Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis – Japan multicenter study
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Kazuhiro Kitajima1, Takako Kihara2, Yusuke Kawanaka1, Aki Kido3, Kotaro Yoshida4, Yasunari Mizumoto5, Akiko Tomiyama6, Shigeo Okuda6, Masahiro Jinzaki6, Fumi Kato7, Junko Takahama8, Akiko Takahata9, Yoshihiko Fukukura10, Atsushi Nakamoto11, Tetsuya Tsujikawa12, Jiro Munechika13, Yoshimitstu Ohgiya13, Nobuyuki Kawai14, Satoshi Goshima15, Ayumi Ohya16, Yasunari Fujinaga16, Takeru Fukunaga17, Shinya Fujii17, Masahiro Tanabe18, Katsuyoshi Ito18, Takahiro Tsuboyama19, Yuichiro Kanie20, Shigeaki Umeoka21, Shintaro Ichikawa22, Utaroh Motosugi22, Sayaka Daido23, Ayumu Kido24, Tsutomu Tamada24, Mitsuru Matsuki25, Tsuneo Yamashiro26 and Koichiro Yamakado1
1 Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
2 Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
3 Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
4 Department of Radiology, Kanazawa University, Graduate School of Medicine Science, Kanazawa, Ichikawa, Japan
5 Department of Obstetrics and Gynecology, Kanazawa University, Graduate School of Medicine Science, Kanazawa, Ichikawa, Japan
6 Department of Radiology, Keio University School of Medicine, Tokyo, Japan
7 Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
8 Department of Radiology, Nara Medical University, Nara, Japan
9 Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
10 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
11 Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
12 Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
13 Department of Radiology, Showa University School of Medicine, Tokyo, Japan
14 Department of Radiology, Gifu University Hospital, Gifu, Japan
15 Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
16 Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
17 Division of Radiology, Department of Pathophysiological and Therapeutic Sciences, Tottori University, Tottori, Japan
18 Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
19 Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
20 Department of Radiology, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan
21 Department of Radiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
22 Department of Radiology, University of Yamanashi, Yamanashi, Japan
23 Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
24 Department of Radiology, Kawasaki Medical School, Okayama, Japan
25 Department of Diagnostic Radiology, Kindai University Faculty of Medicine, Osaka, Japan
26 Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
Keywords: cervical cancer; neuroendocrine carcinoma; small cell carcinoma; large cell carcinoma; MRI
Received: February 11, 2020 Accepted: May 14, 2020 Published: October 06, 2020
Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival.
Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3–151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively.
Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3).
Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.
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