Multicystic mucinous adenocarcinoma of the uterine cervix compared with benign multicystic lesions: Multiparametric MR features

Background: Multicystic mucinous adenocarcinoma is rarely recognized and has a high misdiagnosis rate.

Purpose: To distinguish malignant multicystic mucinous adenocarcinomas from benign multicystic lesions in the uterine cervix using multiparametric MR.

Study type: Retrospective.

Population: Forty patients with seven cystic mucinous adenocarcinomas and 33 benign multicystic lesions.

Field strength/sequence: 3.0T. Diffusion-weighted images (DWI) and dynamic contrast-enhanced (DCE) images.

Assessment: Lesion size, intracystic hemorrhage, solid component, and heterogeneous enhancement were subjectively assessed, and apparent diffusion coefficient (ADC) values, K_trans , K_ep , and V_e parameters were compared.

Statistical analysis: Student's t-test was used to compare age, tumor size, ADC values, and DCE parameters. Pearson's chi-square test was used to compare intracystic hemorrhage, solid component, and heterogeneous enhancement. Receiver-operating-characteristic (ROC) analysis of ADC values, tumor size, and K_trans were performed.

Results: The size of mucinous adenocarcinomas was larger than benign multicystic lesions (4.09 ± 2.09 vs. 2.23 ± 0.58 cm, P < 0.001); the area under the curve (AUC) for tumor size was 0.859 with a sensitivity of 71.4% and specificity of 90.9%. Stromal ADC value was lower for mucinous adenocarcinomas (1.19 ± 0.22 vs. 1.68 ± 0.22 × 10^-3 mm² /s, P < 0.001); AUC for stromal ADC value was 0.970, with a sensitivity of 86.4% and specificity of 100.0%. Among quantitative DCE parameters, only k_trans offered a discriminative value (1.72 ± 1.42 vs. 0.69 ± 0.30 min^-1 , P = 0.031); the AUC for k_trans was 0.831 with a sensitivity of 71.4% and specificity of 97.0%. Intracystic hemorrhage (3/7), solid component (5/7), and heterogeneous enhancement (4/7) were only found in mucinous adenocarcinomas. Five patients (71.4%) had lymphovascular space invasion and three (42.9%) had lymph node metastasis. The 1-year tumor recurrence or metastasis rate was 28.5% (2/7).

Data conclusion: Awareness of multiparametric MR features can assist in the differentiation of mucinous adenocarcinomas from benign multicystic lesions.

Level of evidence: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1336-1343.