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The results of an MRI-based study show that patients with squamous cell cervical cancer with unclear tumor borders have a worse prognosis, lymph node metastases, and distant recurrence.

One of the most common forms of cancer among women is cervical cancer. About 10,000 Japanese women are diagnosed with cervical cancer annually, and approximately 3,000 will ultimately die from the disease. Treatment selections must be made based on the results of the preoperative evaluation for this cancer. Regarding the initial staging and subsequent monitoring of cervical cancer, MRI is considered the most accurate and precise imaging technique.

A study published in the journal Scientific Reports divided a group of cases according to clear or unclear tumor border status using pretreatment MRI images and compared the two groups for demographics, tumor features, and prognosis.

Study Characteristics

This study analyzed 328 cervical cancer patients treated at Nagoya University Hospital. MRI was used to classify 53 early-stage cervical cancer patients who could undergo surgery into clear (40) and unclear (13) tumor border groups. All patients were evaluated for overall survival (OS), recurrence-free survival, lymph node metastases, lymphovascular space invasion (LVSI), and pathological findings, including vimentin immunohistochemistry.

Higher Rate of Lymphovascular Space Invasion Using MRI

The unclear tumor boundary group had a greater rate of LVSI (13/13) and postoperative upgraded staging compared to the clear tumor boundary group (92% vs. 37.5%, respectively). Compared to 15% (6/40) of clear tumor border patients, 76.9% (10/13) of unclear tumor border patients had pathological lymph node metastases. Due to LVSI and lymph node metastases, unclear tumor boundaries increased adjuvant chemoradiotherapy eligibility. 

Higher Rate of Recurrence and Lower OS 

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The recurrence rate in paraaortic lymph nodes and parenchymal organs was higher in the group with unclear tumor borders than in the group with clear tumor borders (23.1% vs. 7.5%, respectively). Patients with an unclear tumor border had significantly lower overall survival than those with a clear tumor border (p=0.0062).

Association Between Vimentin Expression and Tumor Border Clarity

The data showed that vimentin expression was positive in 37 of the 53 cases. There was a statistically significantly higher positivity for vimentin in the group with unclear tumor borders versus the group with clear tumor borders (p = 0.045). Therefore, increased rates of recurrence (3/40 vs. 3/13), LVSI (24/40 vs. 13/13), lymph node metastasis (6/40 vs. 10/13), and vimentin positivity (18/40 vs. 10/13) were observed in the unclear tumor border group compared to the clear tumor border group. 

Sato, M., Tamauchi, S., Yoshida, K., Yoshihara, M., Ikeda, Y., Yoshikawa, N., & Kajiyama, H. (2023). Unclear tumor border in magnetic resonance imaging as a prognostic factor of squamous cell cervical cancer. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-42787-7