Cancer de l'endomètre : bilan d'extension myométrial etcervical - AMC Chirurgie Cancers Pelviens

Titre: AMC Chirurgie Cancers Pelviens - Cancer de l'endomètre : bilan d'extension
myométrial etcervical
Diagnostic: Cancer de l'endomètre : bilan d'extension myométrial etcervical
Auteur: KINKEL Karen
Commentaire: Dfouni Natalia
Hôpital: HUG
Département: Département de Radiologie
Date: 04.04.2003
ID: 3712
Chapitre: Utérus

Commentaire: Cancer of the uterus Endometrial cancer is the mostfrequent
cancer in the female pelvis in developed countries. Thereis no existing routine screening
for endometrial cancer. Thediagnosis is suspected in women presenting with
post-menopausalbleeding and an endometrial thickness larger than 5 mm, measured
bytransvaginal ultrasound. Endometrial biopsy with endocervicalcurettage confirms the
diagnosis in differentiating between benignand malignant conditions. Histopathology also
assesses presence oftumor in the cervix, the type of cancer (adenocarcinoma, clear
cellcarcinoma, papillary carcinoma) and the degree of cellulardifferentiation (grade).
Histological risk factors of poorprognosis (intermediate or high grade tumors, papillary or
clearcell carcinoma) or clinical suspicion of endocervical extensionwarrant pre-operative
staging in order to provide more prognosticinformation concerning the extent of the
disease into themyometrium, the cervix, the adnexa, the peritoneum or lymph nodes.Deep
myometrial invasion is highly correlated with lymph nodeinvasion and cervical invasion.
Preoperative knowledge ofmyometrial invasion can therefore influence the type and extent
ofinitial surgical treatment (extent of lymphadenectomy and type ofhysterectomy) and might
increase the patient's survival due toadequate treatment at the time of diagnosis. Staging
methods ofendometrial cancer are abdominal and transvaginal
ultrasound,contrast-enhanced CT and MR imaging. MR imaging has shown to be themost
accurate method to diagnose deep myometrial invasion comparedto CT and ultrasound. A
MR examination changes the probability ofdeep myometrial invasion from 13% (grade 1),
35% (grade 2) and 54 %(grade 3) to 60%, 84% and 92% respectively with a positive
resultand to 1%, 5% and 10% respectively with a negative result for deepmyometrial
invasion. Therefore MR imaging has become the method ofchoice to differentiate
between patients that will needlymphadenectomy (standby of a surgical oncologist, frozen
section)versus those that will not and that can be operated by a generalgynecologist. MR
imaging is also the only imaging modality withevidence based results for cervical
involvement. If myometrial,cervical and lymph node status assessment are
required,contrast-enhanced MR imaging provides the most completeevaluation.
Description: - diapo 1 : bilan díextension par IRM pour lediagnostic
díenvahissement myométrial: image T1 précoce aprèsinjection IV de produit de contraste :
la masse en hyposignalenvahit plus de la moitié de l'épaisseur du myomètre (stade TNM
1C)- diapo 2: bilan díextension par IRM pour le diagnosticdíenvahissement myométrial et
cervical : image T1 précoce aprèscontraste IV de produit de contraste : la masse en
hyposignalsíétend jusquíà líendocol et fait disparaître le stroma cervicalnormal (stade
TNM 2B) - diapo 3 : bilan díextension par CT : lesimages díun CT pelvien à deux temps
(artériel précoce et portal) :líimage au temps artériel montre la conservation de la prise
decontraste intense normale du myomètre interne, à l'exception d'unepetite partie
antérieure ce qui confirme le caractère limité del'envahissement myométrial par le cancer
de líendomètre (stade TNM1B). Ce diagnostic est impossible au temps tardif. LíIRM
estsupérieur au CT pour le diagnostic díenvahissement dumyomètre.

Ordre: 1009
Dislocation: 0
Polytraumatisé: 0
Ouvert: 0
Pathologic: 0
Opération: 00.00.00
Graft: 0

Références: Radiology 2000 Kinkel : méta-analyse myométrialinvasion

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