Fischetti S G, Politi G, Lomeo E, Garozzo G, Di Leo S, Nuciforo G
Istituto di Radiologia, Università degli Studi di Catania.
Radiol Med. 1994 Oct;88(4):445-52.
In uterine cervical canal carcinoma, the current clinical FIGO criteria often fail not only to differentiate stage IA2 from stage IB but also to demonstrate possible parametrial involvement. Moreover, the analysis of tumor volume and of the depth of neoplastic stromal invasion is not very reliable. The authors investigated MR accuracy in the definition of such variables: to this purpose, 24 patients with histologically confirmed endocervical adenocarcinoma were submitted to MRI, which was performed with an 0.5-T superconductive magnet. Sagittal and oblique transverse or sometimes coronal SE images, oriented so as to be perpendicular to longitudinal cervical major axis were obtained with T2 weighting (TR 1800 ms, TE 25-90 ms). MR data were correlated with pathologic findings. MR accuracy in demonstrating parametrial involvement was 92%, its sensitivity was 86% and specificity 97%. Volumetric MR data showed a high correlation (r = 0.970) with those derived from pathologic findings. In 92% of cases stromal invasion exceeded 5 mm. MRI, thanks to its high accuracy, should be included in diagnostic pretreatment protocols, even though FIGO criteria do not require it yet, especially in the presence of an endocervical adenocarcinoma. Moreover, the accurate definition of tumor volume can allow less extensive surgery with the same survival rates and fewer complications, which are frequently observed after radical hysterectomy.
在子宫颈管癌中，目前的国际妇产科联盟（FIGO）临床标准不仅常常无法区分IA2期和IB期，而且也无法显示可能存在的宫旁组织受累情况。此外，对肿瘤体积和肿瘤间质浸润深度的分析也不太可靠。作者研究了磁共振成像（MR）在定义这些变量方面的准确性：为此，对24例经组织学确诊的宫颈腺癌患者进行了MR检查，使用的是0.5-T超导磁体。通过T2加权（TR 1800 ms，TE 25 - 90 ms）获得矢状面和斜横断面或有时冠状面的SE图像，其方向垂直于宫颈长轴。将MR数据与病理结果进行关联。MR显示宫旁组织受累的准确性为92%，敏感性为86%，特异性为97%。MR体积数据与病理结果得出的数据具有高度相关性（r = 0.970）。在92%的病例中，间质浸润超过5 mm。尽管FIGO标准目前尚未要求，但由于其高准确性，MR应纳入诊断性预处理方案中，尤其是在存在宫颈腺癌的情况下。此外，准确界定肿瘤体积可以在相同生存率和更少并发症的情况下进行范围更小的手术，而这些并发症在根治性子宫切除术后经常出现。
