Novel Strategy for the Management of Cervical Multicystic Diseases

Abstract

Purpose To investigate the clinical practices of diagnosing multicystic cervical lesions as a means to develop a more appropriate diagnostic algorithm for gastric-type adenocarcinoma (GAS) and its precursors. Methods Clinical information for 159 surgically treated patients for multicystic disease of the uterine cervix was collected from 15 hospitals. We performed a central review of the MRI and pathological findings. The MRI findings were categorized into four types including two newly proposed imaging features based on the morphology and distribution of cysts, and the diagnosis accuracy was assessed. Among the four MRI types, types 1 and 2 were categorized as benign lesions that included LEGH; type 3 were precancerous lesions (with an assumption of atypical LEGH); and type 4 were malignant lesions. Results The central pathological review identified 56 cases of LEGH, seven with GAS, four with another form of carcinoma, and 92 with benign disease. In clinical practice, over-diagnosis of malignancy (suspicion of MDA) occurred for 12/19 cases (63.2%) and under-diagnosis of malignancy occurred for 4/11 (36%). Among the 118 patients who had a preoperative MRI and underwent a hysterectomy, type 3 or 4 MRI findings in conjunction with abnormal cytology were positively indicative of premalignancy or malignancy, with a sensitivity and specificity of 61.1% and 96.7%, respectively. Conclusions Although the correct preoperative diagnosis of cervical cancer with a multicystic lesion is challenging, the combination of cytology and MRI findings creates a more appropriate diagnostic algorithm that significantly improves the diagnostic accuracy for differentiating benign disease from premalignancy and malignancy.

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

“…Omori et al 17 divided the cervical multicystic lesions on MR images into two types and reported the raspberry-type with many tiny, closely aggregated cysts indicated adenocarcinoma in situ in postmenopausal women. Yoshino et al 14 found the most common manifestation was watery discharge (27.4%) in patients with cervical proliferative glandular lesions. They also used MRI to classi ed malignant potential into four types by the location of the lesion and the component patterns.…”

“…When radiologists lack experience or encounter the MR images without characteristic features, they are prone to misdiagnose the lesions as Nabothian cysts or provide overdiagnosis, which subsequently impacts the clinical decision-making. 14 We conducted a comparative analysis between the initial MRI diagnosis at our hospital and postoperative pathological diagnosis of each case. The overall consistency rate was 64.7% (22/34) and consistency rate in the precancerous lesions group was only 57.9% (11/19) (Table 2).…”

Preoperative multimodal ultrasonic imaging in a case of Peutz-Jeghers syndrome complicated by atypical lobular endocervical glandular hyperplasia: a case report and literature review

“…Based on the pathomorphological and distribution patterns of lesions, the typical MRI patterns of G-EAC were classified into four types including “cosmos”(small cystic components encompassed by bigger cysts), “diffuse growth”(multiple cysts of small size and diffuse distribution), “focal mass-like bulging”(unilaterally distributed numerous microcysts forming a focal bulge that grows outward of the cervical wall), and “solid and cystic”(bilaterally distributed multiple cysts of various sizes and mixed components). The first two types are deemed benign lesions; the third type is precancerous, whereas the last type indicates malignancy [ 30 ]. Typically, in most cases, G-EAC exhibits barrel-like multicystic massed with hyper-intense in T2-weighted images, comprising solid components that grow from the cervical glands into the stroma, replacing the original fibromuscular cervical stroma [ 24 ].…”

“…Accordingly, cervicitis could be suspected based on these medical imaging features and clinical manifestations. In addition, a high T2 signal intensity and iso-intensity in T1 found in the cervix of patients of reproductive age or a history of oral progesterone usage may suggest cervical endometrial hyperplasia [ 30 , 43 ]. However, special types of cervical hyperplasia, such as LEGH, are precancerous lesions of G-EAC.…”