磁共振成像诊断宫颈内膜腺癌的可能性和局限性

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论证。近几十年来，宫颈腺癌的发病率从 5% 上升到 20%。已证实宫颈内膜腺癌的特点是病程较长，转移较早。由于宫颈腺癌细胞学诊断的困难，放射诊断在诊断和分期阶段发挥着关键作用。迄今为止，关于磁共振成像在宫颈腺癌诊断中的应用的研究还很少。

目的是确定磁共振成像在根据 T 标准对宫颈腺癌进行分期时的诊断信息量，以及在评估肿瘤侵入宫颈基质的深度时的诊断信息量，明确腺癌的符号标志和肿瘤在子宫内生长的特殊性。

材料和方法。2020 年至 2023 年间，123 名确诊为宫颈癌（C53）的患者接受了检查。我们详细分析了 22 名（18%）宫颈腺癌患者（平均年龄 56 岁）使用 1.5 特斯拉磁场强度断层扫描仪接受盆腔器官磁共振成像的结果。对 11/22 例（50%）患者的磁共振成像信息分析进行了评估，这些患者接受了第一阶段手术治疗，切除了子宫和附件。为了分析诊断的信息量，对磁共振成像数据和手术材料的病理形态学检查数据进行了比较。研究结果的统计处理使用 Microsoft Excel 和 JavaStat 软件应用程序进行。

结果。磁共振成像在评估宫颈内膜腺癌局部患病率方面的信息量（根据 T 标准）为（以下主要值后的括号中给出了 95% 的置信区间）：灵敏度为 77.78%（39.99%-97.19%）；特异性为 50.00%（1.26%-98.74%）；阳性结果预测值为 87.50%（62.64%-96.69%）；阴性结果预测值为 33.33%（7.30%-76.04%）；准确度为 72.73%（39.03%-93.98%）。磁共振成像在评估肿瘤侵入宫颈基质深度方面的信息量为：机会比率为 3.500（0.145-84.694）；灵敏度为 85.7%（0.757-0.993），特异性为 33.3%（0.018-0.0648），阳性结果预测值为 75%（0.673-0.883），阴性结果预测值为 50%（0.027-0.972）。

结论。本研究表明了，磁共振成像是检测宫颈内膜腺癌的良好工具，具有很高的诊断信息量。在磁共振成像数据分析过程中发现的宫颈腺癌肿瘤生长宏观结构的 4 种类型表明，肿瘤生长具有局部侵袭性，向子宫内膜脱落的频率较高。这样就能为放射科医生提供描述性的图片结构，在宫颈腺癌得到证实的情况下也是如此，从而为患者制定更好的治疗方案。

作者简介

Irina B. Antonova

Russian Scientific Center of Roentgenoradiology

Email: Iran24@yandex.ru
ORCID iD: 0000-0003-2668-2110
SPIN 代码: 6247-3917

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Svetlana P. Aksenova

Russian Scientific Center of Roentgenoradiology

编辑信件的主要联系方式.
Email: fabella@mail.ru
ORCID iD: 0000-0003-2552-5754
SPIN 代码: 4858-4627

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

Nikolay V. Nudnov

Russian Scientific Center of Roentgenoradiology; Peoples’ Friendship University of Russia; Russian Medical Academy of Continuous Professional Education

Email: nvnudnov@rncrr.ru
ORCID iD: 0000-0001-5994-0468
SPIN 代码: 3018-2527

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow; Moscow; Moscow

Anna V. Kriger

Russian Scientific Center of Roentgenoradiology

Email: dr.akriger@gmail.com
ORCID iD: 0000-0001-6823-2658
SPIN 代码: 2338-6164
俄罗斯联邦, Moscow

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2. Fig. 1. Study design. MRI – magnetic resonance imaging; CT – chemotherapy; CM – cervix.

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3. Fig. 2. An example of measuring the depth of cervical adenocarcinoma invasion into the stroma and the distance from the tumor to the exocervix on T2-weighted images in the sagittal plane: a — the tumor is located in the upper third of the cervix, has an invasion depth of 8 mm and is located at a distance of 20 mm from the external os; b — the tumor is located in the upper and middle thirds of the cervix, has an invasion depth of 6 mm and is located at a distance of 16 mm from the external os. The tumor is outlined with a purple line, the endocervical canal is marked with pink lines. Conclusion of the pathomorphological study: highly differentiated endocervical adenocarcinoma of the cervix; the depth of invasion into the cervical stroma is 5 mm (less than 1/2 the thickness of the cervical wall); angiolymphatic invasion is detected; the tumor grows into the internal os. endometrium in the secretory phase.

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4. Fig. 3. Cervical adenocarcinoma growth pattern. The upper row of images is T2-weighted images in sagittal planes, the lower row is in axial projections.

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5. Fig. 4. Type of macrostructure of adenocarcinoma of the cervix, T2-weighted images in the sagittal plane.

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6. Fig. 5. Stage IIA cervical cancer (T2aNoMo), moderately differentiated adenocarcinoma, lymphovascular invasion is present. Magnetic resonance imaging of the pelvis, a tumor in the cervix and a focus of seeding into the endometrium: a — complex image, from left to right and top to bottom: T2-weighted image, T1FS-weighted image with contrast enhancement (arterial phase of dynamic contrast enhancement), diffusion-weighted image, map of the measured diffusion coefficient (MDC). Also marked: tumor (focus of seeding, arrow), area of ​​the tumor "pedicle" and feeding vessels (dashed arrow). In the arterial phase of dynamic contrast enhancement, accumulation of paramagnetic by the basal layer of the endometrium and vessels in the "feeding pedicle" of the tumor is determined; b — sagittal plane, T2-weighted image (left) and T1FS+C (right). Note: primary tumor (arrow), uterine lesion (star), vessels in uterine lesion (dotted arrow); c — histological examination of surgical specimen, hematoxylin and eosin staining, ×10; d — immunohistochemical examination, p16 expression. Pathological examination conclusion: Moderately differentiated endocervical adenocarcinoma of the cervix. The tumor invades the cervical stroma to a depth of 1.3 cm (2/3 of the cervical wall thickness in the transition zone). The tumor invades the myometrium (to a depth of 0.6 cm, 1/3 of the uterine wall thickness) and the endometrium. The vaginal portion of the cervix is ​​covered with stratified squamous epithelium.

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