Microcystic, Elongated and Fragmented Pattern Invasion Can Adversely Influence Preoperative Staging for Low-grade Endometrial Carcinoma.
Microcystic, Elongated and Fragmented Pattern Invasion Can Adversely Influence Preoperative Staging for Low-grade Endometrial Carcinoma.
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微囊、细长和碎片型浸润可影响低级别子宫内膜癌的术前分期。
DOI：
10.2463/mrms.mp.2019-0153
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发表时间：
2021-03-01
期刊：
影响因子：
--
通讯作者：
Togashi K
中科院分区：
文献类型：
--
作者：
Kuwahara R;Kido A;Yajima R;Nishio N;Nakao K;Kurata Y;Tanaka S;Minamiguchi S;Baba T;Mandai M;Togashi K
目的：探讨微囊、拉长和碎裂(MALF)型侵袭对低度恶性子宫内膜癌患者术前淋巴结转移和肌层侵袭的影响。这项研究包括192名连续的低级别子宫内膜癌患者，他们在手术前接受了计算机断层扫描(CT)和磁共振成像(MRI)，然后进行了手术。161例行LN解剖，并对LN转移情况进行分析。分析所有患者的子宫肌层侵犯情况。根据CT上的大小标准评估LN增大的存在。MRI采用T2加权成像、扩散加权成像和增强T1加权成像综合评价子宫肌层侵犯深度。对MALF组和非MALF组的LN转移和深肌层侵袭的敏感性和特异性进行评估。用卡方检验和Fisher‘s精确检验比较两组敏感度的差异。在192例患者中，43例(22%)表现为MALF型侵袭。盆腔LN MALF组18/39例、非MALF组6/122例、腹主动脉旁LN MALF组11/29例、Non-MELF组4/57例发生淋巴结转移。MALF组检出盆腔LN转移的敏感性(16.7%)明显低于非MALF组(66.7%)。对于深肌层侵犯的评估，MALF组有31/43例有病理性深肌层侵犯，非MALF组有32/149例有病理性深肌层侵犯。MERF组敏感度低于非MERF组(阅读器1的敏感度为54.8%，阅读器2的敏感度为54.8%，62.5%)，但差异无统计学意义(P=0.09，P=0.72)。在低度恶性子宫内膜癌合并MALF侵犯的情况下，CT和MRI的术前分期有被低估的风险。
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 T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-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.
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