Ultrasonographic diagnosis in rare primary cervical cancer | International Journal of Gynecologic Cancer

Results in the Context of Published Literature

A recent study17 has shown that cervical cancer lesions are mostly hypoechoic, while isoechoic, hyperechoic, and mixed echoic lesions are rare. In this study, hypoechoic lesions were found in 57.8% of patients, lower than that reported by Xu et al.17 However, in common-type cervical cancer, hypoechoic lesions were found in 74.5% of patients, consistent with the study by Epstein et al.18 Meanwhile, in rare-type cervical cancer, only five lesions (23.8%) were hypoechoic, with 13 patients (61.9%) having isoechoic lesions. This rate is consistent with that reported by Epstein et al.18 Furthermore, the echogenicity of lesions was significantly different between the two groups. Overall, the diagnosis in three of 13 patients with isoechoic lesions in the rare-type cervical cancer group was missed on ultrasonography, but color Doppler ultrasonography showed color flow signals in these lesions. These findings suggest that color Doppler ultrasonography is a helpful modality for diagnosing rare-type cervical cancer and may be included in standard diagnostic imaging. There was a significant difference in tumor size between the two groups. Therefore, tumor size and the echogenicity of lesions can also be used to diagnose rare-type cervical cancer.

Uterine effusion is often caused by the accumulation of fluid secreted in the uterine cavity and the obstruction of the cervical canal by the lesion. In this study, five patients (23.8%) with rare-type cervical cancer and seven patients (16.3%) with common-type cervical cancer had uterine effusion, with no significant difference between the two groups. Therefore, uterine effusion cannot be used to differentiate rare-type cervical cancer from common-type cervical cancer. In contrast, 67.4% of lesions in the common-type cervical cancer group were exophytic, while 66.7% of lesions in the rare-type cervical cancer group were endophytic, with a significant difference between the two groups (p=0.01). This confirmed that rare-type cervical cancer often diffusely infiltrates the cervical stroma.10

Bạn đang xem: Ultrasonographic diagnosis in rare primary cervical cancer | International Journal of Gynecologic Cancer

Xem thêm : Changes in ICD-10 for Sjögren’s Syndrome

Sozzi et al found no significant difference in the detection rate of parametrial invasion on ultrasonography, MRI, and examination under anesthesia. However, the integrated pre-surgical diagnostic algorithm could better define the local extent of cervical cancer.19 In our study, color Doppler flow signals were found in the cancerous tissue of all patients compared with normal cervical tissue, in which no detectable vascularization was found. The coincidence rate between pre-operative ultrasonography and tumor, nodes, and metastases staging was 87% in rare-type cervical cancer, which was higher than that reported by Byun et al (62.5%) but consistent with the rate reported by Ghi et al (85.7%).20 21 These differences may have been caused by a local infection resulting from prolonged vaginal bleeding in patients with cervical cancer.

Cervical biopsy is the gold standard for the diagnosis of cervical cancer; however, ultrasonography is helpful for targeted cervical biopsy, especially for early diagnosis of rare-type cervical cancer. Although MRI has a high soft-tissue resolution and can be used for pre-operative staging, it is contraindicated if metal objects are present in the body.14 16 With improvements in the resolution achieved by ultrasonic instruments, ultrasonography may be used to determine whether the cervical line is interrupted or if the cervical intima is thickened. Moreover, ultrasonography is a cost-effective and non-invasive technique. Thus, ultrasonography is becoming the preferred modality for the early evaluation of cervical cancer. Transvaginal ultrasonography is a superior method for showing the degree of infiltration in the adjacent tissues. Furthermore, transvaginal ultrasonography is superior to MRI in determining the scope of surgery and the need for radiotherapy and chemotherapy before surgery.15 However, ultrasonography also has its limitations since it can only detect invasive cervical cancer.

Nguồn: https://buycookiesonline.eu
Danh mục: Info