MRI鉴别宫颈腺体叶状增生与宫颈胃型腺癌的价值

doi:10.19401/j.cnki.1007-3639.2024.04.005

摘要/Abstract

摘要：

背景与目的：宫颈胃型腺癌（gastric-type endocervical adenocarcinoma，G-EAC）是一种少见的宫颈腺癌，临床表现不典型，病灶隐匿，极易漏诊、误诊，患者预后差；而宫颈腺体叶状增生（lobular endocervical glandular hyperplasia，LEGH）及非典型LEGH（atypical lobular endocervical glandular hyperplasia，aLEGH）是G-EAC的癌前病变，与G-EAC存在临床、病理学及影像学等诸多重叠，术前诊断极具挑战性。本文旨在分析宫颈囊实性病变的磁共振成像（magnetic resonance imaging，MRI）表现与病理学诊断结果的相关性，以提高LEGH与G-EAC鉴别诊断的准确性。方法：收集2016年7月—2023年8月在复旦大学附属妇产科医院就诊的37例LEGH和53例G-EAC患者的临床、影像学及病理学资料。采用χ²检验或Fisher精确概率法等进行统计学分析，采用logistic回归进行多因素分析，采用受试者工作特征（receiver operator characteristic，ROC）曲线进行效能评价。结果：LEGH和G-EAC两组间患者年龄、症状、病灶范围、大小、成分、强化程度、宫颈间质环、子宫内膜累及、淋巴结肿大、宫腔积液差异有统计学意义（P<0.05）。LEGH及aLEGH组病灶位于宫颈黏膜层，主要表现为大、微小囊混合型或密集微小囊型（32/37），囊壁多明显强化（31/37）；而G-EAC组中多累及宫颈肌层（42/53），多见实性成分（52/53）和低信号间质环中断或消失（46/53）。Logistic回归分析结果显示，病灶实性成分（OR = 50.064）和宫颈间质环中断（OR = 40.180）可作为预测G-EAC的显著MRI特征。综合病灶大小、成分、强化程度、宫颈间质环和子宫内膜累及5个特征，对诊断G-EAC的效能采用ROC分析，曲线下面积（area under curve，AUC）为0.970（95% CI：0.931 ~ 1.008）。结论：结合宫颈囊实性病变的多个MRI征象有助于鉴别LEGH与G-EAC。

关键词: 宫颈腺体叶状增生, 宫颈胃型腺癌, 癌前病变, 磁共振成像, 鉴别诊断

Abstract:

Background and purpose: Gastric-type endocervical adenocarcinoma (G-EAC) is a rare variant of endocervical adenocarcinoma, characterized by atypical clinical manifestations and elusive lesions. Due to these factors, G-EAC is prone to being missed or misdiagnosed, significantly impacting the prognosis. Lobular endocervical glandular hyperplasia (LEGH) and atypical LEGH (aLEGH) are considered to be precancerous lesions of G-EAC. These conditions also present overlapping clinical, pathologic and imaging manifestations, making it challenging to differentiate between them preoperatively. The purpose of this study was to investigate the correlation between magnetic resonance imaging (MRI) findings of cystic-solid lesions in the cervix and their underlying pathology in order to enhance the accuracy of distinguishing between LEGH and G-EAC, ultimately aiding in the early diagnosis and appropriate management of these conditions. Methods: Clinical, imaging and pathological data of 37 LEGH and 53 G-EAC patients who attended the Obstetrics and Gynecology Hospital of Fudan University from July 2016 to August 2023 were collected. Analysis was conducted using Pearson Chi-square χ², Fisher’s exact tests and so on. Multivariate analyses were performed using logistic regression. Receiver operating characteristic (ROC) curves were used for performance evaluation. Results: In this study, differences in age, symptoms, extent, size, composition, degree of enhancement, cervical stromal ring, endometrium invasion, pelvic lymph nodes enlargement, and hydrohystera were statistically significant between the two groups (P<0.05). In the LEGH and aLEGH groups, lesions were primarily localized to the epithelial layer of the endocervical canal. These lesions were predominantly simple cystic (32/37), and the cystic walls often displayed significant enhancement (31/37). In contrast, the G-EAC group presented with lesions involving the myometrium of the uterine cervix (42/53). These lesions were characterized by a solid component in the majority of cases (52/53), a tendency for the disappearance of the cervical stromal ring (46/53). Logistic regression analysis revealed that among the MRI features, lesion composition (OR = 50.064) and incomplete cervical stromal ring (OR = 40.180) were significant predictors for G-EAC. ROC analysis, incorporating lesion size, composition, enhancement degree, cervical stromal ring, and endometrial involvement, yielded an area under curve (AUC) of 0.970 (95% CI: 0.931-1.008). Conclusion: Combining multiple MRI features of cystic-solid lesions in the cervix aids in distinguishing between LEGH and G-EAC.

Key words: Lobular endocervical glandular hyperplasia, Gastric-type endocervical adenocarcinoma, Precancerous lesions, Magnetic resonance imaging, Differential diagnosis

中图分类号:

R737.33

马凤华, 姜安绮, 陈奕清, 徐丛剑, 康玉. MRI鉴别宫颈腺体叶状增生与宫颈胃型腺癌的价值[J]. 中国癌症杂志, 2024, 34(4): 380-388.

MA Fenghua, JIANG Anqi, CHEN Yiqing, XU Congjian, KANG Yu. Magnetic resonance imaging for distinguishing gastric-type endocervical adenocarcinoma from lobular endocervical glandular hyperplasia[J]. China Oncology, 2024, 34(4): 380-388.

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Clinicopathologic characteristics	LEGH+aLEGH (n=37)	G-EAC (n=53)	P value
Mean age/year	41.0±10.5	46.0±12.0	0.015
Manifestations
Vaginal discharge	31 (83.8%)	21 (39.6%)	<0.001
Vaginal bleeding	2 (5.4%)	27 (50.9%)	<0.001
Abdominal pain	0	11 (20.8%)	0.009

Imaging diagnoses	LEGH+aLEGH (n=37)	G-EAC (n=53)
sLEGH	19 (51.4%)	5 (9.4%)
sMT	5 (13.5%)	42(79.2%)
Non-specific	13 (35.1%)	6 (11.3%)
Consistency rate	51.4%	79.2%

MRI features	LEGH+aLEGH (n = 37)	G-EAC (n = 53)	P value
Extent of lesions
Epithelial layer	37 (100.0%)	11 (20.8%)	<0.001
Muscular layer	0 (0.0%)	42 (79.2%)
Mean diameter^a/cm	3.4 ± 1.1	4.7 ± 1.6	<0.001
Components
Mixed cystic pattern	19 (51.4%)	1 (1.9%)	<0.001
Microcystic pattern	13 (35.1%)	0 (0.0%)
Mixed cystic-solid pattern	5 (13.5%)	16 (30.2%)
Solid pattern	0 (0.0%)	36 (67.9%)
Degree of enhancement
Mild/moderate	6 (16.2%)	22 (41.5%)	0.011
Significant	31 (83.8%)	31 (58.5%)
Disrupted cervical stromal ring	1 (2.7%)	46 (86.8%)	<0.001
Endometrium invasion	8 (21.6%)	34 (64.2%)	<0.001
Ovarian lesions	7 (18.9%)	7 (13.2%)	0.462
Lymph nodes enlargement	0 (0.0%)	9 (17.0%)	0.022
Hydrohystera	0 (0.0%)	11 (20.8%)	0.009
Bladder invasion	0 (0.0%)	5 (9.4%)	0.146

MRI features	β	SE	Wald test	OR (95% CI)	P value
Maximal diameter	-0.141	0.379	0.138	0.868 (0.413-1.827)	0.710
Components	3.913	1.294	9.140	50.064 (3.960-632.895)	0.003
Degree of enhancement	-0.951	1.055	0.813	0.386 (0.049-3.053)	0.367
Disrupted cervical stromal ring	3.693	1.330	7.706	40.180 (2.961-545.167)	0.006
Endometrium invasion	-0.222	1.188	0.035	0.801 (0.078-8.214)	0.852
Constant	-2.262	1.666	1.843	0.104	0.175

MRI features	AUC	SE	Asymptotic Sig.	95% CI
Combination	0.970	0.020	0.000	0.931-1.008
Maximal diameter	0.747	0.052	0.000	0.644-0.849
Components	0.923	0.035	0.000	0.854-0.992
Degree of enhancement	0.374	0.059	0.032	0.258-0.489
Disrupted cervical stromal ring	0.920	0.032	0.000	0.858-0.983
Endometrium invasion	0.713	0.056	0.000	0.604-0.822