Share：
Share this content in WeChat
X
[Chinese][PDF]601
• Clinical Article •
Clinical study on MRI features of different pathological subtypes of uterine sarcoma and their relationship with menopausal status
HUANG Bingyao  LI Xuanyi  XIE Yu  SUN Hongzan 

Cite this article as: HUANG B Y, LI X Y, XIE Y, et al. Clinical study on MRI features of different pathological subtypes of uterine sarcoma and their relationship with menopausal status[J]. Chin J Magn Reson Imaging, 2024, 15(6): 94-99, 106. DOI:10.12015/issn.1674-8034.2024.06.014.


[Abstract] Objective To explore the association between MRI features of different pathological subtypes of uterine sarcoma and patients' menopausal status.Materials and Methods Retrospective analysis of clinical and imaging data of 68 patients with surgically and pathologically confirmed uterine sarcoma, including 17 cases of uterine leiomyosarcoma, 18 cases of endometrial stromal sarcoma, 9 cases of undifferentiated uterine sarcoma, and 24 cases of adenosarcoma; the menopausal status of the patients was summarized, including 41 (60.3%) postmenopausal and 27 (39.7%) premenopausal patients; their common MRI features were analyzed, including necrosis, hemorrhage, irregular or nodular tumor borders, and pelvic lymph node enlargement or peritoneal metastasis. By applying the χ²/Fisher test, an analysis is conducted on the distribution differences of MRI features across various menopausal statuses and different pathological subtypes, for multiple subgroup data with statistical significance, Bonferroni correction was applied for multiple comparisons.Results The differences in pelvic lymph node enlargement or peritoneal metastasis among patients with uterine sarcoma in different menopausal statuses are statistically significant (P<0.05). However, necrosis, hemorrhage, and irregular or nodular tumor margins among patients with uterine sarcoma in different menopausal statuses do not show statistically significant differences (P>0.05). Regardless of menopausal status, irregular or nodular tumor margins have statistical significance in differentiating various pathological types (P<0.05), including comparisons between endometrial stromal sarcoma and adenosarcoma, and undifferentiated sarcoma and adenosarcoma in the menopausal state (P<0.008 3, Bonferroni correction), and between endometrial stromal sarcoma and adenosarcoma in the premenopausal state (P<0.008 3, Bonferroni correction). Necrosis, hemorrhage, pelvic lymph node enlargement, or peritoneal metastasis do not have statistical significance in differentiating among the pathological types (P>0.05). In the menopausal group, the proportion of adenosarcoma patients experiencing pelvic lymph node enlargement or peritoneal metastasis is significantly higher than in the non-menopausal group, which is statistically significant (P<0.05).Conclusions Among MRI features, changes in tumor border morphology have a certain diagnostic value for differentiating various subtypes of uterine sarcoma. Uterine adenosarcomas often present with regular, clear margins, whereas endometrial stromal sarcomas, undifferentiated sarcomas, and some leiomyosarcomas exhibit irregular or nodular tumor margins. Patients with adenosarcoma who have not yet reached menopause are more likely to exhibit lymph node or peritoneal metastasis compared to postmenopausal patients.
[Keywords] uterine sarcoma；uterine leiomyosarcoma；endometrial stromal sarcoma；undifferentiated uterine sarcoma；adenosarcoma；menopausal status；magnetic resonance imaging

HUANG Bingyao   LI Xuanyi   XIE Yu   SUN Hongzan*  

Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China

Corresponding author: SUN H Z, E-mail: sunhongzan@126.com

Conflicts of interest   None.

Received  2024-01-20
Accepted  2024-05-13
DOI: 10.12015/issn.1674-8034.2024.06.014
Cite this article as: HUANG B Y, LI X Y, XIE Y, et al. Clinical study on MRI features of different pathological subtypes of uterine sarcoma and their relationship with menopausal status[J]. Chin J Magn Reson Imaging, 2024, 15(6): 94-99, 106. DOI:10.12015/issn.1674-8034.2024.06.014.

[1]
ZAPARDIEL I, GRACIA SEGOVIA M, MACUKS R, et al. Prognostic factors in patients with uterine sarcoma: the SARCUT study[J]. Int J Gynecol Cancer, 2023, 33(6): 897-904. DOI: 10.1136/ijgc-2022-004204.
[2]
WANG F, DAI X Y, CHEN H J, et al. Clinical characteristics and prognosis analysis of uterine sarcoma: a single-institution retrospective study[J/OL]. BMC Cancer, 2022, 22(1): 1050 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/36207687/. DOI: 10.1186/s12885-022-10129-x.
[3]
MCCLUGGAGE W G, SINGH N, GILKS C B. Key changes to the World Health Organization (WHO) classification of female genital tumours introduced in the 5th edition (2020)[J]. Histopathology, 2022, 80(5): 762-778. DOI: 10.1111/his.14609.
[4]
MALLMANN P. Uterine sarcoma - difficult to diagnose, hard to treat[J/OL]. Oncol Res Treat, 2018, 41(11): 674 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/30326471/. DOI: 10.1159/000494393.
[5]
STUKAN M, RUTKOWSKI P, SMADJA J, et al. Ultrasound-guided trans-uterine cavity core needle biopsy of uterine myometrial tumors to differentiate sarcoma from a benign lesion-description of the method and review of the literature[J/OL]. Diagnostics, 2022, 12(6): 1348 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/35741158/. DOI: 10.3390/diagnostics12061348.
[6]
LI K M, YIN R T, LI L, et al. Diagnosis and treatment of uterine sarcoma: a multicenter, real-world study in Western China[J/OL]. Medicine, 2021, 100(51): e28220 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/34941084/. DOI: 10.1097/MD.0000000000028220.
[7]
CAMPONOVO C, NEUMANN S, ZOSSO L, et al. Sonographic and magnetic resonance characteristics of gynecological sarcoma[J/OL]. Diagnostics, 2023, 13(7): 1223 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/37046441/. DOI: 10.3390/diagnostics13071223.
[8]
SMITH J, ZAWAIDEH J P, SAHIN H, et al. Differentiating uterine sarcoma from leiomyoma: BET1T2ER Check![J/OL]. Br J Radiol, 2021, 94(1125): 20201332 [2023-10-25]. https://pubmed.ncbi.nlm.nih.gov/33684303/. DOI: 10.1259/bjr.20201332.
[9]
GUDINO N, LITTIN S. Advancements in gradient system performance for clinical and research MRI[J]. J Magn Reson Imaging, 2023, 57(1): 57-70. DOI: 10.1002/jmri.28421.
[10]
RASLAN O, OZTURK A, OGUZ K K, et al. Imaging cancer in neuroradiology[J/OL]. Curr Probl Cancer, 2023, 47(2): 100965 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/37349190/. DOI: 10.1016/j.currproblcancer.2023.100965.
[11]
MAHESHWARI E, NOUGARET S, STEIN E B, et al. Update on MRI in evaluation and treatment of endometrial cancer[J]. Radiographics, 2022, 42(7): 2112-2130. DOI: 10.1148/rg.220070.
[12]
AKAZAWA M, HASHIMOTO K. Artificial intelligence in gynecologic cancers: current status and future challenges-A systematic review[J/OL]. Artif Intell Med, 2021, 120: 102164 [2024-01-07]. https://pubmed.ncbi.nlm.nih.gov/34629152/. DOI: 10.1016/j.artmed.2021.102164.
[13]
NAJIBI S, GILANI M M, ZAMANI F, et al. Comparison of the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors[J/OL]. Ann Med Surg, 2021, 70: 102813 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/34691413/. DOI: 10.1016/j.amsu.2021.102813.
[14]
XIE L L, LIN Z Q. Interpretation of 2023 NCCN clinical practice guidelines for uterine tumors (1st edition)[J]. Chin J Pract Gynecol Obstet, 2023, 39(2): 197-204. DOI: 10.19538/j.fk2023020116.
[15]
HILL M, TŘÍSKALA Z, HONCŮ P, et al. Aging, hormones and receptors[J]. Physiol Res, 69(Suppl 2): S255-S272. DOI: 10.33549/physiolres.934523.
[16]
MOLENBERG R, THIO C H L, AALBERS M W, et al. Sex hormones and risk of aneurysmal subarachnoid hemorrhage: A Mendelian randomization study[J]. Stroke, 2022, 53(9): 2870-2875. DOI: 10.1161/STROKEAHA.121.038035.
[17]
WU Y L, LI M L, ZHANG J J, et al. Unveiling uterine aging: much more to learn[J/OL]. Ageing Res Rev, 2023, 86: 101879 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/36764360/. DOI: 10.1016/j.arr.2023.101879.
[18]
NEYKOVA K, TOSTO V, GIARDINA I, et al. Endometrial receptivity and pregnancy outcome[J]. J Matern Fetal Neonatal Med, 2022, 35(13): 2591-2605. DOI: 10.1080/14767058.2020.1787977.
[19]
JEWSON M, PUROHIT P, LUMSDEN M A. Progesterone and abnormal uterine bleeding/menstrual disorders[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 69: 62-73. DOI: 10.1016/j.bpobgyn.2020.05.004.
[20]
YUSUF A N M, AMRI M F, UGUSMAN A, et al. Hyperandrogenism and its possible effects on endometrial receptivity: A review[J/OL]. Int J Mol Sci, 2023, 24(15): 12026 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/37569402/. DOI: 10.3390/ijms241512026.
[21]
ULIN M, ALI M, CHAUDHRY Z T, et al. Uterine fibroids in menopause and perimenopause[J]. Menopause, 2020, 27(2): 238-242. DOI: 10.1097/GME.0000000000001438.
[22]
WANG X. Analysis of high-risk factors of uterine sarcoma and preliminary study of preoperative diagnosis scoring system[D]. Binzhou Medical University, 2023. DOI: 10.27749/d.cnki.gbzyx.2021.000043.
[23]
REY VALZACCHI G M, ROSAS P, UZAL M, et al. Incidence of leiomyosarcoma at surgery for presumed uterine myomas in different age groups[J]. J Minim Invasive Gynecol, 2020, 27(4): 926-929. DOI: 10.1016/j.jmig.2019.06.013.
[24]
GADDUCCI A, MULTINU F, DE VITIS L A, et al. Endometrial stromal tumors of the uterus: Epidemiology, pathological and biological features, treatment options and clinical outcomes[J]. Gynecol Oncol, 2023, 171: 95-105. DOI: 10.1016/j.ygyno.2023.02.009.
[25]
HU H J, WEI Z W, ZHAO H, et al. Epidemiology of adenosarcoma and the inverse probability of treatment weighting (IPTW) adjusted survival analysis of lymph node dissection in uterine adenosarcoma[J/OL]. Medicine, 2022, 101(38): e30607 [2023-10-30]. https://pubmed.ncbi.nlm.nih.gov/36197202/. DOI: 10.1097/MD.0000000000030607.
[26]
MUKUND V. Genistein: its role in breast cancer growth and metastasis[J]. Curr Drug Metab, 2020, 21(1): 6-10. DOI: 10.2174/1389200221666200120121919.
[27]
ULRICH U A, DENSCHLAG D. Uterine adenosarcoma[J]. Oncol Res Treat, 2018, 41(11): 693-696. DOI: 10.1159/000494067.
[28]
NATHENSON M J, CONLEY A P. Prognostic factors for uterine adenosarcoma: a review[J]. Expert Rev Anticancer Ther, 2018, 18(11): 1093-1100. DOI: 10.1080/14737140.2018.1518136.
[29]
PASSARELLO K, KURIAN S, VILLANUEVA V. Endometrial cancer: an overview of pathophysiology, management, and care[J]. Semin Oncol Nurs, 2019, 35(2): 157-165. DOI: 10.1016/j.soncn.2019.02.002.
[30]
LI C B, HUA K Q. Dissecting the single-cell transcriptome network of immune environment underlying cervical premalignant lesion, cervical cancer and metastatic lymph nodes[J/OL]. Front Immunol, 2022, 13: 897366 [2023-11-02]. https://pubmed.ncbi.nlm.nih.gov/35812401/. DOI: 10.3389/fimmu.2022.897366.
[31]
NASIOUDIS D, MASTROYANNIS S A, LATIF N A, et al. Role of lymphadenectomy for apparent early stage uterine sarcoma; a comprehensive analysis of the National Cancer Database[J/OL]. Surg Oncol, 2021, 38: 101589 [2023-11-02]. https://pubmed.ncbi.nlm.nih.gov/33957499/. DOI: 10.1016/j.suronc.2021.101589.
[32]
MACHIDA H, NATHENSON M J, TAKIUCHI T, et al. Significance of lymph node metastasis on survival of women with uterine adenosarcoma[J]. Gynecol Oncol, 2017, 144(3): 524-530. DOI: 10.1016/j.ygyno.2017.01.012.
[33]
SOUSA F A E, FERREIRA J, CUNHA T M. MR imaging of uterine sarcomas: a comprehensive review with radiologic-pathologic correlation[J]. Abdom Radiol (NY), 2021, 46(12): 5687-5706. DOI: 10.1007/s00261-021-03263-w.
[34]
SANTOS P, CUNHA T M. Uterine sarcomas: clinical presentation and MRI features[J]. Diagn Interv Radiol, 2015, 21(1): 4-9. DOI: 10.5152/dir.2014.14053.
[35]
SUZUKI A, AOKI M, MIYAGAWA C, et al. Differential diagnosis of uterine leiomyoma and uterine sarcoma using magnetic resonance images: A literature review[J/OL]. Healthcare, 2019, 7(4): 158 [2023-11-02]. https://pubmed.ncbi.nlm.nih.gov/31817500/. DOI: 10.3390/healthcare7040158.

PREV Study on the differential diagnostic efficacy of Kaiser score and apparent diffusion coefficient values for benign and malignant breast lesions during lactation
NEXT Preoperative prediction of FIGO stage of epithelial ovarian cancer based on T2-weighted MRI peritumoral and intratumoral radiomics models
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn