymphadenectomy. Three patients received merely laparoscopic lymphadenectomy without hysterectomy. Two patients with both [18F]FDG and [68 Ga]Ga-FAPI-04 lymph node high metabolism were staged as FIGO IIIC1r, and concurrent chemoradiation therapy (CCRT) was performed. [18F]FDG and [68 Ga]Ga-FAPI-04 had equivalent detection ability on primary tumors, with a positive detection rate of 96.0%. The accuracy of T staging using [18F]FDG and [68 Ga]Ga-FAPI-04 was relatively 50% and 55.0%. Elevated and underrated staging was due to misdiagnosis of either vaginal infiltration or tumor size. In terms of lymph node metastasis detection, the specificity of [68 Ga]Ga-FAPI-04 was 100% (95% CI, 84.6% ~ 100.0%), which was significantly higher than [18F]FDG (59.1% (95% CI, 36.4% ~ 79.3%)) (p = 0.004).

CONCLUSION

[68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT demonstrated an equivalent detection ability on cervical cancer primary tumors. However, [68 Ga]Ga-FAPI-04 PET/MR's diagnostic value in lymph node metastasis was significantly higher than [18F]FDG PET/CT. [68 Ga]Ga-FAPI-04 PET/MR has the potential for more accurate treatment planning, thus clarifying fertility preservation indications for early-stage young patients.

In Vitro Studies Regarding the Safety of Chitosan and Hyaluronic Acid-Based Nanohydrogels Containing Contrast Agents for Magnetic Resonance Imaging

The aim of this study was to investigate the biocompatibility of contrast agents, such as gadolinium 1, 4, 7, 10 tetraazacyclo-dodecane tetraacetic acid (GdDOTA) and gadolinium dioctyl terephthalate (GdDOTP), encapsulated in a polymeric matrix containing chitosan and hyaluronic acid using RAW264.7 murine macrophages and human blood samples. The cell viability and cytotoxicity were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase (LDH) assays, while cell cycle analysis was determined in RAW264.7 cells using flow cytometry. The mitochondrial membrane potential (MMP), hemolytic index, complement activation, and thrombogenic potential of gadolinium (Gd) containing nanohydrogels were measured by fluorometric and spectrophotometric methods. Taken together, our results demonstrate the good bio- and hemocompatibility of chitosan-based nanohydrogels with the RAW264.7 cell line and human blood cells, suggesting that these could be used as injectable formulations for the magnetic resonance imaging diagnostic of lymph nodes.

microRNA Profile Associated with Positive Lymph Node Metastasis in Early-Stage Cervical Cancer

Lymph node metastasis (LNM) is an important prognostic factor in cervical cancer (CC). In early stages, the risk of LNM is approximately 3.7 to 21.7%, and the 5-year overall survival decreases from 80% to 53% when metastatic disease is identified in the lymph nodes. Few reports have analyzed the relationship between miRNA expression and the presence of LNM. The aim of this study was to identify a subset of miRNAs related to LNM in early-stage CC patients. Formalin-fixed paraffin-embedded tissue blocks were collected from patients with early-stage CC treated by radical hysterectomy with lymphadenectomy. We analyzed samples from two groups of patients—one group with LNM and the other without LNM. Global miRNA expression was identified by microarray analysis, and cluster analysis was used to determine a subset of miRNAs associated with LNM. Microarray expression profiling identified a subset of 36 differentially expressed miRNAs in the two groups (fold change (FC) ≥ 1.5 and p < 0.01). We validated the expression of seven miRNAs; miR-487b, miR-29b-2-5p, and miR-195 were underexpressed, and miR-92b-5p, miR-483-5p, miR-4534, and miR-548ac were overexpressed according to the microarray experiments. This signature exhibited prognostic value for identifying early-stage CC patients with LNM. These findings may help detect LNM that cannot be observed in imaging studies.

Clinical value of MRI, serum SCCA, and CA125 levels in the diagnosis of lymph node metastasis and para-uterine infiltration in cervical cancer

Background

Cervical cancer shows great differences in depth of invasion, metastasis, and other biological behaviors. The location of the lesion is special, so it is usually difficult to determine the clinical stage. This study aimed to explore the clinical value of magnetic resonance imaging (MRI) and tumor serum markers for the preoperative diagnosis of cervical cancer lymph node metastasis and para-uterine invasion.

Methods

A total of 200 patients with cervical cancer admitted to our hospital from January 2019 to January 2020 were collected as the research subjects. Comparing the diagnosis results of preoperative MRI scan, serum tumor markers, and postoperative pathological examination using single factor comparison, we determined the MRI scan results, the comprehensive matching rate between serum tumor markers (squamous cell carcinoma antigen (SCCA), carbohydrate antigen 125 (CA125)) and postoperative pathological results, and the differences of sensitivity, specificity, and accuracy in the prediction of lymph node metastasis and para-uterine infiltration of cervical cancer.

Results

The levels of SCCA and CA125 in patients with para-uterine invasion and lymph node metastasis were higher than those of patients without invasion and metastasis. Among them, the level of SCCA was significantly different (P<0.05). The level of CA125 was not statistically significant (P>0.05), so MRI combined with serum SCCA was selected for combined diagnosis in the later period. The sensitivity, specificity, and accuracy of MRI diagnosis of cervical cancer and para-uterine infiltrating lymph node metastasis and metastasis were 55.2, 91.6, and 89.5% and 55.2, 91.6, and 89.5%, respectively. These data in MRI combined with serum SCCA were 76.3, 95.3, and 94.3% and 63.2, 96.0, and 95.1%, respectively. The accuracy of tumor markers combined with MRI in the diagnosis of cervical cancer lymph node metastasis and para-uterine invasion was higher than that of MRI.

Conclusions

MRI combined with serum SCCA can more accurately identify cervical cancer lymph node metastasis and para-uterine invasion compared with MRI alone. Tumor marker combined with MRI diagnosis is an important auxiliary method for cervical cancer treatment and can provide comprehensive and reliable clinical evidence for evaluation before cervical cancer surgery.

CT, MRI, and PET imaging features in cervical cancer staging and lymph node metastasis

OBJECTIVE

To assess the computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) fusion imaging technique features in cervical cancer staging and lymph node metastasis.

METHODS

A total of 196 cervical cancer patients undergoing CT, MRI, PET/CT, and PET/MRI preoperatively were enrolled. The diagnostic accuracy and detection rates for paracervical invasion were evaluated on the basis of the International Federation of Gynecology and Obstetrics (FIGO) staging classification for cervical cancer. The diagnostic efficacy of each examination modality for determining lymph node metastasis was evaluated using surgical pathology as a reference. The CT and MRI imaging features of lymph node metastasis were compared.

RESULTS

PET/MRI had a higher diagnostic accuracy for cervical cancer (94.90%) than PET/CT, MRI, and CT (83.67%, 75.51%, and 69.39%) (P < 0.05). PET/MRI showed a higher detection rate of vaginal invasion, uterine invasion, bladder invasion, and cervical invasion than PET/CT, MRI, and CT (P < 0.05). The metastasis group showed higher maximum long and short axis diameters and axial ratios than the non-metastasis group (P < 0.05). The metastasis group had higher wash-in rates (WIR), maximum relative enhancements (MRE), wash-out ratios (WOR), and apparent diffusion coefficients (ADC), and lower times to peak (TTP) than the non-metastasis group (P < 0.05). The sensitivity (94.74%), specificity (93.33%), and accuracy (93.88%) of PET/MRI in the diagnosis of cervical cancer lymph node metastasis were higher than the sensitivity, specificity, and accuracy of PET/CT, MRI and CT (P < 0.05).

CONCLUSION

CT, MRI, PET/CT and PET/MRI can be used effectively in the diagnosis of cervical cancer staging and lymph node metastasis, among which PET/MRI has a higher diagnostic sensitivity, specificity, and accuracy and is helpful in clinical diagnosis and treatment.

Useful MRI Findings for Minimally Invasive Surgery for Early Cervical Cancer

Simple Summary

Radical hysterectomy and lymph node dissection are extensive procedures with severe post-operative morbidities and should be avoided on patients with low risk of recurrence. Still, due to lack of good prognostic tools, radical surgery is performed on most patients with early stage cervical cancer, leading to overtreatment and unnecessary morbidities. The recent International Federation of Gynecology and Obstetrics (FIGO) staging system accepts the use of magnetic resonance imaging (MRI) in addition to physical examination. Currently, 3 Tesla (3T) MRI is available widely and, due to its high soft tissue contrast, can provide more useful information on precise estimation of tumor size and metastasis than can physical examination in patients with cervical cancer. Therefore, this imaging modality can help gynecologic oncologists to determine whether minimally invasive surgery is necessary and can be used for early detection of small recurrent cancers.

Abstract

According to the recent International Federation of Gynecology and Obstetrics (FIGO) staging system, Stage III cervical cancer indicates pelvic or paraaortic lymph node metastasis. Accordingly, the new FIGO stage accepts imaging modalities, such as MRI, as part of the FIGO 2018 updated staging. Magnetic resonance imaging (MRI) is the best imaging modality to estimate the size or volume of uterine cancer because of its excellent soft tissue contrast. As a result, MRI is being used increasingly to determine treatment options and follow-up for cervical cancer patients. Increasing availability of cancer screening and vaccination have improved early detection of cervical cancer. However, the incidence of early cervical cancers has increased compared to that of advanced cervical cancer. A few studies have investigated if MRI findings are useful in management of early cervical cancer. MRI can precisely predict tumor burden, allowing conization, trachelectomy, and simple hysterectomy to be considered as minimally invasive treatment options for early cervical cancer. This imaging modality also can be used to determine whether there is recurrent cancer following minimally invasive treatments. The purpose of this review is to highlight useful MRI features for managing women with early cervical cancer.

Preoperative magnetic resonance imaging criteria for predicting lymph node metastasis in patients with stage IB1-IIA2 cervical cancer

Objective

This study aimed to identify patients with stage IB1‐IIA2 cervical cancer at low risk for lymph node metastasis (LNM) using preoperative magnetic resonance imaging (MRI) parameters.

Methods

Clinical and MRI data of patients with stage IB1‐IIA2 cervical cancer who underwent radical surgery between 2010 and 2015 were retrospectively reviewed. Clinical stage IB1‐IIA2 cervical cancer was diagnosed according to the 2009 International Federation of Gynecology and Obstetrics staging system. The low‐risk criteria for LNM were identified using logistic regression analysis. The performance of the logistic regression analysis was estimated through receiver operating characteristic curve analysis.

Results

Of 453 patients, 105 (23.2%) exhibited pathological LNM (p‐LNM). The maximal tumor diameter (adjusted odds ratio [aOR], 1.586; 95% confidence interval [CI], 1.312–1.916; p < 0.001) and LNM (aOR, 2.384; 95% CI, 1.418–4.007; p = 0.001) on preoperative MRI (m‐LNM) were identified as independent risk factors for p‐LNM using a multivariate logistic analysis. The p‐LNM rate was 4.0% for low‐risk patients (n = 124) identified using the current criteria (maximal tumor diameter <3.0 cm and no sign of m‐LNM). The 5‐year disease‐free survival rate of low‐risk patients was significantly greater than the rate of patients with a maximal tumor diameter ˃3.0 cm and/or signs of m‐LNM (90.4% vs. 82.1%; p = 0.033).

Conclusions

The low‐risk criteria for p‐LNM were a maximal tumor diameter <3.0 cm and no sign of m‐LNM. Patients with stage IB1‐IIA2 cervical cancer at low risk for m‐LNM could be candidates for radical surgery; hence, they have a lesser need for adjuvant chemoradiotherapy, thus avoiding the severe comorbidities it causes.