Uterine sarcomas: are there MRI signs predictive of histopathological diagnosis? A 50-patient case series with pathological correlation

Congress:

ECR 2020

Poster Number:

C-04290

Type:

Scientific Exhibit

Keywords:

Genitourinary, Genital / Reproductive system female, Oncology, Pelvis, MR, MR-Diffusion/Perfusion, Contrast agent-intravenous, Diagnostic procedure, Cancer, Neoplasia, Pathology, Retrospective, Diagnostic or prognostic study, Multicentre study

Authors:

S. Hélage; Paris/FR

DOI:

10.26044/ecr2020/C-04290

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-04290

Table 1: Tumor macroscopic location within the uterus on MRI.

Table 2: Evaluated MRI features for both type 1 and type 2 uterine sarcomas.

Table 3: Univariate analysis of MRI specific features for type 2 uterine sarcomas.

Fig. 1: Pelvic MRI of endometrial stromal sarcoma: (a, b, c) axial DWI b1000 showing a...

Purpose

Aims: To make clear distinction between two different radiological types of uterine sarcomas in a process for identifying MRI signs predictive of histopathology. To evaluate difficulty in radiological differential diagnosis considering on the one hand endometrial stromal sarcomas (ESS) and mixed malignant mullerian tumors (MMMT) versus endometrial carcinoma, and on the other hand leiomyosarcomas (LMS) and smooth muscle tumors of uncertain malignant potential (STUMP) versus leiomyoma. Introduction: Uterine sarcomas are very rare neoplasms with poor prognosis [1]. In the literature, radiological series include very few...

Methods and materials

Study population: Our study population included 50 women (mean age 60) who underwent MRI for various uterine masses before surgery, in 6 medical centers, from October 2009 to July 2016. All patients underwent surgery (colpohysterectomy±adnexectomy). The diagnosis of all tumors was proved at pathology. Pathological diagnosis for all these uterine sarcomas consisted of ESS (n= 11), MMMT (n= 18), LMS (n=19) and STUMP (n=2). MRI protocol: MRI were performed on 1.5T (Achieva®,Philips Healthcare, Netherlands; Aera®, Siemens Healthcare, Germany; Signa®, GE Healthcare, USA) using a phased...

Results

Correlation between location within the uterus and histological type: In type 1 subgroup, among the 27 tumors there were 9 ESS (33%), 18 MMMT (67%), but neither LMS nor STUMP. In type 2 subgroup, among the 23 tumors there were 19 LMS (83%), 2 STUMP (9%), 2 ESS (9%), and none MMMT. This topographic feature was statistically significant (p

Conclusion

It may be feasible to get as close as possible to the histological type of a uterine sarcoma based on our topographic classification into two radiological subgroups. We identified two radiological types of sarcomas, corresponding to two kinds of diagnostic difficulties. Type 1 includes ESS and MMMT; type 2 includes LMS and STUMP. MRI signs suggestive of histopathological malignancy are identifiable considering the triad T2WI/DWI/DCE-MRI [2-3-4-6], easily for type 1 but somewhat less easily for type 2; the optimal threshold value for ADC is 0.86x10⁻³mm²/s....

Personal information and conflict of interest

Siegfried Hélage (MD, MSc) Department of Radiology Hôtel-Dieu de Paris (AP-HP) 1 place du Parvis Notre-Dame 75004 Paris, France

References

[1] Van den Boscht T, Coosemans A, Morina M, et al. Screening for uterine tumours. Best Pract Res Clin Obstet Gynaecol 2012;26:257-266 [2] Namimoto T, Yamashita Y, Awai K, et al. Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 2009;19:2756-2764. [3] Lin G, Yang LY, Huang YT, et al. Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and...