Jinekolojik Malignitelerde Radyolojik Görüntüleme
Özet
Bu çalışma en sık görülen jinekolojik malignitelerden endometrium, serviks ve over kanserlerinin tanı ve takibinde radyolojinin güncel rolünü incelemektedir. Gelişmekte olan ülkelerde yaygın olan serviks kanserinde tarama programları erken tanıyı hedeflerken, evrelemede 2018 FIGO sistemiyle ilk kez görüntüleme bulguları da sürece dahil edilmiştir. Evrelemede pelvik ve paraaortik lenfadenopatinin varlığı hastalığın evresini yükseltmektedir. Görüntüleme yöntemlerinden ultrason kolay erişilebilir bir metotken, parametrial invazyon ve lokal hastalık boyutunun değerlendirilmesinde yüksek yumuşak doku çözünürlüğü sunan MRG ilk tercih edilen yöntemdir. Gelişmiş ülkelerde en sık rastlanan jinekolojik kanser olan endometrium kanserinde ise miyometrial ve servikal stromal invazyonun doğru tespiti evrelemeyi doğrudan değiştirdiği için kritik öneme sahiptir. Over kanseri jinekolojik maligniteler arasında en önemli ölüm nedenlerinden biri olup sıklıkla geç evrede peritoneal hastalıkla saptanmaktadır. Belirsiz adneksiyal kitlelerin karakterizasyonunda MRG oldukça yararlıdır. Sonuç olarak, BT ve MRG jinekolojik malignitelerde yüksek uzaysal çözünürlük ve doku kontrastı sağlayarak tanı, evreleme ve nüks takibinde kritik faydalar sunar. Özellikle konvansiyonel sekanslara eklenen difüzyon ağırlıklı görüntüleme (DAG), tümör hücrelerinin su moleküllerinin hareketini sınırlaması prensibiyle doğru tanı ve evrelemede vazgeçilmez bir modalitedir.
This study examines the contemporary role of radiology in the diagnosis and follow-up of endometrium, cervical, and ovarian cancers, which are among the most common gynecological malignancies. In cervical cancer, which is prevalent in developing countries, screening programs aim for early detection, and the 2018 FIGO staging system included imaging findings for the first time. The presence of pelvic and para-aortic lymphadenopathy upgrades the disease stage. While ultrasound is an accessible method, MRI is the preferred initial choice for assessing parametrial invasion and local disease extent due to its soft tissue resolution. In endometrial cancer, the most frequent gynecological cancer in developed nations, accurately evaluating myometrial and cervical stromal invasion is critical as it alters staging. Ovarian cancer is a leading cause of death among gynecological malignancies and frequently presents at a late stage with peritoneal involvement. MRI is useful for characterizing indeterminate adnexal masses. Consequently, CT and MRI provide essential benefits in diagnosis, staging, and recurrence monitoring by offering high spatial resolution and tissue contrast. Diffusion-weighted imaging (DWI) added to conventional sequences is an indispensable modality for accurate diagnosis and staging based on tumor cells restricting water molecule movement.
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