Abstract:
HTML
Purpose: The purpose of this study was to assess the ability of MRI to differentiate between cervical and endometrial adenocarcinomas that present clinically as a cervical mass. The treatment options for these two diseases are different and differentiation on small biopsy samples may be problematic.
Methods and Materials: 56 patients with adenocarcinoma on the initial biopsy of a cervical mass underwent MRI at our institution from 1999 to 2002. Of these 42/56 had a visible mass on MRI. Pathology review of all available tissue was the gold standard. A site of origin was determined by the pathologist in 38/42 patients, 14 requiring immunohistochemistry. 32/38 cases were adenocarcinoma and 6/38 adenosquamous cancers. MRI findings were recorded by two radiologists in consensus.
Results: There were 23 primary cervical and 15 primary endometrial cancers (mean size 4.9cm, range 2.3-9.6cm). In patients with endometrial primary the following findings were present on MRI: endometrial polyp 3/15 (20%), endometrial thickening 11/15 (73%), endometrial mass 11/15 (73%), endometrial cavity expansion by a mass 9/15 (60%). Invasion of the myometrium from endometrium was observed in 9/15 (60%) of primary endometrial cancers on MRI and was not seen in any case of cervix primary. On MRI contiguous invasion of myometrium from the cervix was seen in 8/23 (35%) cervix cancers and in only 1/15 cases of endometrial cancer. The 2 patients with solid ovarian masses on MRI had endometrial primaries. The presence of one or more of the following on MRI: endometrial thickening or mass, endometrial cavity expansion by mass, myometrial invasion from endometrium or the presence of ovarian mass was diagnostic for a primary endometrial cancer with sensitivity 80% (12/15), specificity 96% (22/23) , PPV 92% (12/13), NPV 88% (22/25) and accuracy 81% (34/38).
Conclusion: MRI can distinguish between primary cervical and endometrial adenocarcinoma in cases presenting with cervix involvement and may help direct management when histopathology in not clearly diagnostic of a primary site of origin.
Patlas MD, M,
Accuracy of MRI in Differentiation between Cervix vs Endometrial Origin of Adenocarcinoma in Patients with a Cervix Mass. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3103946.html
