Kazuhiro Kitajima1, Takako Kihara2, Yusuke Kawanaka1, Junko Takahama3, Yoshiko Ueno4, Takamichi Murakami4, Kotaro Yoshida5, Fumi Kato6, Akiko Takahata7, Yoshihiko Fukukura8, Jiro Munechika9, Yasunari Fujinaga10, Takeru Fukunaga11, Masahiro Tanabe12, Yuichiro Kanie13, Ayumu Kido14, Tsutomu Tamada14, Rika Yoshida15, Yuki Kamishima16, Koichiro Yamakado1. 1. Department of Radiology, Hyogo College of Medicine. 2. Department of Surgical Pathology, Hyogo College of Medicine. 3. Department of Radiology, Nara Medical University. 4. Department of Radiology, Kobe University Graduate School of Medicine. 5. Department of Radiology, Kanazawa University, Graduate School of Medicine Science. 6. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital. 7. Department of Radiology, Kyoto Prefectural University of Medicine. 8. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University. 9. Department of Radiology, Showa University School of Medicine. 10. Department of Radiology, Shinshu University School of Medicine. 11. Department of Pathophysiological and Therapeutic Sciences, Tottori University. 12. Department of Radiology, Yamaguchi University Graduate School of Medicine. 13. Department of Radiology, Japanese Red Cross Society Himeji Hospital. 14. Department of Radiology, Kawasaki Medical School. 15. Department of Radiology, Faculty of Medicine, Shimane University. 16. Department of Radiology, Nagoya City West Medical Center.
Abstract
PURPOSE: This study aimed to examine MRI features and staging of neuroendocrine carcinoma (NEC) of the endometrium and evaluate survival. MATERIALS AND METHODS: Clinical data, pathological, and preoperative pelvic MRI findings in 22 patients with histologically surgery-proven endometrial NEC were retrospectively reviewed. Tumors were pure NEC (n = 10) or mixed histotype (n = 12), with 13 large and nine small cell type. RESULTS: International Federation of Gynecology and Obstetrics (FIGO) staging was I, II, III, and IV in 6, 2, 12, and 2 patients, respectively. In 13 (76.4%) of 17 patients with pathological deep myometrial invasion, MRI showed abnormal diffusely infiltrative high T2 signal intensity throughout the myometrium with loss of normal uterine architecture. All tumors had restricted diffusion (apparent diffusion coefficient map low signal intensity, diffusion weighted imaging high signal intensity). Accuracy of T staging by MRI for all cases was 81.8%, with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for detecting metastatic pelvic lymph nodes was 60.0%, 100%, and 77.8%, respectively. Two intrapelvic peritoneal dissemination cases were detected by MRI. During follow-up (mean 30.4, range 3.3-138.4 months), 16 patients (72.7%) experienced recurrence and 12 (54.5%) died of disease. Two-year disease-free and overall survival rates for FIGO I, II, III, and IV were 66.7% and 83.3%, 50% and 100%, 10% and 33.3%, and 0% and 0%, respectively. CONCLUSION: Abnormal diffusely infiltrative high T2 signal intensity throughout the myometrium with normal uterine architecture loss and obvious restricted diffusion throughout the tumor are suggestive features of endometrial NEC. Pelvic MRI is reliable for intrapelvic staging of affected patients.
PURPOSE: This study aimed to examine MRI features and staging of neuroendocrine carcinoma (NEC) of the endometrium and evaluate survival. MATERIALS AND METHODS: Clinical data, pathological, and preoperative pelvic MRI findings in 22 patients with histologically surgery-proven endometrial NEC were retrospectively reviewed. Tumors were pure NEC (n = 10) or mixed histotype (n = 12), with 13 large and nine small cell type. RESULTS: International Federation of Gynecology and Obstetrics (FIGO) staging was I, II, III, and IV in 6, 2, 12, and 2 patients, respectively. In 13 (76.4%) of 17 patients with pathological deep myometrial invasion, MRI showed abnormal diffusely infiltrative high T2 signal intensity throughout the myometrium with loss of normal uterine architecture. All tumors had restricted diffusion (apparent diffusion coefficient map low signal intensity, diffusion weighted imaging high signal intensity). Accuracy of T staging by MRI for all cases was 81.8%, with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for detecting metastatic pelvic lymph nodes was 60.0%, 100%, and 77.8%, respectively. Two intrapelvic peritoneal dissemination cases were detected by MRI. During follow-up (mean 30.4, range 3.3-138.4 months), 16 patients (72.7%) experienced recurrence and 12 (54.5%) died of disease. Two-year disease-free and overall survival rates for FIGO I, II, III, and IV were 66.7% and 83.3%, 50% and 100%, 10% and 33.3%, and 0% and 0%, respectively. CONCLUSION: Abnormal diffusely infiltrative high T2 signal intensity throughout the myometrium with normal uterine architecture loss and obvious restricted diffusion throughout the tumor are suggestive features of endometrial NEC. Pelvic MRI is reliable for intrapelvic staging of affected patients.
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Keywords:
endometrial cancer; magnetic resonance imaging; neuroendocrine carcinoma; survival