OBJECTIVE: Indocyanine green with near-infrared fluorescence imaging (NIR-ICG) is a new tracer modality in the limelight used for lymphatic mapping. The advantage of this method is to provide real-time image during surgery. To use ICG for image guided lymph node dissection, a surgeon needs to know initial appearing time and duration. METHODS: A 52-year-old woman undertook surgery diagnosed with endometrial cancer. She had no past medical history and her body mass index was 25.3 kg/m2. Preoperative magnetic resonance imaging examination revealed 2.7 cm sized cancerous mass in the endometrial cavity with superficial myometrial invasion without lymph node enlargement. Four mL (1.25 mg/mL) of ICG solution was prepared for injection. For each site, 1 mL of solution was injected superficially, 2-3 mm into the cervical submucosa and another 1 mL was injected deep, 1-2 cm into the stroma of the cervix. We recorded video with 30° 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). RESULTS: Pelvic lymph node was visualized from around 5 minutes. ICG was dispersed into organs after hysterectomy (53 minutes after ICG injection), yet we could clearly identify sentinel lymph node (SLN). Pathology revealed endometriod adenocarcinoma grade I, myometrial invasion with less than half of myometrium and no lymph node metastasis. CONCLUSION: Cervical injection of ICG provides good visualization of SLN from 5 minutes to over an hour. Our film gives an idea about time management to make a plan for surgery and not to miss SNLs.
Adenocarcinoma/diagnostic imaging/*pathology ; Coloring Agents/*therapeutic use ; Endometrial Neoplasms/diagnostic imaging/*pathology ; Female ; Humans ; Indocyanine Green/*therapeutic use ; Lymphatic Metastasis/diagnostic imaging ; Middle Aged ; Optical Imaging/methods ; Sentinel Lymph Node/*diagnostic imaging ; Time-Lapse Imaging/methods

BACKGROUNDEndometrial carcinoma is one of the most common gynecological malignancies among women. Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis. This study aimed to determine whether features and time-intensity curves (TIC) of transvaginal contrast-enhanced ultrasound (CEUS) differ from those of conventional ultrasound for endometrial carcinoma, and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma.

METHODSForty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue (Bracco, Imaging B.V, Switzerland). The enhancement patterns and TIC of lesions were analyzed. The results of CEUS were compared with those of conventional ultrasound and pathology.

RESULTSIn the early and late enhanced stages, the intensity of enhancement of the normal endometrium was always lower than that in the myometrium, and the boundary between normal endometrium and myometrium was clear. A total of 65.8% (52/79) of lesions presented with inhomogeneous enhancement, 34.2% (27/79) presented with homogeneous enhancement; 60.8% (48/79) presented with hyperechoic enhancement, 27.8% (22/79) presented with isoechoic enhancement, and 11.4% (9/79) presented with hypoechoic enhancement. The average arrival time, time to peak, rise time, half-wash out time of lesions were shorter than of normal endometrium (P < 0.05). The average peak intensity, relative rise in intensity, half-wash out intensity of lesions were higher than of normal endometrium (P < 0.05). There were 49 (must be and may be present) cases of endometrial carcinoma by ultrasound (US); 24 cases were consistent with pathology results, 16 cases were underestimated and 9 cases were overestimated. There were 72 (must be and may be present) cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results, 12 cases were underestimated and 7 cases were overestimated. The qualitative diagnosis of endometrial carcinoma by CEUS was more accurate and definite than that by US (P < 0.01).

CONCLUSIONSBy evaluating contrast-enhanced patterns and analyzing TIC, we found that CEUS can increase the accuracy of ultrasound qualitative diagnosis of endometrial carcinoma. CEUS shows lesions more clearly than conventional ultrasound, which is an advantage in evaluating the encroachment of endometrial carcinoma.

Adult ; Aged ; Contrast Media ; Early Diagnosis ; Endometrial Neoplasms ; diagnosis ; Female ; Humans ; Middle Aged ; Myometrium ; diagnostic imaging ; pathology ; Ultrasonography

OBJECTIVES: Magnetic resonance diffusion-weighted imaging (DWI) has important clinical value in diagnosis and curative effect evaluation on endometrial carcinoma. How to improve the detection rate of endometrial small lesions by DWI is the research focus of MRI technology. This study aims to analyze the image quality of small field MRI ZOOMit-DWI sequence and conventional single-shot echo-planar imaging (SS-EPI) DWI sequence in the scanning of endometrial carcinoma, and to explore the clinical value of ZOOMit-DWI sequence. METHODS: A total of 37 patients with endometrial carcinoma diagnosed by operation and pathology in the Second Xiangya Hospital of Central South University from July 2019 to May 2021 were collected. All patients were scanned with MRI ZOOMit-DWI sequence and SS-EPI DWI sequence before operation. Two radiologists subjectively evaluated the anatomical details, artifacts, geometric deformation and focus definition of the 2 groups of DWI images. At the same time, the signal intensity were measured and the signal-to-noise ratio (SNR), contrast to noise ratio (CNR), and apparent diffusion coefficient (ADC) of the 2 DWI sequences were calculated for objective evaluation. The differences of subjective score, objective score and ADC value of the 2 DWI sequences were analyzed. RESULTS: The SNR of the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (301.96±141.85 vs 94.66±41.26), and the CNR of the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (185.05±105.45 vs 57.91±31.54, P<0.05). There was no significant difference in noise standard deviation between the ZOOMit-DWI group and the SS-EPI DWI group (P>0.05). The subjective score of anatomical detail and focus definition in the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (both P<0.05). The subjective score of artifacts and geometric deformation of ZOOMit-DWI group was significantly lower than that of the SS-EPI DWI group (both P<0.05). ADC had no significant difference between the ZOOMit-DWI group and the SS-EPI DWI group (P>0.05). CONCLUSIONS The image quality of ZOOMit-DWI is significantly higher than that of conventional SS-EPI DWI. In the MRI DWI examination of endometrial carcinoma, ZOOMit-DWI can effectively reduce the geometric deformation and artifacts of the image, which is more conducive to clinical diagnosis and treatment.
Female ; Humans ; Signal-To-Noise Ratio ; Endometrial Neoplasms/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging/methods* ; Endometrium ; Echo-Planar Imaging/methods* ; Reproducibility of Results

Objective: To investigate the value of T2 map and synthetic T2WI generated by T2 mapping in evaluating the histological type, pathological classification and depth of myometrial invasion of endometrial carcinoma (EC). Methods: Seventy-three patients with pathologically proven EC diagnosed at the First Affiliated Hospital of Zhengzhou University from December 2019 to December 2021 and 42 healthy volunteers were enrolled in the study. All subjects underwent conventional MRI, diffusion weighted imaging (DWI) and T2 mapping sequence for the pelvic cavity to test the T2 values and the apparent diffusion coefficient (ADC) of the focus nidus of the patients and the normal endometrium of the volunteers. The T2 and ADC values of EC vs normal endometrium, and those of different histological types and pathological grades were compared. The receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance of T2 and ADC values in determining the pathological type and classification of EC. In addition, two radiologists used synthetic T2WI combined with T2 map and conventional T2WI combined with DWI, respectively, to evaluate the depth of myometrial invasion, and compared the imaging results with the results of pathological diagnosis to evaluate the diagnostic efficacy of the two methods in determining the depth of myometrial invasion. Results: The T2 and ADC values of endometrial carcinoma were 85.0 (80.8, 92.5) ms and 0.71 (0.64, 0.77) ×10(-3) mm(2)/s, respectively, which were significantly lower than those of normal endometrium [147.4 (123.4, 176.7) ms and 1.46 (1.26, 1.76)×10(-3) mm(2)/s, respectively; both P<0.05]. The T2 values of endometrioid carcinoma (EA) [84.1 (79.5, 88.7) ms] were significantly lower than those of non-EA [98.8 (92.1, 102.8) ms; P<0.05]. There was no significant difference in ADC values between EA and non-EA (P=0.075). The T2 values of G1, G2 and G3 groups in EA were 89.1 (84.4, 94.4) ms, 83.6 (80.9, 86.2) ms, and 76.5 (71.4, 80.3) ms, respectively. There were significant differences in the T2 values between G1 vs G2, G1 vs G3, and G2 vs G3 groups, respectively (all P<0.017). Significant difference was also found in the ADC values between the G1 and G3 groups (P<0.017). The area under the ROC curve (AUC) of T2 values in distinguishing EA from non-EA was 0.867. The AUC of T2 values, ADC values and their combination in predicting high-grade EA was 0.888, 0.730 and 0.895, respectively. The accuracy of synthetic T2WI+ T2 map and conventional T2WI+ DWI in the diagnosis of deep myometrial invasion was 78.1% and 79.5%, respectively, with no significant difference (P>0.05). Conclusions: T2 mapping has great potential in preoperative evaluation of EC. The quantitative T2 value can be used in the diagnosis, pathological classification and grading of EC. The combination of synthetic T2WI and T2 map may be helpful to determine the depth of myometrial invasion.
Female ; Humans ; Neoplasm Invasiveness/pathology* ; Endometrial Neoplasms/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging/methods* ; Magnetic Resonance Imaging/methods* ; ROC Curve ; Retrospective Studies

Objective: To investigate the value of T2 map and synthetic T2WI generated by T2 mapping in evaluating the histological type, pathological classification and depth of myometrial invasion of endometrial carcinoma (EC). Methods: Seventy-three patients with pathologically proven EC diagnosed at the First Affiliated Hospital of Zhengzhou University from December 2019 to December 2021 and 42 healthy volunteers were enrolled in the study. All subjects underwent conventional MRI, diffusion weighted imaging (DWI) and T2 mapping sequence for the pelvic cavity to test the T2 values and the apparent diffusion coefficient (ADC) of the focus nidus of the patients and the normal endometrium of the volunteers. The T2 and ADC values of EC vs normal endometrium, and those of different histological types and pathological grades were compared. The receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance of T2 and ADC values in determining the pathological type and classification of EC. In addition, two radiologists used synthetic T2WI combined with T2 map and conventional T2WI combined with DWI, respectively, to evaluate the depth of myometrial invasion, and compared the imaging results with the results of pathological diagnosis to evaluate the diagnostic efficacy of the two methods in determining the depth of myometrial invasion. Results: The T2 and ADC values of endometrial carcinoma were 85.0 (80.8, 92.5) ms and 0.71 (0.64, 0.77) ×10(-3) mm(2)/s, respectively, which were significantly lower than those of normal endometrium [147.4 (123.4, 176.7) ms and 1.46 (1.26, 1.76)×10(-3) mm(2)/s, respectively; both P<0.05]. The T2 values of endometrioid carcinoma (EA) [84.1 (79.5, 88.7) ms] were significantly lower than those of non-EA [98.8 (92.1, 102.8) ms; P<0.05]. There was no significant difference in ADC values between EA and non-EA (P=0.075). The T2 values of G1, G2 and G3 groups in EA were 89.1 (84.4, 94.4) ms, 83.6 (80.9, 86.2) ms, and 76.5 (71.4, 80.3) ms, respectively. There were significant differences in the T2 values between G1 vs G2, G1 vs G3, and G2 vs G3 groups, respectively (all P<0.017). Significant difference was also found in the ADC values between the G1 and G3 groups (P<0.017). The area under the ROC curve (AUC) of T2 values in distinguishing EA from non-EA was 0.867. The AUC of T2 values, ADC values and their combination in predicting high-grade EA was 0.888, 0.730 and 0.895, respectively. The accuracy of synthetic T2WI+ T2 map and conventional T2WI+ DWI in the diagnosis of deep myometrial invasion was 78.1% and 79.5%, respectively, with no significant difference (P>0.05). Conclusions: T2 mapping has great potential in preoperative evaluation of EC. The quantitative T2 value can be used in the diagnosis, pathological classification and grading of EC. The combination of synthetic T2WI and T2 map may be helpful to determine the depth of myometrial invasion.
Female ; Humans ; Neoplasm Invasiveness/pathology* ; Endometrial Neoplasms/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging/methods* ; Magnetic Resonance Imaging/methods* ; ROC Curve ; Retrospective Studies

OBJECTIVE: Magnetic resonance imaging (MRI) is useful for staging endometrial cancer. The treatment and prognosis of MRI-invisible endometrial cancer remain unclear. The purpose of this study was to retrospectively evaluate the long-term outcomes of patients with MRI-invisible endometrial cancer. METHODS: Between February 1995 and December 2011, we reviewed the medical records of 433 patients with endometrial cancer, which was staged IA on MRI. Of these patients, 89 had MRI-invisible cancer and 344 had MRI-visible cancer. Both cancers were treated with simple hysterectomy with or without lymph node dissection according to the surgeon's decision. Both cancers were compared regarding pathologic findings, recurrence rates, and survival rates. RESULTS: The median sizes of MRI-invisible and MRI-visible cancers were 4 mm (0 to 40 mm) and 20 mm (0 to 89 mm), respectively (p<0.001). Myometrial invasion of these groups were detected in 20.2% (18/89) and 56.7% (195/344), respectively (p<0.001). Lymphadenectomy and follow-up imaging revealed no lymph node metastasis in patients with MRI-invisible cancers, while those revealed in 4.7% (16/344) of patients with MRI-visible cancers (p=0.052). The recurrence rates of MRI-invisible and MRI-visible cancers were 1.1% (1/89) and 7.8% (27/344), respectively (p=0.026). The recurrence-free survival rates of these groups were 98.9% (88/89) and 91.6% (315/344), respectively (p=0.022). CONCLUSION: MRI-invisible endometrial cancer can be treated with less invasive surgery because of its lower tumor burden and better prognosis. This cancer may not require lymphadenectomy because of no metastasis or recurrence in lymph nodes.
Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/diagnostic imaging/*pathology ; Female ; Humans ; Lymphatic Metastasis ; *Magnetic Resonance Imaging ; Middle Aged ; Retrospective Studies

OBJECTIVE: Magnetic resonance imaging (MRI) is useful for staging endometrial cancer. The treatment and prognosis of MRI-invisible endometrial cancer remain unclear. The purpose of this study was to retrospectively evaluate the long-term outcomes of patients with MRI-invisible endometrial cancer. METHODS: Between February 1995 and December 2011, we reviewed the medical records of 433 patients with endometrial cancer, which was staged IA on MRI. Of these patients, 89 had MRI-invisible cancer and 344 had MRI-visible cancer. Both cancers were treated with simple hysterectomy with or without lymph node dissection according to the surgeon's decision. Both cancers were compared regarding pathologic findings, recurrence rates, and survival rates. RESULTS: The median sizes of MRI-invisible and MRI-visible cancers were 4 mm (0 to 40 mm) and 20 mm (0 to 89 mm), respectively (p<0.001). Myometrial invasion of these groups were detected in 20.2% (18/89) and 56.7% (195/344), respectively (p<0.001). Lymphadenectomy and follow-up imaging revealed no lymph node metastasis in patients with MRI-invisible cancers, while those revealed in 4.7% (16/344) of patients with MRI-visible cancers (p=0.052). The recurrence rates of MRI-invisible and MRI-visible cancers were 1.1% (1/89) and 7.8% (27/344), respectively (p=0.026). The recurrence-free survival rates of these groups were 98.9% (88/89) and 91.6% (315/344), respectively (p=0.022). CONCLUSION: MRI-invisible endometrial cancer can be treated with less invasive surgery because of its lower tumor burden and better prognosis. This cancer may not require lymphadenectomy because of no metastasis or recurrence in lymph nodes.
Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/diagnostic imaging/*pathology ; Female ; Humans ; Lymphatic Metastasis ; *Magnetic Resonance Imaging ; Middle Aged ; Retrospective Studies

OBJECTIVETo establish a rabbit model bearing endometrial carcinoma and observe the magnetic resonance imaging (MRI) features of the metastatic lymph nodes.

METHODSVX(2) tumor grafts were orthotopically embedded into the endometrium of the rabbits. Three weeks after the implantation, the tumor and the metastatic retroperitoneal lymph nodes were examined with MRI, and the signal intensities and the size of the lymph nodes were compared with those in normal rabbits.

RESULTSOrthotopic tumor growth was observed in all the rabbits. Tumor infiltration of the serosa and retroperitoneal lymph node metastasis occurred 3 weeks after tumor implantation. MRI demonstrated obviously lymph node enlargement in the tumor-bearing rabbits as compared with those of normal rabbits, while the signal intensity of the lymph nodes were comparable between them.

CONCLUSIONThe endometrial carcinoma in this rabbit model well simulate the metastatic behavior of human endometrial carcinoma, and may serve as a good model for testing the efficacy of the contrast agents for MRI of the lymph nodes.

Animals ; Cell Line, Tumor ; Disease Models, Animal ; Endometrial Neoplasms ; pathology ; Female ; Lymph Nodes ; diagnostic imaging ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Neoplasm Transplantation ; Rabbits ; Radiography

OBJECTIVETo study the morphologic feature, immunohistochemistry phenotype of ESS and its metastases, with emphasis on the histogenesis, tumor differentiation and diagnostic criteria.

METHODSThe pathologic features of 15 cases and 4 metastases were studied. The immunohistochemical study was performed on selected sections by a panel of antibodies including CD10, smooth muscle actin, estrogen and progesterone receptors, keratin (AE1/3) and alpha-inhibin.

RESULTSPatients were 22 to 75 years of age (mean 45). The endometrial stromal component predomominated in 7 cases. Three cases showed a picture of smooth muscle differentiation. Endometrial stromal sarcoma with fibromyxoid features were present in 2 cases. There were 3 sarcomas of poorly differentiated. The morphology features of the metastatic foci in 3 of the 4 metastasis cases were not similar to that of the primary counterpart in uteri. Among 14 ESS and 4 metastases, 15 of 18, 5 of 18, 7 of 18, and 10 of 18 were positive for CD10, SMA, ER and PR, respectively. AE1/3 and alpha-inhibin were only positive in the adenomatous area of ESS. Strong expression of SMA was obtained in all 10 cellular leiomyomas, and CD10 was only weakly expressed in 1 case (P < 0.05).

CONCLUSIONSESS are morphologically heterogeneous with multipotential differentiation. The histologic features of the metastases may not be similar to those of the primary. CD10 and SMA are diagnostically useful markers for ESS.

Actins ; metabolism ; Adult ; Aged ; Cell Differentiation ; Endometrial Neoplasms ; metabolism ; pathology ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; metabolism ; secondary ; Middle Aged ; Muscle, Smooth ; pathology ; Neoplasm Recurrence, Local ; Neprilysin ; metabolism ; Radiography ; Sarcoma, Endometrial Stromal ; metabolism ; secondary ; Uterus ; metabolism ; pathology

To reduce extensive radical procedures and decrease morbidity in gynecologic malignancies, much effort is being focused on implementing less aggressive interventions. Two different approaches such as lymphatic mapping and lymphoscintigraphy are currently used to identify sentinel lymph nodes. In vulvar and cervical carcinomas, metastatic spread of disease commonly follows stepwise progressive drainage. Thus, sentinel lymph node identification may significantly reduce the number of patients undergoing unnecessary, extensive lymphadenectomy in the absence of metastatic disease. The addition of novel techniques, such as histopathologic ultrastaging, step sectioning, and immunohistochemistry staining, will help increase the accuracy and rate of detection of the disease. Any definitive statements can be made to the validity of sentinel lymphadenectomy until we got data with long-term follow-up.
Endometrial Neoplasms ; pathology ; Female ; Genital Neoplasms, Female ; pathology ; surgery ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy ; Uterine Cervical Neoplasms ; pathology ; Vaginal Neoplasms ; pathology ; Vulvar Neoplasms ; pathology