European journal of radiology · 2026
Clinical significance of MRI-based tumor status differs by histological subtype in early-stage cervical cancer.
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Kou Kazuhiro, Yamanoi Koji, Kobara Hisanori, Komatsu Hiroaki, Himoto Yuki, Ito Hiroaki, Maehara Mana, Ohya Ayumi, Fujii Shinya, Inayama Yoshihide, Higashiyama Nozomi, Mizuno Rin, Miyamoto Taito, Taki Mana, Murakami Ryusuke, Mandai Masaki
Аннотация
OBJECTIVE: To determine whether Magnetic Resonance Imaging (MRI) findings reflect pathological risk factors in early-stage cervical cancer and whether its clinical significance differs by histological subtype.
METHODS: This multicenter retrospective study included patients with FIGO 2009 stage ≤ IB1 cervical cancer who underwent preoperative MRI. Maximal tumor diameter (MRI(L)) and perpendicular short diameter (MRI(D)) were categorized at 10-mm intervals. Associations with pathological low-risk criteria (tumor length ≤ 20 mm, invasion depth ≤ 10 mm, and their combination [S-criteria]) and lymphovascular space invasion (LVSI) were analyzed for squamous cell carcinoma (SCC) and HPV-associated adenocarcinoma (HPVA-adenocarcinoma) using the Cochran-Armitage trend test, with interobserver agreement assessed using weighted kappa statistics.
RESULTS: The study included 246 SCC and 93 HPVA-adeno cases. MRI categorization showed substantial interobserver agreement (κ = 0.87-0.97). The S-criteria threshold differed by subtype: in SCC, the proportion meeting S-criteria fell to 58.6 % in the MRI(L) 10-20 mm category, versus 83.3 % in HPVA-adeno. LVSI positivity also increased significantly with MRI category in both subtypes (p < 0.0001 and p = 0.006), with distinct patterns: in SCC, LVSI rose sharply once MRI(L) reached 10 mm (14.8 % vs. 56.5 %); in HPVA-adeno, LVSI was rare among MRI-invisible tumors (2.7 %) but present in 33.3 % of visible tumors < 10 mm. This histology-specific pattern was confirmed by a formal interaction test for LVSI (p = 0.024).
CONCLUSIONS: The clinical significance of MRI findings differs by histological subtype in early-stage cervical cancer: MRI size categories reliably reflect pathological risk in SCC, whereas MRI size alone is insufficient for risk stratification in early-stage HPVA-adenocarcinoma.
METHODS: This multicenter retrospective study included patients with FIGO 2009 stage ≤ IB1 cervical cancer who underwent preoperative MRI. Maximal tumor diameter (MRI(L)) and perpendicular short diameter (MRI(D)) were categorized at 10-mm intervals. Associations with pathological low-risk criteria (tumor length ≤ 20 mm, invasion depth ≤ 10 mm, and their combination [S-criteria]) and lymphovascular space invasion (LVSI) were analyzed for squamous cell carcinoma (SCC) and HPV-associated adenocarcinoma (HPVA-adenocarcinoma) using the Cochran-Armitage trend test, with interobserver agreement assessed using weighted kappa statistics.
RESULTS: The study included 246 SCC and 93 HPVA-adeno cases. MRI categorization showed substantial interobserver agreement (κ = 0.87-0.97). The S-criteria threshold differed by subtype: in SCC, the proportion meeting S-criteria fell to 58.6 % in the MRI(L) 10-20 mm category, versus 83.3 % in HPVA-adeno. LVSI positivity also increased significantly with MRI category in both subtypes (p < 0.0001 and p = 0.006), with distinct patterns: in SCC, LVSI rose sharply once MRI(L) reached 10 mm (14.8 % vs. 56.5 %); in HPVA-adeno, LVSI was rare among MRI-invisible tumors (2.7 %) but present in 33.3 % of visible tumors < 10 mm. This histology-specific pattern was confirmed by a formal interaction test for LVSI (p = 0.024).
CONCLUSIONS: The clinical significance of MRI findings differs by histological subtype in early-stage cervical cancer: MRI size categories reliably reflect pathological risk in SCC, whereas MRI size alone is insufficient for risk stratification in early-stage HPVA-adenocarcinoma.