Diagnostic Value of MRI in Detection of Small Lymph Node Metastasis and Its Effects on Radiotherapy Target Volume Design in Cervical Cancer Patients
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摘要: 目的 探讨MRI对宫颈癌小淋巴结转移的诊断价值和对放射治疗中靶区设计的影响。方法 收集四川省肿瘤医院经手术病理证实的宫颈癌患者37例，术前均行常规MRI平扫加增强扫描，结合T1WI增强序列，在T2WI上测量可见的淋巴结最长径和最短径，并对其强化方式、边缘形态、包膜侵犯情况进行记录。结果 MRI上转移淋巴结短径较非转移淋巴结短径更长，差异有统计学意义（P=0.01）；淋巴结短径标准下的ROC曲线下面积更大，其诊断价值较淋巴结长径和淋巴结长短经比值更大。转移淋巴结标准取短径≥9 mm时其敏感度、特异性和准确性分别为57.14%、91.67%、75.56%。本研究的患者若接受放射治疗，若只针对短径≥9、10 mm的淋巴结给予阳性淋巴结的剂量照射，将有42.86%、80.95%的小阳性淋巴结接受不足剂量的照射。结论 MRI对宫颈癌小淋巴结转移有一定的诊断价值，在宫颈癌放射治疗中有必要对盆腔淋巴结行预防性照射，并对高度怀疑恶性的小淋巴结以根治剂量照射。
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关键词:
- 宫颈癌 /
- 磁共振成像（MRI） /
- 小淋巴结转移 /
- 放射治疗 /
- 靶区设计
Abstract: Objective To explore the diagnostic value of magnetic resonance imaging(MRI) in the detection of small lymph node(LN) metastasis and its effect on radiotherapy target volume design in cervical cancer patients. Methods We collected 37 patients with cervical cancer diagnosed pathologically in Sichuan cancer hospital.They were all received preoperative MRI scan and enhanced scan. Combined with T1WI enhanced sequence, the longest diameter and shortest diameter of visible lymph nodes on T2WI were measured respectively，and the morphological features such as enhancement patterns，extra capsular spread(ECS), edge of the lymph nodes andcapsular invasion were recorded. Results Short diameter of metastatic LN was longer than that of non-metastatic LN statistically(P=0.01).Area under curve(AUC) of short diameter in receiver operator characteristic curve(ROC) was larger than those of long diameter and ratio of long-toshort diameter, which showed a more important diagnosis value.When short diameter≥9 mm was choosed as the standard of metastatic LN，the sensitivity,specificity and accuracy were 57.14%,91.67%and 75.56%，respectively.If LN with short diameter≥9,10 mm as GTV-N(gross tumor volume-node) in this experiment were exposed to positive LN dose irradiation,42.86%, 80.95% of malignant LNs may receive insufficient dose radiation. Conclusion MRI has certain value in diagnosing small lymph node metastasis from cervical cancer. It is necessary to conduct prophylactic radiotherapy to pelvic lymph node and a radical cure dose irradiation to small lymph node highly suspected to be malignant. -
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[1] Balleyguier C, Sala E, Da Cunha T, et al. Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology[J]. Eur Radiol,2011,21(5):1102-10. [2] Kasuya G, Ogawa K, Iraha S, et al. Postoperative radiotherapy for uterine cervical cancer: impact of lymph node and histological type on survival[J]. Anticancer Res,2013,33(5):2199-204. [3] Brockbank E, Kokka F, Bryant A, et al. Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer[J]. Cochrane Database Syst Rev,2013,3:CD008217. [4] Downey K, deSouza NM. Imaging cervical cancer: recent advances and future directions[J]. Curr Opin Oncol,2011,23(5):519-25. [5] Loubeyre P, Navarria I, Undurraga M, et al. Is imaging relevant for treatment choice in early stage cervical uterine cancer?[J]. Surg Oncol,2012,21(1):e1-6. [6] Monteil J, Maubon A, Leobon S, et al. Lymph node assessment with (18)F-FDG-PET and MRI in uterine cervical cancer[J]. Anticancer Res,2011,31(11):3865-71. [7] Liyanage SH, Roberts CA, Rockall AG. MRI and PET scans for primary staging and detection of cervical cancer recurrence[J]. Womens Health (Lond Engl),2010,6(2):251-67. [8] Liu Y, Liu H, Bai X, et al. Differentiation of metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer using diffusion-weighted imaging[J]. Gynecol Oncol,2011,122(1):19-24. [9] Bhosale P, Peungjesada S, Devine C,et al. Role of magnetic resonance imaging as an adjunct to clinical staging in cervical carcinoma[J]. J Comput Assist Tomogr,2010,34(6):855-64. [10] Williams AD, Cousins C, Soutter WP, et al. Detection of pelvic lymph node metastases in gynecologic malignancy: a comparison of CT, MR imaging, and positron emission tomography[J]. AJR Am J Roentgenol,2001,177(2):343-8.
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