Zhang Jingjing, Wang Yingteng, Cao Dongyan, Shen Keng
Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
Ann Transl Med. 2021 Sep;9(18):1398. doi: 10.21037/atm-21-2246.
Cervical tumors usually have an irregular morphology. It is often difficult to estimate tumor size or volume based on a diameter measurement from a two-dimensional magnetic resonance imaging slice. This study aimed to explore the use of magnetic resonance imaging-based three-dimensional reconstruction in cervical cancer.
We retrospectively created a three-dimensional reconstruction based on the pre-treatment magnetic resonance imaging data of 54 cervical cancer patients at a single center to evaluate tumor size and extent of invasion, as well as to review cervical cancer staging and treatment. The tissues and organs were automatically outlined by the three-dimensional application, based on the signal intensity difference of magnetic resonance imaging data.
The maximum tumor diameters calculated using the magnetic resonance imaging-based three-dimensional reconstruction were larger than those calculated from the direct magnetic resonance imaging findings or gynecological examinations. Initial underestimation of the maximum tumor diameter led to under-staging in up to 29.6% of patients. The magnetic resonance imaging-based three-dimensional reconstruction revealed that upstaging was warranted based on lymph node metastasis (3.7% of patients) and invasion of the vaginal fornix (1.9% of patients). Lymph node metastasis was associated with a significantly larger tumor volume (P<0.05). A volume cut-off value ≥18.6 mL provided 60% sensitivity, 96.7% specificity, 75% positive predictive value and 93.5% negative predictive value for predicting high-risk patients (P<0.05).
Magnetic resonance imaging-based three-dimensional reconstruction is a new approach that could potentially measure cervical cancer more accurately.
宫颈肿瘤通常形态不规则。基于二维磁共振成像切片的直径测量来估计肿瘤大小或体积往往很困难。本研究旨在探索基于磁共振成像的三维重建在宫颈癌中的应用。
我们回顾性地基于单中心54例宫颈癌患者的治疗前磁共振成像数据创建三维重建，以评估肿瘤大小和浸润范围，以及回顾宫颈癌分期和治疗情况。基于磁共振成像数据的信号强度差异，通过三维应用自动勾勒组织和器官。
使用基于磁共振成像的三维重建计算出的最大肿瘤直径大于直接磁共振成像结果或妇科检查所计算出的直径。高达29.6%的患者因最初对最大肿瘤直径的低估导致分期不足。基于磁共振成像的三维重建显示，基于淋巴结转移（3.7%的患者）和阴道穹窿浸润（1.9%的患者）有必要进行分期上调。淋巴结转移与显著更大的肿瘤体积相关（P<0.05）。体积截断值≥18.6 mL对预测高危患者具有60%的敏感性、96.7%的特异性、75%的阳性预测值和93.5%的阴性预测值（P<0.05）。
基于磁共振成像的三维重建是一种新方法，有可能更准确地测量宫颈癌。
