MRI grading for informed clinical decision-making in Peutz-Jeghers syndrome patients with cervical lesions

The preoperative diagnosis and management of Peutz-Jeghers syndrome (PJS) patients with cervical lesions remain problematic. This study analysed the associations between pathological types of cervical lesions in PJS patients and their MRI features. A total of 34 PJS patients were included and two experienced radiologists reviewed the MRIs independently. Based on the pathological diagnosis, the patients were categorized into four groups: normal (n  =  4), lobular endocervical glandular hyperplasia (LEGH, n  =  11), atypical LEGH (aLEGH, n  =  8), and gastric-type endocervical adenocarcinoma (G-EAC, n  =  11). By observing the MRI features, we found statistically significant differences in the extent of lesions (P  = 0 .001), distribution of microcysts (P  = 0 .001), proportion of microcysts (P  <  0.001) and endometrial involvement (P  = 0.019) among the four groups. Notably, solid components and disrupted cervical stromal rings were found only in the aLEGH and G-EAC groups (P  < 0.001).  Consequently, we created a novel grading system based on the aforementioned MRI features to align with the potential malignancy of cervical lesions in PJS patients. This system enables patients to receive timely and appropriate treatment recommendations while facilitating collaboration between radiologists and physicians.