Research Papers:

Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis – Japan multicenter study

Kazuhiro Kitajima _, Takako Kihara, Yusuke Kawanaka, Aki Kido, Kotaro Yoshida, Yasunari Mizumoto, Akiko Tomiyama, Shigeo Okuda, Masahiro Jinzaki, Fumi Kato, Junko Takahama, Akiko Takahata, Yoshihiko Fukukura, Atsushi Nakamoto, Tetsuya Tsujikawa, Jiro Munechika, Yoshimitstu Ohgiya, Nobuyuki Kawai, Satoshi Goshima, Ayumi Ohya, Yasunari Fujinaga, Takeru Fukunaga, Shinya Fujii, Masahiro Tanabe, Katsuyoshi Ito, Takahiro Tsuboyama, Yuichiro Kanie, Shigeaki Umeoka, Shintaro Ichikawa, Utaroh Motosugi, Sayaka Daido, Ayumu Kido, Tsutomu Tamada, Mitsuru Matsuki, Tsuneo Yamashiro and Koichiro Yamakado

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Oncotarget. 2020; 11:3675-3686. https://doi.org/10.18632/oncotarget.27613

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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

Correspondence to:

Kazuhiro Kitajima,email: ka-kitajima@hyo-med.ac.jp

Keywords: cervical cancer; neuroendocrine carcinoma; small cell carcinoma; large cell carcinoma; MRI

Received: February 11, 2020     Accepted: May 14, 2020     Published: October 06, 2020

Copyright: © 2020 Kitajima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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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