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Journal ArticleDOI

The Added Role of MR Imaging in Treatment Stratification of Patients with Gynecologic Malignancies: What the Radiologist Needs to Know

01 Mar 2013-Radiology (Radiological Society of North America, Inc.)-Vol. 266, Iss: 3, pp 717-740
TL;DR: The purpose of this review is to highlight the added role of MR imaging in the treatment stratification and overall care of patients with endometrial, cervical, or ovarian cancer.
Abstract: Advances in MR imaging techniques, along with the growing role of the radiologist as part of a multidisciplinary treatment-planning team, have become central in tailoring treatment options and frequently lead to modifications in the therapeutic approach in patients with gynecologic malignancies.
Citations
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Journal ArticleDOI
TL;DR: Clinical features of uterine sarcomas are discussed, as well as their most common appearances and distinct characteristics in MRI, which help differentiate from more common leiomyomas and endometrial carcinoma.
Abstract: Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI.

138 citations


Cites background from "The Added Role of MR Imaging in Tre..."

  • ...2% of cases) it may result from a sarcomatous transformation in a benign leiomyoma (2)....

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  • ...Some authors have suggested the presence of irregular margins, necrosis, and rapid growth as the most suggestive features of malignancy (2)....

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  • ...U terine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies (1), although they were thought to represent only 2% to 3% of all uterine tumors in the past (2)....

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Journal ArticleDOI
TL;DR: Radiogenomics aims to correlate imaging characteristics with gene expression patterns, gene mutations, and other genome‐related characteristics and is designed to facilitate a deeper understanding of tumor biology and capture the intrinsic tumor heterogeneity.
Abstract: With the genomic revolution in the early 1990s, medical research has been driven to study the basis of human disease on a genomic level and to devise precise cancer therapies tailored to the specific genetic makeup of a tumor. To match novel therapeutic concepts conceived in the era of precision medicine, diagnostic tests must be equally sufficient, multilayered, and complex to identify the relevant genetic alterations that render cancers susceptible to treatment. With significant advances in training and medical imaging techniques, image analysis and the development of high-throughput methods to extract and correlate multiple imaging parameters with genomic data, a new direction in medical research has emerged. This novel approach has been termed radiogenomics. Radiogenomics aims to correlate imaging characteristics (ie, the imaging phenotype) with gene expression patterns, gene mutations, and other genome-related characteristics and is designed to facilitate a deeper understanding of tumor biology and capture the intrinsic tumor heterogeneity. Ultimately, the goal of radiogenomics is to develop imaging biomarkers for outcome that incorporate both phenotypic and genotypic metrics. Due to the noninvasive nature of medical imaging and its ubiquitous use in clinical practice, the field of radiogenomics is rapidly evolving and initial results are encouraging. In this article, we briefly discuss the background and then summarize the current role and the potential of radiogenomics in brain, liver, prostate, gynecological, and breast tumors. Level of evidence 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;47:604-620.

125 citations

Journal ArticleDOI
TL;DR: A meta-analysis shows that DCE and DW do not differ in diagnostic accuracy, and MR diagnostic accuracy in presurgical detection of deep myometrial infiltration in endometrial cancer is high.
Abstract: To compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MR imaging in detecting deep myometrial invasion in endometrial cancer, using surgical-pathological staging as reference standard. After searching a wide range of electronic databases and screening titles/abstracts, we obtained full papers for potentially eligible studies and evaluated according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. From each study, we extracted information on diagnostic performance of DW and DCE sequences. After exploring heterogeneity, we adopted a bivariate generalized linear mixed model to compare the effect of the two MR sequences jointly on sensitivity and specificity. Nine studies (442 patients) were considered. Significant evidence of heterogeneity was found only for specificity, both in DW and DCE imaging (I 2 = 70.8 % and 70.6 %). Pooled sensitivity of DW and DCE was 0.86 and specificity did not significantly differ (p = 0.16) between the two sequences (DW = 0.86 and DCE = 0.82). No difference was found between 3-T and 1.5-T MR. There was no evidence of publication bias. MR diagnostic accuracy in presurgical detection of deep myometrial infiltration in endometrial cancer is high. DCE and DW imaging do not differ in sensitivity and specificity. • Myometrial invasion is the most important morphological prognostic feature of endometrial cancer • MR diagnostic accuracy in presurgical detection of deep myometrial infiltration is high • MR examination including T2 and DCE imaging is considered the reference standard • DW imaging has been increasingly employed with heterogeneous results • This meta-analysis shows that DCE and DW do not differ in diagnostic accuracy

111 citations


Cites methods from "The Added Role of MR Imaging in Tre..."

  • ...Diffusion-weighted (DW) imaging is increasingly used as an add-on to T2 and DCE MR imaging [15, 16], even if DW imaging is not yet included in current imaging guidelines updated by 2011 [9, 12]....

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Journal ArticleDOI
TL;DR: PET/MRI is superior to PET/CT for primary tumour delineation and might be the preferred imaging modality for staging cervical and endometrial tumours and whole-body staging for detection and evaluation of extra-abdominal metastases is mandatory.
Abstract: To compare the diagnostic accuracy of PET/MRI and PET/CT for staging and re-staging advanced gynaecological cancer patients as well as identify the potential benefits of each method in such a population. Twenty-six patients with suspicious or proven advanced gynaecological cancer (12 ovarian, seven cervical, one vulvar and four endometrial tumours, one uterine metastasis, and one primary peritoneal cancer) underwent whole-body imaging with a sequential trimodality PET/CT/MR system. Images were analysed regarding primary tumour detection and delineation, loco-regional lymph node staging, and abdominal/extra-abdominal distant metastasis detection (last only by PET/CT). Eighteen (69.2 %) patients underwent PET/MRI for primary staging and eight patients (30.8 %) for re-staging their gynaecological malignancies. For primary tumour delineation, PET/MRI accuracy was statistically superior to PET/CT (p < 0.001). Among the different types of cancer, PET/MRI presented better tumour delineation mainly for cervical (6/7) and endometrial (2/3) cancers. PET/MRI for local evaluation as well as PET/CT for extra-abdominal metastases had therapeutic consequences in three and one patients, respectively. PET/CT detected 12 extra-abdominal distant metastases in 26 patients. PET/MRI is superior to PET/CT for primary tumour delineation. No differences were found in detection of regional lymph node involvement and abdominal metastases detection. • PET/MRI is superior to PET/CT for primary tumour delineation • PET/CT represents a reliable tool to detect extra-abdominal distant metastasis • PET/MRI might be the preferred imaging modality for staging cervical and endometrial tumours • Whole-body staging for detection and evaluation of extra-abdominal metastases is mandatory

96 citations


Cites background from "The Added Role of MR Imaging in Tre..."

  • ...Furthermore, whole-body staging is important, especially in advanced gynaecological cancer, in which incidence of extrapelvic disease at time of diagnosis is high [15]....

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  • ...The presence of lymph node metastases represents generally a poor prognostic factor and is partly influential on therapy planning, especially in cervical and endometrial cancers [14, 15, 30]....

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Journal ArticleDOI
TL;DR: New advanced MRI techniques can improve TNM staging and show promise for tumour classification and for assessing the risk of tumour recurrence and may be helpful for developing optimised and personalised therapy for patients with cervical cancer.
Abstract: To assess the value of new magnetic resonance imaging (MRI) techniques in cervical cancer. We searched PubMed and MEDLINE and reviewed articles published from 1990 to 2016 to identify studies that used MRI techniques, such as diffusion weighted imaging (DWI), intravoxel incoherent motion (IVIM) and dynamic contrast enhancement (DCE) MRI, to assess parametric invasion, to detect lymph node metastases, tumour subtype and grading, and to detect and predict tumour recurrence. Seventy-nine studies were included. The additional use of DWI improved the accuracy and sensitivity of the evaluation of parametrial extension. Most studies reported improved detection of nodal metastases. Functional MRI techniques have the potential to assess tumour subtypes and tumour grade differentiation, and they showed additional value in detecting and predicting treatment response. Limitations included a lack of technical standardisation, which limits reproducibility. New advanced MRI techniques allow improved analysis of tumour biology and the tumour microenvironment. They can improve TNM staging and show promise for tumour classification and for assessing the risk of tumour recurrence. They may be helpful for developing optimised and personalised therapy for patients with cervical cancer. • Conventional MRI plays a key role in the evaluation of cervical cancer. • DWI improves tumour delineation and detection of nodal metastases in cervical cancer. • Advanced MRI techniques show promise regarding histological grading and subtype differentiation. • Tumour ADC is a potential biomarker for response to treatment.

93 citations


Cites background or methods from "The Added Role of MR Imaging in Tre..."

  • ...MRI has no role in evaluating stage IA cervical cancer, because microscopic disease cannot be reliably detected [20]....

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  • ...Parametrial extension can be overestimated on T2weighted images, especially in large tumours, which can induce changes in the surrounding stromal tissue due to tumour compression or increased inflammation [20, 41]....

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  • ...Especially in cases of advanced disease, PET/CT has a high sensitivity (75-100%) and specificity (87-100%) [20] and can help demonstrate sites of unexpected disease such as supraclavicular lymph nodes [72]....

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  • ...Where available, conventional MRI is the preferred imaging modality for evaluating the local extent of cervical cancer due to its excellent soft tissue contrast [20, 21]....

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  • ...MRI can accurately exclude parametrial invasion, with a negative predictive value ranging from 94–100% [20, 36]....

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References
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Journal ArticleDOI
TL;DR: The American Cancer Society as mentioned in this paper estimated the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data regarding cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from National Center for Health Statistics.
Abstract: Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data regarding cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,529,560 new cancer cases and 569,490 deaths from cancer are projected to occur in the United States in 2010. Overall cancer incidence rates decreased in the most recent time period in both men (1.3% per year from 2000 to 2006) and women (0.5% per year from 1998 to 2006), largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and 2 major cancer sites in women (breast and colorectum). This decrease occurred in all racial/ethnic groups in both men and women with the exception of American Indian/Alaska Native women, in whom rates were stable. Among men, death rates for all races combined decreased by 21.0% between 1990 and 2006, with decreases in lung, prostate, and colorectal cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2006 decreased by 12.3%, with decreases in breast and colorectal cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates translates to the avoidance of approximately 767,000 deaths from cancer over the 16-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, geographic area, and calendar year. Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment. CA Cancer J Clin 2010;60:277-300. © 2010 American Cancer Society, Inc.

11,920 citations

Journal ArticleDOI
TL;DR: Neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to primary debulked surgery followed by chemotherapy as a treatment option for patients with bulky stage IIIC or IV ovarian carcinoma in this study.
Abstract: Of the 670 patients randomly assigned to a study treatment, 632 (94.3%) were eligible and started the treatment. The majority of these patients had extensive stage IIIC or IV disease at primary debulking surgery (metastatic lesions that were larger than 5 cm in diameter in 74.5% of patients and larger than 10 cm in 61.6%). The largest residual tumor was 1 cm or less in diameter in 41.6% of patients after primary debulking and in 80.6% of patients after interval debulking. Postoperative rates of adverse effects and mortality tended to be higher after primary debulking than after interval debulking. The hazard ratio for death (intention-to-treat analysis) in the group assigned to neoadjuvant chemotherapy followed by interval debulking, as compared with the group assigned to primary debulking surgery followed by chemotherapy, was 0.98 (90% confidence interval [CI], 0.84 to 1.13; P = 0.01 for noninferiority), and the hazard ratio for progressive disease was 1.01 (90% CI, 0.89 to 1.15). Complete resection of all macroscopic disease (at primary or interval surgery) was the strongest independent variable in predicting overall survival. Conclusions Neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to primary debulking surgery followed by chemotherapy as a treatment option for patients with bulky stage IIIC or IV ovarian carcinoma in this study. Complete resection of all macroscopic disease, whether performed as primary treatment or after neoadjuvant chemotherapy, remains the objective whenever cytoreductive surgery is performed. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00003636.)

1,865 citations

Journal ArticleDOI
TL;DR: DW-MRI should be tested as an imaging biomarker in the context of well-defined clinical trials, by adding DW-MRI to existing NCI-sponsored trials, particularly those with tissue sampling or survival indicators, and standards for measurement, analysis, and display are needed.

1,805 citations