Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine.
Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine.
Magn Reson Med Sci. 2021 Mar 1;20(1):20-27. doi: 10.2463/mrms.mp.2019-0153. Epub 2020 Feb 19.
To investigate the influence of microcystic, elongated and fragmented (MELF) pattern invasion on preoperative evaluation of lymph node (LN) metastasis and myometrial invasion in patients with low-grade endometrial carcinoma.
The study included 192 consecutive patients with low-grade endometrial carcinoma who underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI), followed by surgery. One hundred sixty one of 192 patients underwent LN dissection and were analyzed for LN metastasis. All patients were analyzed for myometrial invasion. Presence of enlarged LN was evaluated by using size criteria on CT. Depth of myometrial invasion was evaluated on MRI using T-weighted imaging, diffusion-weighted imaging and contrast-enhanced T-weighted imaging comprehensively. Sensitivity and specificity for LN metastasis and deep myometrial invasion were evaluated for MELF group and non-MELF group. The difference of sensitivity between two groups was compared using Chi-square and Fisher's exact test.
MELF pattern invasion was identified in 43/192 patients (22%). LN metastases were observed in 18/39 patients in MELF group and 6/122 patients in non-MELF group for pelvic LN and 11/29 patients in MELF group and 4/57 patients in non-MELF group for para-aortic LN. Sensitivity for the detection of pelvic LN metastasis in MELF group was significantly lower than in non-MELF group (16.7% vs 66.7%). As for the assessment of the deep myometiral invasion, pathological deep myometrial invasion were found in 31/43 patients in MELF group and 32/149 patients in non-MELF group. Sensitivity in MELF group showed lower values than in non-MELF group (54.8% vs 78.1% for reader 1, 54.8% vs 62.5% for reader 2), although there was no statistically significant difference (P = 0.09 for reader 1 and P = 0.72 for reader 2).
In case of low-grade endometrial carcinoma with MELF pattern invasion, preoperative staging by CT and MRI have a risk for underestimation.
研究微囊性、拉长和碎裂（MELF）模式浸润对低级别子宫内膜癌患者术前淋巴结（LN）转移和肌层浸润评估的影响。
本研究纳入了 192 例连续的低级别子宫内膜癌患者，这些患者术前接受了计算机断层扫描（CT）和磁共振成像（MRI）检查，随后进行了手术。192 例患者中有 161 例行 LN 解剖，并对 LN 转移进行了分析。所有患者均对肌层浸润进行了分析。使用 CT 上的大小标准评估增大的 LN。使用 T 加权成像、弥散加权成像和对比增强 T 加权成像综合评估肌层浸润的深度。评估 MELF 组和非 MELF 组的 LN 转移和深肌层浸润的敏感性和特异性。使用卡方检验和 Fisher 确切检验比较两组之间的敏感性差异。
在 192 例患者中，有 43 例（22%）存在 MELF 模式浸润。在 MELF 组中，39 例患者中有 18 例出现盆腔 LN 转移，122 例患者中有 6 例出现盆腔 LN 转移；29 例患者中有 11 例出现腹主动脉旁 LN 转移，57 例患者中有 4 例出现腹主动脉旁 LN 转移。MELF 组盆腔 LN 转移的检测敏感性明显低于非 MELF 组（16.7%比 66.7%）。在评估深肌层浸润方面，在 MELF 组中，31 例患者存在病理深肌层浸润，149 例患者中存在 32 例患者存在病理深肌层浸润。MELF 组的敏感性低于非 MELF 组（1 号读者为 54.8%比 78.1%，2 号读者为 54.8%比 62.5%），但差异无统计学意义（1 号读者为 P = 0.09，2 号读者为 P = 0.72）。
在存在 MELF 模式浸润的低级别子宫内膜癌患者中，CT 和 MRI 的术前分期存在低估的风险。
