Role of MRI in staging and follow-up of endometrial and cervical cancer:pitfalls and mimickers

Abstract MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis

Endometrial cancer

Endometrial cancer is the most common gynecological malignancy in well-developed countries. Biologically and clinicopathologically, endometrial carcinomas are divided into two types: type 1 or estrogen-dependent carcinomas and type 2 or estrogen-independent carcinomas. Type 1 cancers correspond mainly to endometrioid carcinomas and account for approximately 90 % of endometrial cancers, whereas type 2 cancers correspond to the majority of the other histopathological subtypes. The vast majority of endometrial cancers present as abnormal vaginal bleedings in postmenopausal women. Therefore, 75 % of cancers are diagnosed at an early stage, which makes the overall prognosis favorable. The first diagnostic step to evaluate women with an abnormal vaginal bleeding is the measurement of the endometrial thickness with transvaginal ultrasound. If endometrial thickening or heterogeneity is confirmed, a biopsy should be performed to establish a definite histopathological diagnosis. Magnetic resonance imaging is not considered in the International Federation of Gynaecology and Obstetrics staging system. Nonetheless it plays a relevant role in the preoperative staging of endometrial carcinoma, helping to define the best therapeutic management. Moreover, it is important in the diagnosis of treatment complications, in the surveillance of therapy response, and in the assessment of recurrent disease.info:eu-repo/semantics/publishedVersio

Different neurophysiological mechanisms underlying word and rule extraction from speech

The initial process of identifying words from spoken language and the detection of more subtle regularities underlying their structure are mandatory processes for language acquisition. Little is known about the cognitive mechanisms that allow us to extract these two types of information and their specific time-course of acquisition following initial contact with a new language. We report time-related electrophysiological changes that occurred while participants learned an artificial language. These changes strongly correlated with the discovery of the structural rules embedded in the words. These changes were clearly different from those related to word learning and occurred during the first minutes of exposition. There is a functional distinction in the nature of the electrophysiological signals during acquisition: an increase in negativity (N400) in the central electrodes is related to word-learning and development of a frontal positivity (P2) is related to rule-learning. In addition, the results of an online implicit and a post-learning test indicate that, once the rules of the language have been acquired, new words following the rule are processed as words of the language. By contrast, new words violating the rule induce syntax-related electrophysiological responses when inserted online in the stream (an early frontal negativity followed by a late posterior positivity) and clear lexical effects when presented in isolation (N400 modulation). The present study provides direct evidence suggesting that the mechanisms to extract words and structural dependencies from continuous speech are functionally segregated. When these mechanisms are engaged, the electrophysiological marker associated with rule-learning appears very quickly, during the earliest phases of exposition to a new language