Himoto Yuki, Kido Aki, Yamanoi Koji, Kurata Yasuhisa, Morita Satoshi, Kikkawa Nao, Fukui Hideyuki, Ohya Ayumi, Iraha Yuko, Tsuboyama Takahiro, Ito Kimiteru, Fujinaga Yasunari, Minamiguchi Sachiko, Mandai Masaki, Nakamoto Yuji
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoinkawahara-Cho 54, Sakyo-Ku, Kyoto, 606-8507, Japan.
Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Jpn J Radiol. 2025 May;43(5):810-819. doi: 10.1007/s11604-024-01713-1. Epub 2024 Dec 3.
The purposes of the study are to assess the diagnostic performance of preoperative imaging for staging factors in gastric-type endocervical adenocarcinoma (GEA) and to compare the performance for GEA with that of usual-type endocervical adenocarcinoma (UEA) among patients preoperatively deemed locally early stage (DLES) (< T2b without distant metastasis).
For this multi-center retrospective study, 58 patients were enrolled. All had undergone MRI with or without CT and FDG PET-CT preoperatively and had been pathologically diagnosed with GEA at five institutions. Based on the medical charts and radiological reports, the diagnostic performances of preoperative imaging for the International Federation of Gynecology and Obstetrics staging factors were assessed retrospectively. Next, the imaging performance was assessed in preoperatively DLES-GEA (n = 36) and DLES-UEA (n = 136, with the same inclusion criteria). The proportions of underestimation of GEA and UEA were compared using Fisher's exact test.
Imaging diagnostic performance for GEA was limited, especially for sensitivity: parametrial invasion, 0.49; vaginal invasion, 0.54; pelvic lymph node metastasis (PELNM), 0.48; para-aortic lymph node metastasis, 0.00; and peritoneal dissemination, 0.25. Among preoperatively DLES patients, the proportions of underestimation were significantly higher in GEA than in UEA; parametrial invasion, 35% vs. 5% (p < 0.01); vaginal invasion, 28% vs. 6% (p < 0.01); PELNM, 24% vs. 6% (p < 0.05); peritoneal dissemination, 6% vs. 0% (p < 0.05).
At present, preoperative imaging diagnostic performance for staging factors in GEA does not meet clinical expectations, especially for sensitivity. Among patients preoperatively DLES, the proportions of underestimation in GEA were significantly higher than in UEA. Future incorporation of approaches specifically emphasizing GEA is desirable to improve imaging performance.
本研究旨在评估术前影像学检查对胃型宫颈腺癌（GEA）分期因素的诊断性能，并比较术前诊断为局部早期（DLES）（<T2b且无远处转移）的患者中GEA与普通型宫颈腺癌（UEA）的影像学表现。
在这项多中心回顾性研究中，纳入了58例患者。所有患者术前均接受了MRI检查，部分还接受了CT和FDG PET-CT检查，并在五家机构经病理诊断为GEA。根据病历和放射学报告，回顾性评估术前影像学检查对国际妇产科联盟分期因素的诊断性能。接下来，对术前DLES-GEA患者（n = 36）和DLES-UEA患者（n = 136，纳入标准相同）的影像学表现进行评估。使用Fisher精确检验比较GEA和UEA低估的比例。
GEA的影像学诊断性能有限，尤其是敏感性方面：宫旁浸润为0.49；阴道浸润为0.54；盆腔淋巴结转移（PELNM）为0.48；腹主动脉旁淋巴结转移为0.00；腹膜播散为0.25。在术前DLES患者中，GEA低估的比例显著高于UEA；宫旁浸润为35% 对5%（p < 0.01）；阴道浸润为28% 对6%（p < 0.01）；PELNM为24% 对6%（p < 0.05）；腹膜播散为6% 对0%（p < 0.05）。
目前，术前影像学检查对GEA分期因素的诊断性能未达临床预期，尤其是敏感性方面。在术前DLES患者中，GEA低估的比例显著高于UEA。未来需要纳入专门针对GEA的方法以提高影像学表现。
