| BackgroundCervical cancer FIGO staging is a clinical staging system.MRI is recognized as the best imaging examination to observe cervical cancer nowadays,but there are still some limitations.The cervical cancer lesion is a complex three-dimensional shape.But gynecological examination could not observe the lesion in its entirety,while MRI could not visually observe the lesion,and there are still many measured parameters of the lesion which is worth to explore their relationship with cervical cancer.However,the accurate measurement of the size of cervical cancer lesions is crucial for the accurate staging of cervical cancer and the decision making of subsequent humanized treatment strategy.3D imaging analysis is a possible solution to overcome this problem.We tried to measure the minimum TFM and volume of cervical cancer lesions on MRI and 3D-MRI reconstruction.The relationship between these parameters and postoperatively adverse pathological risk factors,as well as the role of 3D-MRI reconstruction on the FIGO staging and treatment strategy of cervical cancer were preliminarily explored.In addition,the significance of surgery for non-genital ovarian metastases has not been determined.We analyzed this to see if three-dimensional imaging analysis could also help solve this gynecological problem.Methods1.The patients who received the initial treatment of radical resection of cervical cancer in our hospital from July I,2017 to June 30,2019 was collected.The minimum TFM and volume of the cervical cancer lesion were measured on preoperative MRI.The relationship between minimum TFM and volume of the lesion and adverse pathological risk factors was analyzed,including lymph node metastasis,parametrial infiltration,positive surgical margin,lymph vascular space invasion,deep cervical infiltration,and lesion diameter ≥ 4cm.2.Cervical cancer patients who visited the gynecological oncology outpatient department of our hospital on December 31,2019 on November I,2019 were collected.Pelvic MRI containing T2 3D SPACE sequence was completed.Gynecological examination was performed by the gynecological oncologists designated in this study Then enrolled patients’ FIGO staging and treatment strategies were determined Patients’ 3D reconstruction based on their MRI data was conducted.The maximum diameter,minimum TFM and volume of the cervical cancer lesion were measured and the lesion involvement scope was interpreted on the 3D-MRI reconstruction.According to the 3D-MRI reconstruction,the stages and treatment strategies of the patients were adjusted,and the changes of stages and treatment strategies were analyzed.The relationship between minimum TFM and volume of the lesion and adverse pathological risk factors was analyzed and verified in patients undergoing radical resection of cervical cancer.3.The clinicopathological data of patients with non-genital ovarian metastatic tumor who underwent surgical treatment in our hospital from May 2005 to May 2018 were retrospectively analyzed to assess their clinicopathological features,the role of surgery,survival rate and prognostic factors.Results1.The minimum TFM with lymph node metastasis was significantly smaller than that without lymph node metastasis(P<0.05),which was 1.6 mm(1.2 mm,2.4 mm)vs.2.4 mm(1.3 mm,5.3 mm).The volume with parametrial infiltration was significantly greater than that without parametrial infiltration(P<0.05),which was 8979 mm3(4527 mm3,14258 mm3)vs.1545 mm3(885 mm3,4247 mm3).The volume with deep cervical infiltration was significantly greater than that without deep cervical deep infiltration(P<0.05),which was 3175 mm3(1311 mm3,5462 mm3)vs.1025 mm3(508 mm3,1934 mm3).The volume with lymph vascular space invasion was significantly greater than that without lymph vascular space invasion(P<0.05),which was 2958 mm3(1137 mm3,5116 mm3)vs.1282 mm3(714 mm3,2258 mm3).There was a statistically significant difference in volume among the three groups of non-risk,medium-risk and high-risk patients(P<0.05),which were 1118 mm3(589 mm3,2128 mm3)vs.3188 mm3(1306 mm3,5581 mm3)vs.4776 mm3(3192 mm3,10889mm3).2.The volume was of diagnostic value for parametrial infiltration,deep cervical infiltration,deep cervical infiltration,and high-risk patients(P<0.05).With 3882 mm3 as the cut-off value,the sensitivity and specificity of the diagnosis of parametrial infiltration were 100%and 74.2%,respectively.With 2881 mm3 as cut-off value,the sensitivity and specificity of the diagnosis of deep cervical infiltration were 52.5%and 88.9%,respectively.With 1072 mm3 as cut-off value,the sensitivity and specificity of the diagnosis of lymph vascular space in vasion were 81.9%and 46.8%,respectively.With 3505 mm3 as cut-off value,the sensitivity and specificity of the diagnosis of high-risk patients were 88.9%and 84.8%,respectively.3.Stage was increased in 34.1%of patients and treatment strategies were changed in 27.3%of patients after reference to 3D-MRI reconstruction.Among patients with optimal treatment strategies changes,58.3%of them needed to expand the scope of surgery;33.3%of them changed from radical resection of cervical cancer to primary chemotherapy followed by hysterectomy or radical concurrent chemoradiotherapy;8.3%of them changed from radical resection of cervical cancer to radical concurrent chemoradiotherapy.4.The median survival of different primary tumor sites,different degrees of tumor differentiation,the diameter of the largest residual lesion<2 cm or≥2 cm,and whether or not adjuvant treatment were all statistically significant(P<0.05).ConclusionsThe minimum TFM and volume of cervical cancer lesions were associated with adverse pathological factors.The volume of cervical cancer can be used as a great predictor of high-risk patients.3D-MRI reconstruction can assist in more accurate staging and humanized treatment strategies of cervical cancer.For the surgical treatment of non-genital ovarian metastatic tumor,the maximum residual lesion diameter<2 cm should be reached as far as possible.Preoperative 3D-MRI reconstruction can be referred to evaluate whether this goal can be achieved. |
PDF Full Text Request