|
Integrating MR imaging and clinical features to differentiate uterine carcinosarcoma from endometrial carcinoma
|
Z. Huang   , Y. Jiang , L. Wan , W. Chen , J. Zhao |
| Radiology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China , 453606904@qq.com |
|
|
Abstract: (618 Views) |
Background: This study aimed to investigate the clinical and MRI features of uterine carcinosarcoma (UCS) and endometrial carcinoma (EC), and to explore how integrating these characteristics could help distinguish UCS from EC. Materials and Methods: A total of 33 UCS patients and 114 EC patients were included in this study. Mann-Whitney U test was used to compare clinical-pathological characteristics and MR features between UCS and EC groups. Univariate and multivariate logistic regression analyses were conducted to identify the factors differentiating UCS from EC. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate diagnostic ability to distinguish UCS from EC. Results: UCS patients exhibited higher median age and elevated levels of carbohydrate antigen12-5 (CA 12-5) than EC patients. Compared to EC, UCS showed a greater propensity for ill-defined boundary, tumor prolapse, heterogeneous T2WI signals, hemorrhage, cystic degeneration, and more advanced stage than EC. The tumor size, anterior-posterior (AP) dimension, the ratio of the endometrial thickness (ET) to AP, and apparent diffusion coefficient (ADC) value of UCS were significantly larger than those of EC. Multivariate analysis identified independent factors for differentiating UCS from EC, including ill-defined tumor boundary, heterogenous T2WI signal intensity, heterogenous enhancement pattern, larger tumor volume, greater AP dimension, and higher ADC value. The AUC of the multivariate analysis for differentiating UCS from EC was 0.935, with 87.88% sensitivity and 94.74% specificity. Conclusion: Combining clinical characteristics with MRI features may significantly enhance the differentiation of UCS from EC. |
|
| Keywords: Uterine carcinosarcoma, endometrial neoplasms, magnetic resonance imaging, diffusion magnetic resonance imaging, gynecological malignancy. |
|
|
Full-Text [PDF 1216 kb]
(256 Downloads)
|
|
Type of Study: Original Research |
Subject:
Radiation Biology
|
|
|
|
|
|
|
| References |
1. 1. Matsuzaki S, Klar M, Matsuzaki S, Roman LD, Sood AK, Matsuo K (2021) Uterine carcinosarcoma: contemporary clinical summary, molecular updates, and future research opportunity. Gynecologic Oncology, 160(2): 586-601. [ DOI:10.1016/j.ygyno.2020.10.043] 2. Toboni MD, Crane EK, Brown J, Shushkevich A, Chiang S, Slomovitz BM, et al. (2021) Uterine carcinosarcomas: From pathology to practice. Gynecologic Oncology, 162(1): 235-41. [ DOI:10.1016/j.ygyno.2021.05.003] 3. Travaglino A, Raffone A, Raimondo D, Arciuolo D, Angelico G, Valente M, et al. (2022) Prognostic value of the TCGA molecular classification in uterine carcinosarcoma. Int J Gynecology & Obstetrics, 158(1): 13-20. [ DOI:10.1002/ijgo.13937] 4. Cherniack AD, Shen H, Walter V, Stewart C, Murray BA, Bowlby R, et al. (2017) Integrated molecular characterization of uterine carcinosarcoma. Cancer Cell, 31(3): 411-23. [ DOI:10.1016/j.ccell.2017.02.010] 5. Matsuo K, Takazawa Y, Ross M, Elishaev E, Podzielinski I, Yunokawa M, et al. (2016) Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Annals of Oncology, 27(7): 1257-66. [ DOI:10.1093/annonc/mdw161] 6. Ferguson SE, Tornos C, Hummer A, Barakat RR, Soslow RA (2007) Prognostic features of surgical stage I uterine carcinosarcoma. The American J Surgical Pathology, 31(11):1653-61. [ DOI:10.1097/PAS.0b013e3181161ba3] 7. Menczer J (2015) Review of recommended treatment of uterine carcinosarcoma (2015) Current Treatment Options in Oncology, 16:1-18. [ DOI:10.1007/s11864-015-0370-4] 8. Tanaka YO, Tsunoda H, Minami R, Yoshikawa H, Minami M (2008) Carcinosarcoma of the uterus: MR findings. Journal of Magnetic Resonance Imaging, 28(2): 434-9. [ DOI:10.1002/jmri.21469] 9. Huang YT, Huang YL, Ng KK, Lin G (2019) Current status of magnetic resonance imaging in patients with malignant uterine neoplasms: a review. Korean Journal of Radiology, 20(1): 18-33. [ DOI:10.3348/kjr.2018.0090] 10. Genever A and Abdi S (2011) Can MRI predict the diagnosis of endometrial carcinosarcoma? Clinical Radiology, 66(7): 621-4. [ DOI:10.1016/j.crad.2011.02.008] 11. Li L, Huang W, Xue K, Feng L, Han Y, Wang R, Gao J (2021) Clinical and imaging features of carcinosarcoma of the uterus and cervix. Insights into Imaging, 12: 1-10. [ DOI:10.1186/s13244-021-01084-5] 12. Takeuchi M, Matsuzaki K, Harada M (2016) Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy. Acta Radiologica, 57(10):1277-84. [ DOI:10.1177/0284185115626475] 13. Takahashi M, Kozawa E, Tanisaka M, Hasegawa K, Yasuda M, Sakai F (2016) Utility of histogram analysis of apparent diffusion coefficient maps obtained using 3.0 T MRI for distinguishing uterine carcinosarcoma from endometrial carcinoma. J Magnetic Resonance Imaging, 43(6):1301-7. [ DOI:10.1002/jmri.25103] 14. Huang YT, Chang CB, Yeh CJ, Lin G, Huang HJ, Wang CC, et al. (2018) Diagnostic accuracy of 3.0 T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis. J Magnetic Resonance Imaging, 48(3): 622-31. [ DOI:10.1002/jmri.25981] 15. Lopez-Garcia MA, Palacios J (eds). Pathologic and molecular features of uterine carcinosarcomas. Semin Diagn Pathol. 2010;27(3):145-156. Philadelphia: WB Saunders; 2010. [ DOI:10.1053/j.semdp.2010.09.005] 16. Chen X, Arend R, Hamele-Bena D, Tergas AI, Hawver M, Tong GX, et al. (2017) Uterine carcinosarcomas: clinical, histopathologic and immunohistochemical characteristics. Int J Gynecological Pathology, 36(5): 412-9. [ DOI:10.1097/PGP.0000000000000346] 17. Jonson AL, Bliss RL, Truskinovsky A, Judson P, Argenta P, Carson L, et al. (2006) Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecologic Oncology, 100(3): 561-4. [ DOI:10.1016/j.ygyno.2005.09.017] 18. Huang GS, Chiu LG, Gebb JS, Gunter MJ, Sukumvanich P, Goldberg GL, et al. (2007) Serum CA125 predicts extrauterine disease and survival in uterine carcinosarcoma. Gynecologic Oncology, 107(3): 513-7. [ DOI:10.1016/j.ygyno.2007.08.060] 19. Ross MS, Chandler CK, Matsuo K, Vargo JA, Elishaev E, Siripong N, et al. (2019) Cancer antigen 125 is associated with disease status in uterine carcinosarcoma. Rare Tumors, 11: 2036361319884159. [ DOI:10.1177/2036361319884159] 20. Harano K, Hirakawa A, Yunokawa M, Nakamura T, Satoh T, Nishikawa T, et al. (2016) Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. Int J Clinical Oncology, 21(1):168-76. [ DOI:10.1007/s10147-015-0859-7] 21. Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA (2015) Imaging Features of Uncommon Gynecologic Cancers. AJR Am J Roentgenol, 205(6): 1346-59. [ DOI:10.2214/AJR.14.12695] 22. Gui B, Lupinelli M, Russo L, Micco M, Avesani G, Panico C, et al. (2022) MRI in uterine cancers with uncertain origin: Endometrial or cervical? Radiological point of view with review of the literature. Eur J Radiol, 153:110357. [ DOI:10.1016/j.ejrad.2022.110357] 23. Pintican R, Bura V, Zerunian M, Smith J, Addley H, Freeman S, et al. (2021) MRI of the endometrium-from normal appearances to rare pathology. The British J Radiology, 94(1125): 20201347. [ DOI:10.1259/bjr.20201347] 24. Ravishankar P, Smith DA, Avril S, Kikano E, Ramaiya NH (2019) Uterine carcinosarcoma: a primer for radiologists. Abdominal Radiology, 44: 2874-85. [ DOI:10.1007/s00261-019-02038-8] 25. Li F, Li L, Li H (2024) Estrogen receptor ER-α36: A diagnostic biomarker for endometrial cancer. Int J Radiat Res, 22(2): 403-409. [ DOI:10.61186/ijrr.22.2.403] |
|
| Send email to the article author |
|
|
|
| Add your comments about this article |
|
|
|
|
Huang Z, Jiang Y, Wan L, Chen W, Zhao J. Integrating MR imaging and clinical features to differentiate uterine carcinosarcoma from endometrial carcinoma. Int J Radiat Res 2026; 24 (2) :473-480 URL: http://ijrr.com/article-1-7029-en.html
|
