MRI鉴别宫颈腺体叶状增生与宫颈胃型腺癌的价值

马凤华; 姜安绮; 陈奕清; 徐丛剑; 康玉

doi:10.19401/j.cnki.1007-3639.2024.04.005

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MRI鉴别宫颈腺体叶状增生与宫颈胃型腺癌的价值

论著 | 更新时间：2025-12-31

- MRI鉴别宫颈腺体叶状增生与宫颈胃型腺癌的价值
- Magnetic resonance imaging for distinguishing gastric-type endocervical adenocarcinoma from lobular endocervical glandular hyperplasia
- 中国癌症杂志 2024年34卷第4期页码：380-388
- 作者机构：
  
  1. 复旦大学附属妇产科医院放射科，上海 200011
  2. 复旦大学附属妇产科医院妇科，上海 200011
  3. 上海市女性生殖内分泌相关疾病重点实验室，上海 200011
- 作者简介：
  
  [ "马凤华（ORCID: 0000-0002-6486-8058），博士，副主任医师；" ]
  [ "姜安绮（ORCID: 0009-0004-8954-2435），博士研究生在读。" ]
  徐丛剑（ORCID: 0000-0002-7954-5832），博士，主任医师。
  康玉（ORCID: 0000-0003-1197-4727），博士，主任医师；
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2024.04.005
  中图分类号： R737.33
- 收稿：2023-12-29，
  
  修回：2024-04-03，
  
  纸质出版：2024-04-30
- 稿件说明：
移动端阅览
马凤华, 姜安绮, 陈奕清, 等. 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.

Fenghua MA, Anqi JIANG, Yiqing CHEN, et al. Magnetic resonance imaging for distinguishing gastric-type endocervical adenocarcinoma from lobular endocervical glandular hyperplasia[J]. China Oncology, 2024, 34(4): 380-388.
马凤华, 姜安绮, 陈奕清, 等. 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. DOI： 10.19401/j.cnki.1007-3639.2024.04.005.

Fenghua MA, Anqi JIANG, Yiqing CHEN, et al. Magnetic resonance imaging for distinguishing gastric-type endocervical adenocarcinoma from lobular endocervical glandular hyperplasia[J]. China Oncology, 2024, 34(4): 380-388. DOI： 10.19401/j.cnki.1007-3639.2024.04.005.

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

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（

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。

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

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 (

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 contra

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.

关键词

Keywords

references

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