Japanese Journal of Radiology

The usefulness of the follicle-preserving sign in differentiating between benign, borderline, and malignant ovarian tumors on magnetic resonance imaging

Abstract Purpose The study aimed to evaluate the incidence and features of the follicle-preserving sign (FPS) and investigate its usefulness in differentiating the grades of malignancy of ovarian tumors using magnetic resonance imaging (MRI). Materials and methods This retrospective study examined 234 patients of reproductive age with a confirmed diagnosis of ovarian lesions at Shinshu University Hospital between January 2014 and December 2023. Preoperative MR images of each patient were independently evaluated by two radiologists. First, 20 patients with malignant ovarian tumors were randomly selected. To define the MR findings of normal follicles, we observed the contralateral unaffected ovary. Next, the presence of FPS in the affected ovaries was examined in all patients. Finally, the FPS frequency was statistically analyzed in relation to patient age, maximum tumor diameter, tumor malignancy, MRI magnetic field strength, MRI slice thickness (MRIST), and histological subtype. Results Among 276 ovarian lesions (benign, 146; borderline, 51; malignant, 79), the follicle-preserving sign (FPS) was significantly more frequent in benign tumors than in malignant tumors ( p  < 0.001), while no significant difference was observed between borderline tumors and the other two groups. Multivariate analysis identified patient age, tumor diameter, and MRIST as independent factors associated with FPS, with MRIST exerting the greatest influence (OR = 0.75, p  = 0.006). Compared with malignant tumors, benign tumors tended to be smaller and were imaged with thinner slices, contributing to a higher FPS incidence. Importantly, even after stratification by MRIST, benign tumors consistently showed a significantly higher FPS rate than malignant tumors across all subgroups ( p  < 0.05). FPS frequency also varied by histological subtype, being frequent in serous/seromucinous borderline tumors and immature teratomas, but uncommon in mucinous tumors irrespective of malignancy status. Conclusion The incidence of FPS was significantly higher in benign tumors than malignant tumors. However, it should be noted that FPS expression is affected by MRIST.

Computed tomography and magnetic resonance imaging features of adnexal and leiomyoma torsion: correlation with laparoscopic findings

Abstract Adnexal torsion and pedunculated subserosal leiomyoma torsion are significant gynecological emergencies requiring prompt recognition and surgical intervention. Although ultrasound remains the primary imaging modality, cross-sectional imaging with computed tomography and magnetic resonance imaging plays a crucial role in diagnosis, particularly in complex cases. This review provides a comprehensive analysis of the imaging features of various types of torsion, with direct correlation with laparoscopic findings. We describe key imaging features across different modalities, focusing on specific manifestations of ovarian torsion variants, including massive ovarian edema, mature cystic teratoma, fibroma, and mucinous cystadenoma. Special attention was given to isolated fallopian tube torsion and its subtypes and the unique features of leiomyoma torsion. Understanding these imaging features and their correlation with laparoscopic findings is crucial for accurate diagnosis and appropriate surgical planning. This review emphasizes the importance of recognizing specific imaging patterns that can help guide clinical decision-making and improve patient outcomes through timely intervention.

Multi–b-value diffusion-weighted imaging–derived parameters for differentiating high-grade serous ovarian carcinoma from other epithelial ovarian cancers

Abstract Objective High-grade serous carcinoma (HGSC) is the most common ovarian cancer subtype, and its differentiation from others is crucial for treatment. This study aimed to evaluate parameters derived from multi–b-value diffusion-weighted imaging (DWI), including apparent diffusion coefficient (ADC), and metrics based on intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI), for differentiating HGSC from other ovarian cancers. Methods We retrospectively analysed patients with primary epithelial ovarian cancer who underwent preoperative MRI including multi-b-value DWI. From the solid tissues of the tumours, diffusion parameters were derived from the multi–b-value DWI data using different models: ADC using a mono-exponential model; the true diffusion coefficient (Di), pseudo-diffusion coefficient (D*), and perfusion fraction (f) using the IVIM model; and kurtosis (K) using the DKI model. Results This study included 56 patients with different histological cancer subtypes (mean age, 60 years; range, 24–87 years). The mean values of HGSC compared to the other cancers showed lower ADC (0.58 ± 0.21 × 10⁻3 mm2/s vs. 0.76 ± 0.18 × 10⁻3 mm2/s, p < 0.001), lower Di (0.37 ± 0.09 × 10⁻3 mm2/s vs. 0.42 ± 0.15 × 10⁻3 mm2/s, p = 0.201), and lower f (35.79 ± 11.48% vs. 48.01 ± 17.21%, p = 0.003), with a higher K (1.06 ± 0.25 vs. 0.84 ± 0.20, p = 0.341). Among these parameters, ADC showed the highest diagnostic performance in differentiating HGSC from others, with an area under the receiver operating characteristic curve of 0.79. These trends were particularly pronounced between HGSC and clear cell carcinoma, with significant differences in all parameters except D*. Additionally, K Mean was the only parameter that showed a significant difference between HGSC and endometrioid carcinoma. Conclusion Multi–b-value DWI–derived parameters, particularly ADC, may aid in the non-invasive preoperative differentiation of HGSC from other ovarian cancers. Secondary Abstract Multi–b-value DWI–derived parameters, especially ADC, demonstrated utility in differentiating high-grade serous carcinoma (HGSC) from other ovarian cancers, highlighting their potential in non-invasive preoperative tumor characterization.

MRI characteristics of ovarian metastasis: differentiation from stomach and colorectal cancer

Abstract Purpose To evaluate the efficacy of MRI findings for differentiating between ovarian metastasis from stomach cancer (OMSC) and colorectal cancer (OMCC). Methods Twenty-six patients with histopathologically proven ovarian metastasis (n = 8 with 12 OMSCs and n = 18 with 25 OMCCs) were enrolled in the study. All patients had undergone pelvic MRI before surgery. We retrospectively reviewed MRI findings and compared them between the two pathologies. The black scrunchie sign was defined as a thick (> 5 mm) and lobulated hypointense rim (> 180°) with central hyperintense areas on T2-weighted images. Results Predominantly solid lesions (100% vs. 20%, p < 0.01), black scrunchie sign (33% vs. 0%, p < 0.01), and flow void (67% vs. 20%, p < 0.01) were frequently observed in OMSCs than in OMCCs. The signal intensity ratio of solid components on T2-weighted images (3.30 ± 0.70 vs. 2.52 ± 0.77, p < 0.01) and gadolinium-enhanced T1-weighted images (2.21 ± 0.57 vs. 1.43 ± 0.32, p < 0.01) were significantly higher in OMSCs than in OMCCs. Furthermore, hyperintense areas within cystic components on T1-weighted images (71% vs. 18%, p < 0.01) and stained-glass appearance (44% vs. 0%, p < 0.01) were frequently observed in OMCCs than in OMSCs. Conclusion The black scrunchie sign was only observed in OMSCs. OMSCs always exhibited predominantly solid lesions and had higher signal intensity of solid components on T2- and gadolinium-enhanced T1-weighted images. OMCCs usually presented as cystic lesions, usually accompanied by hyperintense areas within the cystic components on T1-weighted images.

Comprehensive analysis of calcification frequency and patterns in ovarian tumours using non-contrast CT

Abstract Objectives To investigate the frequency and patterns of calcification in ovarian tumours and evaluate their association with various histological types and malignancy grades. Methods This retrospective study included patients who underwent non-contrast CT between March 2015 and March 2024 and had pathologically confirmed ovarian tumours. CT scans were reviewed for the presence and patterns of calcification (punctate, linear, coarse, and amorphous) by three radiologists. Statistical analysis was performed using the Fisher–Freeman–Halton exact test with Bonferroni correction. Results This study included 328 patients (mean age, 55 years; range, 18–88 years). Significant differences in calcification frequency were observed among major tumour categories (p < 0.001), with with germ cell tumours being more calcified and metastases less calcified. Similarly, a significant difference was also found among epithelial tumours (p = 0.005), where mucinous and Brenner tumours were more calcified, whereas serous tumours were less calcified. Benign epithelial tumours showed a significantly higher frequency of calcification than borderline tumours and carcinomas (p < 0.001). When comparing the calcification patterns observed among epithelial tumours, significant differences were found for all calcification patterns: punctate (p = 0.024), linear (p < 0.001), coarse (p < 0.001), and amorphous (p < 0.001). The linear pattern was more common in mucinous tumours, whereas the amorphous pattern was more common in serous and Brenner tumours. Among non-epithelial tumours, germ cell tumours frequently exhibited liner and many calcifications, and immature teratomas were characterised by a mixture of punctate, linear, and coarse calcifications. Granulosa cells and metastatic tumours did not exhibit calcification. Conclusions Among epithelial tumours, mucinous and Brenner tumours had a significantly higher frequency of calcification, and benign tumours had a significantly higher frequency of calcification. Amorphous patterns were significantly more common in serous and Brenner tumours, while linear patterns were significantly more common in mucinous tumours.

Suppressive effect of vitamin K2 (menatetrenone) against bone mineral density loss after radiotherapy in uterine cancer patients

Abstract Purpose This study aimed to investigate whether vitamin K2 (menatetrenone) suppresses bone mineral density (BMD) loss in the irradiated region after radiotherapy (RT) in uterine cancer patients. Materials and Methods Our study included 34 patients who underwent whole pelvic irradiation for uterine cancer between 2001 and 2010. The patients were categorized in two groups: (1) Vitamin K2 (45 mg/day) administration group (group A) with 18 cases and (2) non-administered group (group B) with 16 cases. The duration of vitamin K2 administration was 1 year or longer. BMD was measured before and immediately, 3 months, 6 months, 1 year, 1 year or more after RT. Results Regarding change rate in the BMD of L3-L4 which was outside the irradiated field, no significant changes were observed in BMD after radiation in either groups compared to BMD before radiotherapy. Regarding change rate in BMD of L5-S1 which was inside the irradiated field, BMD reduced significantly at 6 months after radiotherapy compared to BMD before the start of radiotherapy in Group B (P = 0.0234). However, no significant change was seen in group A. Grade 2 and 3 insufficiency fractures appeared in both groups, one in each. Regarding outside the irradiation field, one patient developed compression fracture in L2 in group B, none occurred in group A. Conclusion We suggest that vitamin K2 could suppress the decrease in BMD due to whole pelvic radiotherapy. Further studies are needed in the future to improve quality of life such as the prevention of insufficiency fractures.

Prediction of grading of ovarian endometrioid carcinoma using conventional MRI features

Abstract Objective The purpose of this study was to evaluate MRI findings of ovarian endometrioid carcinoma (OEC) as a predictor of histological grade. Materials and methods This study included 60 patients with histopathologically confirmed OEC (20, 30, and 10 with grades 1, 2, and 3, respectively). Clinical and MRI results were retrospectively reviewed. We compared the following parameters between the three grades: age, tumor markers, presence of uterine corpus cancer, bilaterality, configuration, peritoneal dissemination, abnormal ascites, signal intensities of cystic and solid components, tumor size, and apparent diffusion coefficient (ADC) values of solid components. Results T1-hyperintense cysts were more common in grade 1 than in grades 2–3 OEC (80% vs. 60%, vs. 40%, p < 0.05). The signal intensity ratio between the cystic components with the largest solid component and muscle (1.49 vs. 1.08 vs. 0.98, p < 0.05) was higher in grade 1 than in grades 2–3 OEC. Necrosis within solid components was less common in grade 1 than in grades 2–3 OEC (31% vs. 68% vs. 88%, p < 0.05), and the ADC values of solid components were higher in grade 1 than in grades 2–3 OEC (1.10 vs. 0.99 vs. 0.79 × 10−3 mm2/sec, p < 0.05). There were no significant differences in other factors. Conclusion On T1-weighted images, grade 1 OEC showed a higher signal intensity in the cystic components than grades 2–3 OEC. Necrosis and lower ADC values were more frequently observed in grades 2–3 than in grade 1 OEC.

Magnetic resonance imaging-based radiomics analysis of the differential diagnosis of ovarian clear cell carcinoma and endometrioid carcinoma: a retrospective study

Abstract Purpose To retrospectively evaluate the diagnostic potential of magnetic resonance imaging (MRI)-based features and radiomics analysis (RA)-based features for discriminating ovarian clear cell carcinoma (CCC) from endometrioid carcinoma (EC). Materials and methods Thirty-five patients with 40 ECs and 42 patients with 43 CCCs who underwent pretherapeutic MRI examinations between 2011 and 2022 were enrolled. MRI-based features of the two groups were compared. RA-based features were extracted from the whole tumor volume on T2-weighted images (T2WI), contrast-enhanced T1-weighted images (cT1WI), and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator (LASSO) regression with tenfold cross-validation method was performed to select features. Logistic regression analysis was conducted to construct the discriminating models. Receiver operating characteristic curve (ROC) analyses were performed to predict CCC. Results Four features with the highest absolute value of the LASSO algorithm were selected for the MRI-based, RA-based, and combined models: the ADC value, absence of thickening of the uterine endometrium, absence of peritoneal dissemination, and growth pattern of the solid component for the MRI-based model; Gray-Level Run Length Matrix (GLRLM) Long Run Low Gray-Level Emphasis (LRLGLE) on T2WI, spherical disproportion and Gray-Level Size Zone Matrix (GLSZM), Large Zone High Gray-Level Emphasis (LZHGE) on cT1WI, and GLSZM Normalized Gray-Level Nonuniformity (NGLN) on ADC map for the RA-based model; and the ADC value, spherical disproportion and GLSZM_LZHGE on cT1WI, and GLSZM_NGLN on ADC map for the combined model. Area under the ROC curves of those models were 0.895, 0.910, and 0.956. The diagnostic performance of the combined model was significantly superior (p = 0.02) to that of the MRI-based model. No significant differences were observed between the combined and RA-based models. Conclusion Conventional MRI-based analysis can effectively distinguish CCC from EC. The combination of RA-based features with MRI-based features may assist in differentiating between the two diseases.

MRI findings of malignant transformation arising from mature cystic teratoma of the ovary: comparison with benign mature cystic teratoma

Abstract Objective This study aimed to evaluate the efficacy of MRI findings to differentiate malignant transformation arising from mature cystic teratoma (MT-MCT) of the ovary from benign mature cystic teratoma (BMCT). Materials and methods This study included 11 patients with histopathologically proven MT-MCT and 50 with BMCT. Overall, 7 patients with MT-MCT and all 50 with BMCT underwent unenhanced and contrast-enhanced MRIs and 4 with MT-MCT only underwent unenhanced MRIs. The MRI findings were evaluated and compared between the two diseases. Results The median age (55 vs. 38 years, p < 0.01) and maximum diameter (109 vs. 65 mm, p < 0.01) were higher in MT-MCT than in BMCT. Fat component occupancy was lower in MT-MCT than in BMCT (median, 5% vs. 63%, p < 0.01). Only MT-MCT exhibited irregular tumor margins (64%), peritoneal dissemination (18%), and abnormal ascites (27%). The solid components were more commonly observed in MT-MCT than in BMCT (100% vs. 32%, p < 0.01) on contrast-enhanced images. The maximum diameter of solid components in MT-MCT was larger than that in BMCT (median, 61 mm vs. 14 mm, p < 0.01). In MT-MCT, the common configuration of solid components was endophytic or exophytic sessile (85%), whereas in BMCT, it was endophytic papillary (88%). Conclusion Compared with BMCT, MT-MCT demonstrated a larger maximum diameter, lower occupancy rate of fat components, and sessile solid components. The characteristic configuration of solid components was endophytic or exophytic sessile in MT-MCT and endophytic papillary in BMCT.

Age-related changes in the radiologic findings of lobular endocervical glandular hyperplasia: a multicenter study

Abstract Purpose To investigate the age-related changes in magnetic resonance imaging (MRI) findings of lobular endocervical glandular hyperplasia (LEGH) during long-term follow-up. Materials and methods This multicenter study included 91 patients who underwent preoperative MRI and had a histopathological diagnosis of LEGH, atypical LEGH, or adenocarcinoma in situ (AIS) with LEGH after surgical resection. Thirty patients underwent follow-up MRIs at intervals of more than 3 months. According to the age and menopausal status, patients were categorized into four groups: group A, 31–40 years; group B, 41–50 years (premenopausal); group C, more than 50 years (premenopausal); group D, postmenopausal. Differences in the MRI findings (size and morphological pattern) were compared among the four groups. Results The lesion volume was the largest in group C and smallest in group D, showing a statistically significant difference (p < 0.05). The typical cosmos pattern was seen in 60.0% of group A, 62.2% of group B, 75.0% of group C, and 29.2% of group D. The cosmos pattern was significantly less frequent in postmenopausal patients compared to premenopausal patients (p < 0.05). During follow-up, five of 12 individuals in group A exhibited the typical cosmos pattern. Among the seven individuals who did not initially show the cosmos pattern, two later developed the typical cosmos pattern. No changes in the lesion pattern were observed in participants in their 40 s up to the premenopausal 50 s. From the premenopausal 50 s to the postmenopausal period, the cosmos pattern changed to a microcystic pattern in one case of atypical LEGH. Conclusions LEGH increases in volume with age until menopause, along with an increasing frequency of the typical cosmos pattern in MRI. However, after menopause, both the volume of the lesion and frequency of the typical cosmos pattern decrease.

Clinical changes in serum intercellular adhesion molecule 1 in cervical cancer patients receiving radiotherapy

The levels of soluble intracellular adhesion molecule-1 (sICAM-1) increased in cervical cancer patients and those patients with recurrence. However, the pattern of change in sICAM-1 and its association with prognosis in cervical cancer patients after radiotherapy remain unknown. sICAM-1 level was detected using enzyme-linked immunosorbent assay in different patient groups. The predictive value of sICAM-1 for cervical cancer occurrence was evaluated using receiver operating characteristics analysis. The association of sICAM-1 with clinical pathology was analyzed using Fisher's exact test. Association of sICAM-1 with prognosis was evaluated by alteration of sICAM-1 level in cervical cancer patients with or without complete remission at pre-radiotherapy, post-radiotherapy, and post-follow-up. The survival rate of cervical cancer patients with low or high sICAM-1 was plotted using the Kaplan-Meier curve. sICAM-1 level significantly increased in cervical cancer patients and could predict the occurrence of cervical cancer. sICAM-1 was closely associated with tumor size, differentiation, and radiotherapy effect. Importantly, the level of sICAM-1 gradually decreased in patients with complete remission after radiotherapy, while it remained unchanged in those without complete remission. Furthermore, the cervical cancer patients with high expression of sICAM-1 had a shorter survival time. The level of sICAM-1 could predict the occurrence of cervical cancer and is closely related to the prognosis of cervical cancer patients after radiotherapy.

Ovarian solid tumors: MR imaging features with radiologic–pathologic correlation

Ovarian solid tumors have variable histological types including benign and malignant tumors. In addition, non-neoplastic lesions sometimes show a tumor-like appearance. It is important to differentiate benign from malignant tumors. In general, low signal intensity (SI) on T2-weighted imaging (T2WI), low SI on diffusion-weighted imaging (DWI), and gradual increased pattern on dynamic contrast-enhanced magnetic resonance (MR) imaging are known to be suggestive of a benign tumor. Conversely, there are some cases in which these rules do not apply. We should, therefore, strive for a greater understanding of these exceptional cases. Several tumors show characteristic findings on MR imaging reflecting pathologic features, which leads to the correct diagnosis. Additionally, MR imaging provides important information other than the nature of tumors, such as secondary uterine changes. Furthermore, clinical findings and laboratory examination data also help in determining the correct diagnosis.

MR imaging findings of low-grade serous carcinoma of the ovary: comparison with serous borderline tumor

To assess MR imaging findings of low-grade serous carcinoma (LGSC) of the ovary compared with those of serous borderline tumor (SBT). Twenty-four patients with histopathologically proven 7 LGSCs and 25 SBTs who underwent preoperative MR imaging were included. We retrospectively reviewed MR images and compared MR findings between the two pathologies. The predominantly solid lesions were marginally more frequent in LGSCs than in SBTs (43% vs. 8%, p = 0.057). All predominantly cystic LGSCs were multilocular cystic lesions with mural nodules. Predominantly solid LGSCs exhibited pure solid masses in 2 of 3 and solid masses with intratumoral cysts in 1 of 3. Papillary growth pattern with internal branching was observed only in 18 of 25 SBTs. Signal intensity ratio on T2-weighted images (4.48 ± 1.55 vs. 8.40 ± 3.53, p < 0.01) and apparent diffusion coefficient (ADC) values (1.12 ± 0.21 vs. 1.73 ± 0.27 × 10 Compared with SBTs, lower signal intensity on T2-weighted images and lower ADC values were characteristic features of solid components in LGSCs. Papillary growth pattern with internal branching was not observed in LGSCs.

Clinical results of image-guided interstitial brachytherapy with or without external beam radiotherapy for postsurgical vaginal recurrence of cervical and endometrial cancers

Abstract Purpose This study aimed to evaluate the clinical outcome and efficacy of image-guided interstitial brachytherapy (ISBT) for postsurgical vaginal recurrence of cervical and endometrial cancers. Materials and methods The study included 11 patients who received CT-based image-guided high-dose-rate ISBT with or without external beam radiotherapy (EBRT). Local control, progression-free survival, and treatment-related toxicities were evaluated retrospectively. Results Of the 11 patients, 4 underwent ISBT with EBRT and the other 7 ISBT alone; two of the latter patients received previous pelvic radiotherapy. After a median follow-up of 43.9 months (range 3.9–92.7 months), the 2-year local control rate was 100%. The median equivalent doses in 2 Gy fractions received by at least 90% of the clinical target volume for ISBT with versus without EBRT were 82.2 Gy (range 60.4–84.2 Gy) versus 69.0 Gy (range 50.8–98.2 Gy). The 2-year progression-free survival rates after ISBT with versus without EBRT were 75% versus 80%, and the difference was not significant (p = 0.74). Grade 3 late toxicities occurred in two patients. Conclusion Our radiotherapy strategy using image-guided ISBT, either with or without EBRT, for postsurgical vaginal recurrence showed effective treatment outcomes.

Amide proton transfer imaging in differentiation of type II and type I endometrial carcinoma: a pilot study

AbstractPurposeThis study aimed at evaluating the efficacy of amide proton transfer (APT) imaging in differentiation of type II and type I uterine endometrial carcinoma.Materials and methodsThirty-three patients diagnosed with uterine endometrial carcinoma, including 24 with type I and 9 with type II carcinomas, underwent APT imaging. Two readers evaluated the magnetization transfer ratio at 3.5 ppm [MTRasym(3.5 ppm)] in each type of carcinoma. The average MTRasym(APTmean) and the maximum MTRasym(APTmax) were analyzed. The receiver operating characteristic (ROC) curve analysis was performed.ResultsThe APTmaxwas significantly higher in type II carcinomas than in type I carcinomas (reader1,p = 0.004; reader 2,p = 0.014; respectively). However, APTmeanshowed no significant difference between type I and II carcinomas. Based on the results reported by reader 1, the area under the curve (AUC) pertaining to the APTmaxfor distinguishing type I from type II carcinomas was 0.826, with a cut-off, sensitivity, and specificity of 9.90%, 66.7%, and 91.3%, respectively. Moreover, based on the results reported by reader 2, the AUC was 0.750, with a cut-off, sensitivity, and specificity of 9.80%, 62.5%, and 87.5%, respectively.ConclusionAPT imaging has the potential to determine the type of endometrial cancer.

Cervical cancer in the modern era: cutting-edge strategies for diagnosis and treatment

Abstract Cervical cancer remains a major cause of mortality among women worldwide, highlighting the need for advances in diagnostic and therapeutic strategies. This review provides a comprehensive overview of recent developments in histopathological classification based on human papillomavirus association, as well as progress in imaging and treatment approaches supported by current research. Emerging technologies, such as artificial intelligence-assisted imaging, targeted molecular therapies, and personalized radiotherapy, hold substantial promise for improving patient outcomes. These innovations offer new possibilities for precision medicine in cervical cancer care, and their current applications are discussed in this review.

High visceral-to-subcutaneous fat area ratio is an unfavorable prognostic indicator in patients with uterine sarcoma

Abstract Purpose Uterine sarcoma is a rare disease whose association with body composition parameters is poorly understood. This study explored the impact of body composition parameters on overall survival with uterine sarcoma. Materials and methods This multicenter study included 52 patients with uterine sarcomas treated at three Japanese hospitals between 2007 and 2023. A semi-automatic segmentation program based on deep learning analyzed transaxial CT images at the L3 vertebral level, calculating body composition parameters as follows: area indices (areas divided by height squared) of skeletal muscle, visceral and subcutaneous adipose tissue (SMI, VATI, and SATI, respectively); skeletal muscle density; and the visceral-to-subcutaneous fat area ratio (VSR). The optimal cutoff values for each parameter were calculated using maximally selected rank statistics with several p value approximations. The effects of body composition parameters and clinical data on overall survival (OS) and cancer-specific survival (CSS) were analyzed. Results Univariate Cox proportional hazards regression analysis revealed that advanced stage (III–IV) and high VSR were unfavorable prognostic factors for both OS and CSS. Multivariate Cox proportional hazard regression analysis revealed that advanced stage (III–IV) (hazard ratios (HRs), 4.67 for OS and 4.36 for CSS, p &lt; 0.01), and high VSR (HRs, 9.36 for OS and 8.22 for CSS, p &lt; 0.001) were poor prognostic factors for both OS and CSS. Added values were observed when the VSR was incorporated into the OS and the CSS prediction models. Conclusion Increased VSR and tumor stage are significant predictors of poor overall survival in patients with uterine sarcoma.

Limited diagnostic performance of imaging evaluation for staging in gastric-type endocervical adenocarcinoma: a multi-center study

Abstract Purpose The purposes of the study are to assess the diagnostic performance of preoperative imaging for staging factors in gastric-type endocervical adenocarcinoma (GEA) and to compare the performance for GEA with that of usual-type endocervical adenocarcinoma (UEA) among patients preoperatively deemed locally early stage (DLES) (&lt; T2b without distant metastasis). Materials and methods For this multi-center retrospective study, 58 patients were enrolled. All had undergone MRI with or without CT and FDG PET-CT preoperatively and had been pathologically diagnosed with GEA at five institutions. Based on the medical charts and radiological reports, the diagnostic performances of preoperative imaging for the International Federation of Gynecology and Obstetrics staging factors were assessed retrospectively. Next, the imaging performance was assessed in preoperatively DLES-GEA (n = 36) and DLES-UEA (n = 136, with the same inclusion criteria). The proportions of underestimation of GEA and UEA were compared using Fisher’s exact test. Results Imaging diagnostic performance for GEA was limited, especially for sensitivity: parametrial invasion, 0.49; vaginal invasion, 0.54; pelvic lymph node metastasis (PELNM), 0.48; para-aortic lymph node metastasis, 0.00; and peritoneal dissemination, 0.25. Among preoperatively DLES patients, the proportions of underestimation were significantly higher in GEA than in UEA; parametrial invasion, 35% vs. 5% (p &lt; 0.01); vaginal invasion, 28% vs. 6% (p &lt; 0.01); PELNM, 24% vs. 6% (p &lt; 0.05); peritoneal dissemination, 6% vs. 0% (p &lt; 0.05). Conclusion At present, preoperative imaging diagnostic performance for staging factors in GEA does not meet clinical expectations, especially for sensitivity. Among patients preoperatively DLES, the proportions of underestimation in GEA were significantly higher than in UEA. Future incorporation of approaches specifically emphasizing GEA is desirable to improve imaging performance.

Efficacy of uterine artery embolization (UAE) for uterine fibroids according to FIGO classification: a single-center experience

This study aims to retrospectively evaluate the outcomes of uterine artery embolization (UAE) for uterine fibroids (UFs), specifically submucosal UFs, according to the International Federation of Gynecology and Obstetrics (FIGO) classification of UFs. Forty-two patients with symptomatic UFs underwent UAE with Embosphere Thirty-seven of the 42 patients were evaluated. Overall, VRR was 37.0% at 3 months and 52.1% at 6 months; TSR, SIR, and RR were 100%, 95.2%, and 5.4%, respectively; VRR at 6 months was 80.7% for group A (n = 7), 57.8% for group B (n = 13), and 37.1% for group C (n = 17). Significant differences were found between A and C (p < 0.001) and B and C (p = 0.023). Hormone levels before UAE had no effect on VRR. There was no significant AEs other than grade 3 pulmonary embolism in one patient. UAE was effective for submucosal FIGO types 0-3. UAE was especially useful as an option for FIGO type 3 with a low protrusion rate that is difficult to treat with transcervical resection.

Magnetic resonance imaging findings of cystic ovarian tumors: major differential diagnoses in five types frequently encountered in daily clinical practice

AbstractThere are many types of ovarian tumors, and these different types often form cystic masses with a similar appearance, which can make their differentiation difficult. However, with the exclusion of rare ovarian tumors, the number of ovarian tumors encountered in daily practice is somewhat fixed. It goes without saying that magnetic resonance imaging (MRI) is useful for differentiating ovarian tumors. In this review, we summarize the differential diagnoses for each of the five types of MRI findings commonly encountered in daily practice. First, unilocular cystic masses without mural nodules/solid components include benign lesions such as serous cystadenoma, functional cysts, surface epithelial inclusion cysts, paratubal cysts, and endometriosis. Second, multilocular cystic ovarian lesions include mucinous tumors and ovarian metastases. It should be noted that mucinous tumors may be diagnosed as borderline or carcinoma, even if no solid component is observed. Third, cystic lesions with mural nodules that are unrelated to endometriosis include serous borderline tumor and serous carcinoma. Cystic lesions with solid components are more likely to be malignant, but some may be diagnosed as benign. Fourth, ovarian tumors deriving from endometriosis include seromucinous borderline tumors, endometrioid carcinoma, and clear cell carcinoma. These tumors sometimes need to be differentiated from serous tumors. Finally, cystic lesions with lipid contents include teratoma-related tumors. In mature cystic teratoma, mural nodules (called “Rokitansky protuberance” or “dermoid nipple”) are sometimes seen, but they do not suggest malignancy. Some of these lesions can be diagnosed accurately by considering their characteristic imaging findings, their changes over time, MRI findings other than those of the primary lesion, and information from other modalities such as tumor markers. To ensure the optimal treatment for ovarian tumors, it is important to estimate the histological type as well as to diagnose whether a lesion is benign or malignant.

Impact of changes in body contours on radiation therapy dose distribution after uterine cervical cancer surgery

Patients receiving postoperative irradiation for uterine cervical cancer might not be able to eat during radiation therapy because of the effects of concurrent chemo-radiotherapy; this may lead to changes in the patient's body shape during treatment. When performing image-guided radiotherapy, it is necessary to determine immediately whether treatment can be performed on the day or whether re-planning is required. The purpose of this study was to determine indicators for re-planning by examining the effects of changing body contours on radiation therapy dose. The original body contour was reduced by 1 cm in the front portion (structure-set 1). Based on the original dose distribution, the dose recalculation was performed with a structure set created using the body contour of structure-set 1. The difference between the original and recalculated dose distributions of structure-set 1 was evaluated through gamma analysis (GA). In the GA results for dose distribution obtained via recalculation with structure-set 1, a pass rate of 90% or more was obtained for a criterion of 2 mm/2% in all cases. The results suggest that dose re-planning is rarely required when the body shape is reduced by only 1 cm in the front.

A multi-scanner study of MRI radiomics in uterine cervical cancer: prediction of in-field tumor control after definitive radiotherapy based on a machine learning method including peritumoral regions

This study aimed to identify the most appropriate volume of interest (VOI) setting in prognostic prediction using pretreatment magnetic resonance imaging (MRI) radiomic analysis for cervical cancer (CC) treated with definitive radiotherapy. The study participants were 87 patients who had undergone pretreatment MRI and definitive radiotherapy for CC. VOI VOI expansion improved AUC-ROCs compared with the predictive models of VOI Recurrence could be predicted with high accuracy using expanded VOI for CC treated with definitive radiotherapy, suggesting that including the pathological characteristics of invasive margins in radiomics may improve predictive ability.

Magnetic resonance imaging findings in 11 cases of dedifferentiated endometrial carcinoma of the uterus

Abstract Purpose We evaluated magnetic resonance imaging (MRI) findings of dedifferentiated endometrial carcinoma (DEC), comprising undifferentiated carcinoma and low-grade endometrioid carcinoma. Materials and methods We recruited 11 patients with pathologically proven DEC treated at our institute. We evaluated primary lesion size, location and signal intensity on MRI, and prognosis. MRI and pathological findings were compared in eight resected patients. Results Primary tumors ranged from 16 to 206 mm in diameter. DEC was located at the endometrium in 9 of the 11 patients; the remaining two patients showed diffuse involvement of the enlarged myometrium. These two patients with diffuse involvement type died within 4 months. Of the eight patients who underwent resection, seven had macroscopic intratumoral hemorrhage and six showed a high signal on T1-weighted images or low signal on T2-weighted images. Of the eight resected patients, four had tumor necrosis &gt; 25% and tumor size &gt; 5 cm. In these patients, necrosis appeared as nonenhanced areas on contrast-enhanced MRI. Conclusion MRI findings of DEC showed two patterns: mass-forming type and diffuse myometrial type with poor prognosis. Most patients with DEC had intratumoral hemorrhage, and large tumors (&gt; 5 cm) had gross necrosis, which appeared as nonenhanced areas on contrast-enhanced MRI.

Transvaginal approach combined intracavitary and interstitial brachytherapy assisted by transrectal ultrasound: results from 30 patients with locally advanced cervical cancer

Abstract Purpose This study evaluated the efficacy and safety of transvaginal approach combined intracavitary and interstitial brachytherapy (IC/IS BT) assisted by transrectal ultrasound (TRUS) for treatment of locally advanced cervical cancer (LACC). Materials and Methods A total of 30 patients of LACC treated with external beam radiotherapy and IC/IS BT via transvaginal approach assisted by transrectal ultrasound were observed retrospectively. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were analyzed using the Kaplan–Meier method. Late adverse events were also evaluated to assess the safety of IC/IS BT. Results The median follow-up period was 22 months. The 2-year LC, PFS, and OS were 90%, 61%, and 82%, respectively. We observed no critical complications related to the IC/IS BT technique. Late adverse events of grade 3 or more included one case of grade 4 colon perforation. Conclusion Our patient series demonstrated that radiotherapy combined with transvaginal approach, TRUS-assisted IC/IS BT achieves favorable local control and safety for LACC.

Frequency of thoracic recurrence based on pathological features in patients with ovarian epithelial tumors in stage I versus higher stages

Abstract Purpose The aim of this study was to clarify the frequency of thoracic recurrence and identify associated pathological features in postoperative patients with borderline or malignant ovarian epithelial tumors (BMOT) in stage I versus higher stages. Materials and methods A total of 368 consecutive patients with a single primary BMOT were treated at our hospital. This study included the 217 patients with no residual disease on the first CT after standard treatment. The timing and pattern of recurrence on follow-up CT images with a scan range from chest to pelvis were evaluated retrospectively. Patient characteristics, tumor histology, and stage were recorded from electronic medical records. Results After a median follow-up period of 48 months, recurrence was detected by CT in 9 patients in stage I (n = 159) and 15 in stage II/III (n = 58) (p = 0.0001). Thoracic recurrence was detected in four patients in stage I and four in stage II/III (p = 0.15). Abdominal recurrence was identified as a factor associated with thoracic recurrence (P &lt; 0.001). Clear cell carcinomas accounted for three out of four thoracic recurrences in stage I and two out of four in stage II/III, and had the highest rates of thoracic recurrence (7.7% in stage I and 22.2% in stage II/III) among all histological types associated with thoracic recurrence. Among patients with recurrence, thoracic recurrence-free probability (p = 0.38), median abdominal recurrence-free interval (18 vs 16 months; p = 0.55) and thoracic recurrence-free interval (16.5 vs 23 months; p = 0.89) did not differ significantly between stage I and stage II/III. Conclusion The frequency and timing of thoracic recurrence did not differ significantly in postoperative patients with BMOT in stage I versus stage II/III. Abdominal recurrence and a histological type of clear cell carcinoma were most often associated with thoracic recurrence in stage I.

High tumor mutational burden predicts worse prognosis for cervical cancer treated with radiotherapy

Abstract Purpose Tumor mutational burden (TMB) is a surrogate biomarker of neo-antigens and high TMB status is associated with favorable response to immune-checkpoint inhibitors (ICIs). This study aimed to elucidate the association between TMB and the outcome of definitive radiotherapy in patients with cervical cancer. Materials and methods TMB and treatment outcome were retrospectively analyzed in patients with newly diagnosed cervical cancer treated with definitive radiotherapy available with somatic mutation data of pre-treatment tumors obtained using a commercially available gene panel. Results The study enrolled 98 patients (median follow-up period, 61 months). The median TMB was 9.5 mutations per megabase (range, 3.0–35.5 mutations per megabase). After dichotomization based on this median value, the 5-year overall survival (OS) for TMB-high patients was significantly worse than that of TMB-low patients (61.1% vs. 82.2%). Multivariate analysis identified high TMB status as a significant prognostic factor for worse OS, along with advanced stage, para-aortic lymph node involvement, and absence of concurrent chemotherapy. Conclusion These data indicate that TMB is a potential prognostic factor for worse survival in patients with cervical cancer treated with definitive radiotherapy, thereby providing a rationale for treatment of TMB-high cervical cancers with a combination of ICIs plus radiotherapy. Secondary abstract This retrospective study of 98 patients demonstrates for the first time that tumor mutational burden (TMB) is an independent prognostic factor for worse overall survival of patients treated with definitive radiotherapy, providing a rationale for treatment of TMB-high cervical cancers with a combination of immune-checkpoint inhibitors plus radiotherapy.

Impact of high-dose pelvic radiotherapy combined with chemotherapy on local control, symptom relief, and safety in patients with stage IVB cervical cancer (FIGO 2018): a two-center retrospective study

Abstract Purpose This study evaluated the efficacy and safety of high-dose pelvic radiotherapy combined with chemotherapy, including bevacizumab and immune checkpoint inhibitors (ICI) in patients with stage IVB cervical cancer (CC) based on the 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging system. Materials and methods A retrospective analysis was conducted on 38 patients with stage IVB CC, as classified by the 2018 FIGO cervical cancer staging system, who received pelvic external beam radiotherapy (≥ 40 Gy) with or without brachytherapy and chemotherapy. Data were collected from two centers. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) rates were analyzed using the Kaplan–Meier method. Symptom relief, including reductions in genital bleeding and pain from the primary lesion, was assessed. Acute and late adverse events were also evaluated. Results The median follow-up period was 17.5 months. The 2-year LC, PFS, and OS were 82%, 11%, and 47%, respectively. Although the evaluation method has limitations, most patients with genital bleeding and pain from the primary lesion showed improvement in symptoms. Late adverse events of grade ≥ 2 related to both pelvic radiotherapy and bevacizumab included one case of grade 3 gastrointestinal bleeding and two cases of grade 2 fistula. Conclusion This two-center study demonstrated that high-dose pelvic radiotherapy combined with chemotherapy, including bevacizumab and ICI, may achieve favorable local control and symptom relief in patients with stage IVB CC while maintaining an acceptable safety profile.

Phase I/II study of stereotactic body radiotherapy boost in patients with cervical cancer ineligible for intracavitary brachytherapy

Abstract Purpose Stereotactic body radiotherapy (SBRT) boost is a promising treatment for cervical cancer patients who are ineligible for intracavitary brachytherapy (ICBT). The aim of this multicenter, single-arm, phase I/II study was to prospectively evaluate the efficacy and toxicity of SBRT boost. Materials and methods ICBT-ineligible patients with untreated cervical cancer were enrolled. Patients underwent whole-pelvic radiotherapy (45 Gy in 25 fractions) with SBRT boost to the primary lesion. In the phase I dose-escalation cohort (3 + 3 design), patients were treated with SBRT boost of 21 or 22.5 Gy in three fractions. Although dose-limiting toxicity was not confirmed, a dose of 21 Gy was selected for the phase II cohort because it was difficult to reproduce the pelvic organs position in two patients during the phase I trial. The primary endpoint was 2-year progression-free survival. Results Twenty-one patients (phase I, n = 3; phase II, n = 18) were enrolled between April 2016 and October 2020; 17 (81%) had clinical stage III–IV (with para-aortic lymph node metastases) disease. The median (range) follow-up was 40 (10–84) months. The initial response was complete response in 20 patients and partial response in one patient. The 2-year locoregional control, progression-free survival, and overall survival rates were 84%, 67%, and 81%, respectively. Grade ≥ 3 toxicity was confirmed in one patient each in the acute (diarrhea) and late (urinary tract obstruction) phases. Conclusion These findings suggested that a SBRT boost is more effective than the conventional EBRT boost and can be an important treatment option for ICBT-ineligible patients with cervical cancer. Study registration This study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000036845).

Locally advanced squamous cervical carcinoma (M0): management and emerging therapeutic options in the precision radiotherapy era

Squamous cervical carcinoma (SCC) requires particular attention in diagnostic and clinical management. New diagnostic tools, such as (positron emission tomography-magnetic resonance imaging) PET-MRI, consent to ameliorate clinical staging accuracy. The availability of new technologies in radiation therapy permits to deliver higher dose lowering toxicities. In this clinical scenario, new surgical concepts could aid in general management. Lastly, new targeted therapies and immunotherapy will have more room in this setting. The aim of this narrative review is to focus both on clinical management and new therapies in the precision radiotherapy era.

Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma

To clarify imaging and clinical characteristics of ovarian carcinosarcoma (CS) compared with high-grade serous carcinoma (HGSC). We retrospectively reviewed MR imagings of 12 patients with CS and 30 patients with HGSC and evaluated tumor size, shape, appearance, nature of cystic and solid components, hemorrhage, and necrosis. Age, premenopausal or postmenopausal, histologic subtype, presence of endometriosis, tumor markers, and stage were also evaluated. These parameters were compared using the Mann-Whitney U test and the chi-square test/Fisher's exact test. The mean size of CSs was 13.6 cm, and significantly larger than that of HGSCs (mean 9.0 cm, p = 0.022). The stained-glass appearance (67% vs. 23%, p = 0.013), hemorrhage (100% vs. 50%, p = 0.003), necrosis (75.0% vs. 13%, p = 0.000), and endometriosis (33% vs. 7%, p = 0.012) were significantly more common in CSs. The postmenopausal ratio of CSs was 100% and significantly higher than that of HGSCs (70.0%, p = 0.041). Among the tumor makers, only CA-125 was significantly lower in CSs than in HGSCs (mean 715.1 U/ml vs. 1677.1 U/ml, p = 0.009). The stage distribution was similar and was not significantly different. CSs formed larger masses, and the stained-glass appearance, hemorrhage, and necrosis were more frequently observed in CSs.

Ovarian and non-ovarian teratomas: a wide spectrum of features

Teratoma is a germ cell tumor (GCT) derived from stem cells of the early embryo and the germ line. Teratoma is the most common neoplasm of the ovaries and is usually diagnosed easily using imagings by detecting fat components. However, there are various histopathological types and the imaging findings differ according to the type. Teratoma usually occurs in the gonads or in the midline due to migration of primordial germ cells during development. The clinical course of teratomas depends on the age of the patient, histological type, and anatomical site. Sometimes teratomas show unusual manifestations, such as mature teratoma without demonstrable fat components, torsion, rupture, growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and autoimmune hemolytic anemia. For all of these reasons, teratomas demonstrate a wide spectrum of imaging features and radiologists should be familiar with these variabilities. The present article aims to introduce a model encompassing types of GCTs based on their developmental potential, and to review several histopathological types in various anatomical sites and unusual manifestations of teratomas, with representative imaging findings.

Predictive factors of posttreatment fracture by definitive radiotherapy for uterine cervical cancer

Abstract Purpose Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be multifactorial. In this study, we examined risk factors for fractures in cervical cancer patients, especially by evaluating bone densities and DVH parameters for fractured bones. Materials and Methods For 42 patients, clinical characteristics, pretreatment CT bone densities, and radiation dose were compared between patients with and without fractures. Results Posttreatment fractures occurred in 25 bones among ten patients. Pretreatment CT bone densities were significantly lower in patients with fractures (P &lt; 0.05–0.01 across sites, except for the ilium and the ischium). Although DVH parameters were also significantly associated with fractures in univariate analysis, only CT densities were significantly associated with fractures in multivariate analysis. Conclusion Pretreatment CT densities of spinal and pelvic bones, which may reflect osteoporosis, have a significant impact on the risk for posttreatment fractures.

Comparison of CT-based and MRI-based high-risk clinical target volumes in image guided-brachytherapy for cervical cancer, referencing recommendations from the Japanese Radiation Oncology Study Group (JROSG) and consensus statement guidelines from the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC ESTRO)

The Working Group of the Gynecological Tumor Committee of the Japanese Radiation Oncology Study Group (JROSG) published recommendations for contouring high-risk clinical target volumes (HR-CTV) on CT for 3-dimentional image-guided brachytherapy for cervical cancer. The purpose of this study was to compare HR-CTV delineated on CT, referencing recommendations from JROSG, with HR-CTV delineated on MRI, referencing consensus guidelines from the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC ESTRO). Fourteen patients were evaluated. After the insertion of the CT/MR applicator into the patient, CT and MRI were performed. HR-CTV The median volumes of HR-CTV Somewhat difference could be seen between HR-CTV

Significance of definitive concurrent chemoradiotherapy for vulvar cancer: a Japanese Gynecologic Oncology Group nationwide survey study

Abstract Objective This study aimed to show the results of radical radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) for vulvar cancer (VC) based on data from a Japanese nationwide survey. Materials and methods We collected data from 108 institutions on cases of VC diagnosed between January 2001 and December 2010. Patients with histologically proven squamous cell carcinoma and adenocarcinoma with curative intent were selected, and 172 patients with VC were included in this study. The collected data were analyzed for overall survival (OS) using the Kaplan–Meier method. Univariate and multivariate analyses were performed to examine the prognostic factors for patients with VC. Results The median follow-up period was 16.8 (range; 3.2–154.8) months. Fifty-five patients received CCRT, and 117 patients received RT alone. The 2-year OS rates (95% confidence interval [CI]) for stages I, II, III, and IV were 77.9% (55.8–100.0), 71.9% (53.8–89.9), 55.4% (42.5–68.3), and 41.5% (27.3–55.7) respectively. Univariate analyses showed that the FIGO stage (p = 0.001), tumor diameter (p = 0.005), and lymph node (LN) status (p = 0.001) were associated with OS. The concurrent use of chemotherapy resulted in a significantly longer OS in Stage III (p = 0.013). Multivariate analysis showed that the hazard ratios (95% CI) for tumor diameter, positivity for LN metastasis, and RT alone (no concurrent chemotherapy) were 1.502 (1.116–2.021), 1.801 (1.287–2.521), and 1.936 (1.187–3.159), respectively. Conclusions Our analysis revealed that CCRT should be recommended, especially for Stage III VC patients. Further studies are warranted to determine who benefits from CCRT, considering primary tumor size and LN status. The study was registered at the University Hospital Medical Information Network (protocol number: UMIN000017080) on April 8th, 2015.

Clinical and prognostic 18F-FDG PET/CT role in recurrent vulvar cancer: a multicentric experience

Abstract Purpose The aim of this retrospective multicentric study was to investigate the diagnostic performance, the prognostic value and the impact of 18F-FDG PET/CT on treatment decision-making in patients with suspected recurrent vulvar cancer (VC). Materials and methods Sixty-three patients affected by VC performed 18F-FDG-PET/CT for restaging purposes in case of suspected clinical and/or radiological recurrence. Histopatology results if available and/or clinical-imaging follow-up for at least 12 months were considered as reference standard. The diagnostic accuracy and the clinical impact of 18F-FDG PET/CT were investigated. Progression free survival (PFS) and overall survival (OS) were calculated using Kaplan–Meier curves. Results Fifty-two (82.5%) PET/CT showed the presence of recurrence, while the remaining 11 (17.5%) were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT were 100% (95%CI 93–100%), 92% (95%CI 62–100%), 98% (95%CI 89–99%), 100% and 98% (95%CI 92–100%). A relevant impact of 18F-FDG PET/CT imaging was registered in 28 cases: in 12 cases moving from local therapy to chemotherapy due to the recognition of disseminate localizations; in 10 showing the site of recurrence in presence of negative conventional imaging, and in 6 cases confirming to be true negative and avoiding unnecessary therapies. Beside advanced age and HPV status, a positive restaging 18F-FDG PET/CT scan was significantly correlated with shorter PFS and OS compared to negative scan (p &lt; 0.001). Conclusions 18F-FDG PET/CT demonstrated to be an accurate tool in the assessing of recurrent VC with high sensitivity and specificity and with a significant impact on clinical decision-making. Restaging 18F-FDG PET/CT findings were associated with survival.

Multi-modality MRI radiomics phenotypes in intermediate-high risk endometrial cancer: correlations with histopathology and prognosis

This study aimed to identify the magnetic resonance imaging (MRI)-based radiomics phenotypes of intermediate-to-high-risk endometrial cancers (ECs), explore their association with histopathologic features, and compare their prognostic ability with the International Federation of Gynecology and Obstetrics (FIGO) stage. This study retrospectively recruited 355 patients with pathologically confirmed EC from 01/2016 to 06/2023. 166(46.8%) were classified as intermediate-to-high-risk ECs according to the European Society for Medical Oncology guidelines. Radiomics clustering analysis was performed on preoperative MRI to identify the radiomics phenotype of intermediate-to-high-risk ECs. The association between the radiomics phenotypes and the clinicopathologic information was explored, and the added value in predicting the recurrence was also evaluated using concordance index (C-index). Of the included 166 patients (average age 56.83 ± 9.25 years), 23 were recurrent patients. The corresponding tumors in various clusters were assigned to phenotypes 1 and 2. Larger tumor diameter (P < .01), cervical mucosa invasion [30(36.15%) vs 15(18.07%), P = .01], deep myometrial infiltration [51(61.45%) vs 31(37.35%), P = .00], and histologic subtype [17(20.48%) vs 5(6.02%), P = .01] were associated with subtype 1. The risk of recurrence (P = .01) was higher in phenotype 1, and the FIGO stage could further differentiate higher recurrence risk in phenotype 1 (P < .01). The C-index was 0.66 for the radiomics phenotype model, 0.69 for the FIGO stage model, and 0.72 for the combined model. MRI-based radiomics consensus clustering enabled the identification of associations between radiomics features and histopathologic features in intermediate-to-high-risk EC. The FIGO stage could further elevate the prediction ability of recurrence risk.

Radiotherapy for HPV-related cancers: prediction of therapeutic effects based on the mechanism of tumor immunity and the application of immunoradiotherapy

AbstractHuman papillomavirus (HPV)-related cancer is one of the diseases entities for which the applications of radiotherapy have been increasing. Recently, the process of carcinogenesis from HPV infection and the mechanism of tumor immunity that develops during disease progression have been elucidated. In this review, we will describe the mechanism of tumor immunity and how chemoradiotherapy may overcome and improve the efficacy of tumor immunity. We will also discuss the usefulness of proteins involved with tumor immunity as a predictive marker of radiotherapy response, and present an overview of ongoing clinical trials of combinations of immune checkpoint inhibitors and radiotherapy to demonstrate the promising combination therapy that has been currently emerging.