MRI grading for informed clinical decision-making in Peutz-Jeghers syndrome patients with cervical lesions

Abstract

Objective: The preoperative diagnosis and management of Peutz-Jeghers syndrome (PJS) patients with cervical lesions remains problematic. This study analyzed the associations between pathological types of cervical lesions in PJS patients and their imaging features, aiming to grade the potential malignancy and provide recommendations for clinical decision-making accordingly. Methods: A total of 34 PJS patients who attended the Obstetrics and Gynecology Hospital of Fudan University from October 2017 to August 2023 were included. Two experienced physicians reviewed their MRIs independently. Results: Based on pathological diagnosis, the patients were categorized into four groups: normal (n = 4), lobular endocervical glandular hyperplasia (LEGH, n = 11), atypical lobular endocervical glandular hyperplasia (aLEGH, n = 8), and gastric-type endocervical adenocarcinoma (G-EAC, n = 11). The mean age of 34 patients was 33.2 ± 8.4 years. Increased vaginal discharge was very common (20/34) and significant difference was observed among the four groups (P = .004). Through observing imaging features, we found statistically significant differences in the extent of lesions (P = .001), distribution of microcysts (P = .001), proportion of microcysts (P < .001) and endometrium invasion (P = .019) among the four groups. Notablely, the solid components and disrupted cervical stromal ring were only found within the aLEGH and G-EAC groups (P < .001). We proposed grading criteria to re-diagnose their images, with an overall consistency rate of 94.1% (32/34). Finally, we applied our grading criteria and corresponding clinical decisions to 2 PJS patients who had not yet undergone biopsy. Conclusions: We used MRI to grade the potential malignancy of cervical lesions and proposed appropriate management recommendations for PJS patients, which facilitated the collaboration between radiologists and physicians.