Abstract
Purpose To make clear distinction between two radiological types of uterine sarcomas. Methods 50 preoperative MRI were analyzed retrospectively, blinded to histopathology: 11 endometrial stromal sarcomas (ESS), 19 leiomyosarcomas (LMS), 18 carcinosarcomas/malignant mixed Mullerian tumors (MMMT), and 2 smooth muscle tumors of uncertain malignant potential (STUMP). Results According to their locations, two radiological types of sarcomas were identified: type 1: intracavitary (ESS, MMMT) and type 2: intramyometrial (LMS, STUMP). In both types, all tumors displayed intermediate T2-weighted signal (p < 0.001) and high diffusion-weighted imaging (DWI) b1000 signal (p < 0.001). Dynamic contrast-enhanced (DCE) MRI showed intratumoral pathologic vessels (98%) and heterogeneity at venous phase (p < 0.001). In the type 1 subgroup, all tumors displayed local spread: invasion of junctional zone on T2-weighted imaging (T2WI), irregular margins on DWI, and disruption of arcuate arteries subendometrial ring on DCE-MRI. In the type 2 subgroup, all tumors displayed irregular margins on T2WI, DWI, and DCE-MRI. Tumor heterogeneity was due to necrosis (p < 0.001). Most commonly the tumor was single (61%). In both types, apparent diffusion coefficient (ADC) lesser than or equal to 0.86 × 10−3 mm2/s (sensitivity = 73%, specificity = 92%) was suggestive of malignancy. Conclusion It may be feasible to get close to histological type of a uterine sarcoma based on our topographic classification into two radiological subgroups, corresponding to two kinds of diagnostic difficulties. Advances in knowledge. MRI signs suggestive of histopathological malignancy are identifiable, considering the triad T2WI/DWI/DCE-MRI, easily for type 1 but less easily for type 2; the threshold value for ADC is 0.86 × 10−3 mm2/s.
Highlights
Uterine sarcomas are very rare neoplasms with poor prognosis. ey account for only 1 to 3% of gynecological tumors and 3 to 7% of uterine tumors. e 5-year survival rate in advanced stages is less than 10% [1, 2]
In the type 2 subgroup, among the 23 tumors, there were 19 LMS (83%), 2 smooth muscle tumors of uncertain malignant potential (STUMP) (9%), 2 endometrial stromal sarcomas (ESS) (9%), and no malignant mixed Mullerian tumors (MMMT). is topographic feature was statistically significant (p < 0.001) (Table 1)
Disruption of the endometrial-myometrial interface is usually easy to demonstrate, in addition to the criteria of malignancy related to each sequence we found statistically significant in our study. ese criteria were an intermediate signal on T2-weighted imaging (T2WI), a high diffusion-weighted imaging (DWI) b1000 signal increasing compared with b0, and visible intratumoral vessels of malignant type on Dynamic contrast-enhanced (DCE)-MRI. e greater ease in determining the proper diagnosis at radiological step for type 1 tumors is found at pathological step
Summary
Uterine sarcomas are very rare neoplasms with poor prognosis. ey account for only 1 to 3% of gynecological tumors and 3 to 7% of uterine tumors. e 5-year survival rate in advanced stages is less than 10% [1, 2]. Ey account for only 1 to 3% of gynecological tumors and 3 to 7% of uterine tumors. Authors never make a distinction between endometrial sarcomas and myometrial sarcomas [3,4,5]. MR features predictive of histological malignancy have not been much evaluated, especially a combination of several signs. Considering myometrial tumors, pathological distinction between benign and malignant types is often difficult to such an extent that there are borderline types termed “STUMP” for which only tumor progression during followup will allow physicians to conclude [6]. Us, we assessed MR features predictive of histological malignancy for each of these two location types. We pointed out the value of DCE-MRI, especially concerning angiograms analysis, to determine the malignant character of the tumor and histological differential diagnoses
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