Uterine sarcoma vs adenocarcinoma: Can the MRI distinguish between them?

Mateo, Paula Hernández; Fernández, R. Méndez; Tamayo, E. Serrano

doi:10.1016/j.rxeng.2016.05.001

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…It has been reported that the ADC mean of carcinosarcomas was significantly higher than that of grade 2 or 3 endometrial carcinomas, also supported by histogram analysis, corresponding to hypocellular regions caused by intratumoral necrosis. In addition, the ADC map might distinguish components of adenocarcinoma from sarcoma, as the ADC map was more heterogeneous in the sarcomatous component . Whether the tumor heterogeneity implicated patient survival warrants further evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Conventional MRI studies on carcinosarcoma mainly focus on tumor characteristics and differentiation against endometrial cancer. Carcinosarcomas present as intracavitary polypoid masses with dilatation of the endocervical canal, demonstrating heterogeneous T 2 ‐hyperintensity, T 1 ‐isointensity to myometrium, with high‐intensity areas suggesting intratumoral hemorrhage, as well as strong and prolonged tumoral enhancement . A longer anteroposterior tumor ratio >0.63 has been proposed to differentiate carcinosarcoma from endometrial cancer .…”

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confidence: 99%

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Diagnostic accuracy of 3.0T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis

Huang

Chang

Yeh

et al. 2018

Magnetic Resonance Imaging

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Diagnostic accuracy of 3.0T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis

Huang

Chang

Yeh

et al. 2018

Magnetic Resonance Imaging

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“…It was reported that the ADCmean of UCS was much higher than that of grade 2 or 3 EC [ 19 ]. Furthermore, the ADC map could also make a distinction between adenocarcinoma and sarcoma [ 33 ], since the ADC map was more heterogeneous in the sarcomatous component [ 34 ]. High ADC values have been reported to indicate high-grade malignancy with necrosis, which was often more common with UCS than EC [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and multiparametric MRI features for differentiating uterine carcinosarcoma from endometrioid adenocarcinoma

Chen,

Guo,

Chen

et al. 2024

BMC Med Imaging

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Introduction The purpose of our study was to differentiate uterine carcinosarcoma (UCS) from endometrioid adenocarcinoma (EAC) by the multiparametric magnetic resonance imaging (MRI) features. Methods We retrospectively evaluated clinical and MRI findings in 17 patients with UCS and 34 patients with EAC proven by histologically. The following clinical and pathological features were evaluated: post- or pre-menopausal, clinical presentation, invasion depth, FIGO stage, lymphaticmetastasis. The following MRI features were evaluated: tumor dimension, cystic degeneration or necrosis, hemorrhage, signal intensity (SI) on T2-weighted images (T2WI), relative SI of lesion to myometrium on T2WI, T1WI, DWI, ADCmax, ADCmin, ADCmean (RSI-T2, RSI-T1, RSI-DWI, RSI-ADCmax, RSI-ADCmin, RSI-ADCmean), ADCmax, ADCmin, ADCmean, the maximum, minimum and mean relative enhancement (RE) of lesion to myometrium on the arterial and venous phases (REAmax, REAmin, REAmean, REVmax, REVmin, REVmean). Receiver operating characteristic (ROC) analysis and the area under the curve (AUC) were used to evaluate prediction ability. Results The mean age of UCS was higher than EAC. UCS occurred more often in the postmenopausal patients. UCS and EAC did not significantly differ in depth of myometrial invasion, FIGO stage and lymphatic metastasis. The anterior-posterior and transverse dimensions were significantly larger in UCS than EAC. Cystic degeneration or necrosis and hemorrhage were more likely occurred in UCS. The SI of tumor on T2WI was more heterogeneous in UCS. The RSI-T2, ADCmax, ADCmean, RSI-ADCmax and RSI-ADCmean of UCS were significantly higher than EAC. The REAmax, REAmin, REAmean, REVmax, REVmin and REVmean of UCS were all higher than EAC. The AUCs were 0.72, 0.71, 0.86, 0.96, 0.89, 0.84, 0.73, 0.97, 0.88, 0.94, 0.91, 0.69 and 0.80 for the anterior-posterior dimension, transverse dimension, RSI-T2, ADCmax, ADCmean, RSI-ADCmax, RSI-ADCmean, REAmax, REAmin, REAmean, REVmax, REVmin and REVmean, respectively. The AUC was 0.997 of the combined of ADCmax, REAmax and REVmax. Our study showed that ADCmax threshold value of 789.05 (10–3mm2/s) can differentiate UCS from EAC with 100% sensitivity, 76.5% specificity, and 0.76 AUC, REAmax threshold value of 0.45 can differentiate UCS from EAC with 88.2% sensitivity, 100% specificity, and 0.88 AUC. Conclusion Multiparametric MRI features may be utilized as a biomarker to distinguish UCS from EAC.

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“…Distinguishing USC from uterine sarcoma is not possible because these tumours share many imaging characteristics, including heterogeneity, cystic degeneration and necrosis [13][14][15]. Therefore, the final diagnosis must rely on immunohistochemistry.…”

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confidence: 99%

Dynamic contrast-enhanced MR and PET/CT findings of uterine sarcomatoid carcinoma: a case report

Cui

Jin

et al. 2020

BMC Women's Health

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Background Sarcomatoid carcinoma (SC) is a malignant tumour composed of spindle cells. The incidence of SC is low, especially in the uterus. The imaging features of uterine sarcomatoid carcinoma (USC) are rarely reported. We report a case of USC and discuss the dynamic contrast-enhanced MR (DCE-MR) and PET/CT findings. Case presentation A 69-year-old woman presented to the Department of Gynaecology with vaginal bleeding. Ultrasound examination discovered a heterogeneous mass in the cervix. Then, MRI examination of the pelvis was performed. On T2-weighted images, the uterus was replaced by an ill defined and diffuse lesion with inhomogeneous intensity. On T1-weighted images, the lesion appeared with signal hypointensity and was heterogeneously enhanced with contrast material. Additionally, enlarged lymph nodes were found in the pelvic cavity. PET/CT demonstrated high uptake in the region of the uterus and pelvic lymph nodes, which was consistent with MRI findings. The radiologists diagnosed the patient with malignant uterine lesions. The patient underwent hysterectomy and bilateral adnexectomy with pelvic lymph node dissection. Then, systemic radiotherapy and chemotherapy were performed. USC with lymph node metastasis was diagnosed with the help of immuno-histochemical analysis. There was no treatment related complication and no evidence of tumour recurrence at the postoperative 6-month follow-up. Conclusion MRI and PET/CT features are sufficient to indicate the malignant nature of a USC, but they are not pathognomonic.

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Uterine sarcoma vs adenocarcinoma: Can the MRI distinguish between them?

Cited by 5 publications

References 19 publications

Diagnostic accuracy of 3.0T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis

Diagnostic accuracy of 3.0T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis

Clinical and multiparametric MRI features for differentiating uterine carcinosarcoma from endometrioid adenocarcinoma

Dynamic contrast-enhanced MR and PET/CT findings of uterine sarcomatoid carcinoma: a case report

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