Clinical study on MRI features of different pathological subtypes of uterine sarcoma and their relationship with menopausal status
Objective: To explore the association between MRI features of different pathological subtypes of uterine sarcoma and patients' menopausal status. Materials and Methods: Retrospective analysis of clinical and imaging data of 68 patients with surgically and pathologically confirmed uterine sarcoma, including 17 cases of uterine leiomyosarcoma, 18 cases of endometrial stromal sarcoma, 9 cases of undifferentiated uterine sarcoma, and 24 cases of adenosarcoma; the menopausal status of the patients was summarized, including 41 (60.3%) postmenopausal and 27 (39.7%) premenopausal patients; their common MRI features were analyzed, including necrosis, hemorrhage, irregular or nodular tumor borders, and pelvic lymph node enlargement or peritoneal metastasis. By applying the x²/Fisher test, an analysis is conducted on the distribution differences of MRI features across various menopausal statuses and different pathological subtypes, for multiple subgroup data with statistical significance, Bonferroni correction was applied for multiple comparisons. Results: The differences in pelvic lymph node enlargement or peritoneal metastasis among patients with uterine sarcoma in different menopausal statuses are statistically significant (P<0.05). However, necrosis, hemorrhage, and irregular or nodular tumor margins among patients with uterine sarcoma in different menopausal statuses do not show statistically significant differences (P>0.05). Regardless of menopausal status, irregular or nodular tumor margins have statistical significance in differentiating various pathological types (P<0.05), including comparisons between endometrial stromal sarcoma and adenosarcoma, and undifferentiated sarcoma and adenosarcoma in the menopausal state (P<0.0083, Bonferroni correction), and between endometrial stromal sarcoma and adenosarcoma in the premenopausal state (P<0.0083, Bonferroni correction). Necrosis, hemorrhage, pelvic lymph node enlargement, or peritoneal metastasis do not have statistical significance in differentiating among the pathological types (P>0.05). In the menopausal group, the proportion of adenosarcoma patients experiencing pelvic lymph node enlargement or peritoneal metastasis is significantly higher than in the non-menopausal group, which is statistically significant (P<0.05). Conclusions: Among MRI features, changes in tumor border morphology have a certain diagnostic value for differentiating various subtypes of uterine sarcoma. Uterine adenosarcomas often present with regular, clear margins, whereas endometrial stromal sarcomas, undifferentiated sarcomas, and some leiomyosarcomas exhibit irregular or nodular tumor margins. Patients with adenosarcoma who have not yet reached menopause are more likely to exhibit lymph node or peritoneal metastasis compared to postmenopausal patients.