Abstract:

Objective

To explore the application value of ultrasound, magnetic resonance imaging(MRI), and computed tomography (CT) in the diagnosis of gastric-type endocervical adenocarcinoma(G-EAC).

Methods

The clinical data of 53 patients with G-EAC confirmed by surgery and pathology at the Women’s Hospital School of Medicine Zhejiang University from August 2020 to August 2024 were collected, including age, clinical symptoms, and pathological results, as well as imaging data such as conventional ultrasound, MRI, and enhanced CT. The image characteristics of various imaging techniques were summarized. Using pathological results as the golden standard, the diagnostic recognition rates of the three imaging modalities were compared using the chi-square test or Fisher’s exact test.

Results

All the 53 patients underwent ultrasound examination, by which 36 achieved a diagnosis and 17 had a missed diagnosis. The imaging characteristics of 36 lesions diagnosed with cervical abnormalities by ultrasound include solid lesions (44.44%, 16/36) and predominantly solid solid-cystic lesions (41.67%, 15/36), with the solid part mainly having high echogenicity (52.78%, 19/36). Among the solid-cystic lesions, the cystic part was mostly large cysts (75.00%, 15/20), and the cysts were locally clustered, with some cyst walls slightly thickened. Rich blood flow signals can be detected in the solid part of the lesion (88.89%, 32/36). Fortynine cases underwent MRI examination, with 4 cases misdiagnosed or missed. Most of them showed signals such as homogeneous signal intensity on T1 weighted imaging (73.33%, 33/45), high signal intensity on T2 weighted imaging (77.78%, 35/45), high signal on intensity diffusion weighted imaging (88.89%, 40/45), and unclear boundaries (71.11%, 32/45). Forty-seven cases underwent CT examination, with 6 cases missed or misdiagnosed. Among the 41 cases diagnosed with cervical abnormalities by CT, the imaging characteristics were mainly inhomogeneous low-density lesions and inhomogeneous enhancement in the cervix. Comparing the diagnostic recognition rates of the three imaging techniques, it was found that ultrasound had no significant statistical difference in identifying endometrial, muscular, and ovarian tissue involvement in the uterus compared to MRI and CT (P＞0.05), and was inferior to MRI and CT in identifying lesions,vaginal involvement, and pelvic and abdominal lymph node metastasis (P＜0.05).

Conclusion

Each of the three imaging techniques has its own advantages in identifying lesions, surrounding infiltration, and distant metastasis. Imaging physicians, especially ultrasound physicians, should strengthen their learning of G-EAC imaging features, in order to improve the diagnostic ability of ultrasound and provide more effective information for preoperative diagnosis, postoperative treatment, and follow-up of patients.

Key words: Gastric-type endocervical adenocarcinoma, Ultrasound, Magnetic resonance imaging, Computed tomography, Diagnosis