Department of Obstetrics and Gynecology, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan.
Department of Obstetrics and Gynecology, Yao Municipal Hospital, 1-3-1 Ryuge-cho, Yao, Osaka, 581-0069, Japan.
J Ovarian Res. 2019 Feb 25;12(1):20. doi: 10.1186/s13048-019-0497-1.
Common cancerous histological types associated with endometriosis are clear cell carcinoma (CCC) and endometrioid carcinoma (EC). CCC is regarded as an aggressive, chemoresistant histological subtype. Magnetic resonance imaging (MRI) offers some potential advantages to diagnose ovarian tumors compared with ultrasonography or computed tomography. This study aimed to identify MRI features that can be used to differentiate between CCC and EC.
We searched medical records of patients with ovarian cancers who underwent surgical treatment at Nara Medical University Hospital between January 2008 and September 2018; we identified 98 patients with CCC or EC who had undergone preoperative MRI. Contrasted MRI scans were performed less than 2 months before surgery. Patients were excluded from the study if they had no pathology, other pathological subtype of epithelial ovarian cancer, and/or salvage treatment for recurrence and metastatic ovarian cancer at the time of study initiation. Clinically relevant variables that were statistically significant by univariate analysis were selected for subsequent multivariate regression analysis to identify independent factors to distinguish CCC from EC.
MRI of CCC and EC showed a large cystic heterogeneous mixed mass with mural nodules protruding into the cystic space. Univariate logistic regression analysis revealed that the growth pattern (broad-based nodular structures [multifocal/concentric sign] or polypoid structures [focal/eccentric sign]), surface irregularity (a smooth/regular surface or a rough/irregular/lobulated surface), "Width" of mural nodule, "Height-to-Width" ratio (HWR), and presence of preoperative ascites were factors that significantly differed between CCC and EC. In the multivariate logistic regression analysis, the growth pattern of the mural nodule (odds ratio [OR] = 0.69, 95% confidence interval [CI]: 0.013-0.273, p = 0.0004) and the HWR (OR = 3.71, 95% CI: 1.128-13.438, p = 0.036) were independent predictors to distinguish CCC from EC.
In conclusion, MRI data showed that the growth pattern of mural nodules and the HWR were independent factors that could allow differentiation between CCC and EC. This finding may be helpful to predict patient prognosis before operation.
与子宫内膜异位症相关的常见癌症组织学类型是透明细胞癌（CCC）和子宫内膜样癌（EC）。CCC 被认为是一种侵袭性、化疗耐药的组织学亚型。与超声或计算机断层扫描相比，磁共振成像（MRI）在诊断卵巢肿瘤方面具有一些潜在优势。本研究旨在确定可用于区分 CCC 和 EC 的 MRI 特征。
我们检索了 2008 年 1 月至 2018 年 9 月在奈良医科大学医院接受手术治疗的卵巢癌患者的病历；我们确定了 98 例接受术前 MRI 检查的 CCC 或 EC 患者。对比 MRI 扫描在手术前不到 2 个月进行。如果患者在研究开始时没有病理学、其他上皮性卵巢癌的病理亚型和/或复发性和转移性卵巢癌的挽救性治疗，则将其排除在研究之外。通过单变量分析选择有统计学意义的临床相关变量，进行后续多变量回归分析，以确定区分 CCC 和 EC 的独立因素。
CCC 和 EC 的 MRI 显示为大的囊性混杂混合肿块，壁结节向囊性空间突出。单变量逻辑回归分析显示，生长模式（宽基底结节结构[多灶性/同心征]或息肉样结构[局灶性/偏心征]）、表面不规则（光滑/规则表面或粗糙/不规则/分叶状表面）、壁结节的“宽度”、“高宽比”（HWR）和术前腹水是 CCC 和 EC 之间差异有统计学意义的因素。在多变量逻辑回归分析中，壁结节的生长模式（优势比[OR] = 0.69，95%置信区间[CI]：0.013-0.273，p = 0.0004）和 HWR（OR = 3.71，95% CI：1.128-13.438，p = 0.036）是区分 CCC 和 EC 的独立预测因子。
总之，MRI 数据显示壁结节的生长模式和 HWR 是可以区分 CCC 和 EC 的独立因素。这一发现可能有助于在手术前预测患者的预后。
