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Cervical Cancer
The Role of Magnetic Resonance Imaging in Pretreatment Evaluation of Early-Stage Cervical Cancer
  1. Wei Zhang, MD*,
  2. Jie Zhang, MD†,
  3. Jiaxin Yang, MD*,
  4. Huadan Xue, MD†,
  5. Dongyan Cao, MD*,
  6. Huifang Huang, MD*,
  7. Ming Wu, MD*,
  8. Quancai Cui, MD‡,
  9. Jie Chen, MD‡,
  10. Jinghe Lang, MD* and
  11. Keng Shen, MD*
  1. *Departments of Obstetrics and Gynecology,
  2. †Radiology, and
  3. ‡Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  1. Address correspondence and reprint requests to Keng Shen, MD, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1. Shuaifuyuan, Dongcheng District, Beijing 100730, China. E-mail: shenkeng{at}vip.sina.com.

Abstract

Objective The aim of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in the preoperative assessments of primary tumor size, parametrial invasion, and pelvic lymph node metastasis in patients with early-stage cervical cancer.

Materials and Methods A cohort of 125 patients with International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer who had preoperative MRI and underwent radical hysterectomy were enrolled and analyzed. The accuracy of preoperative MRI scan and pelvic examination in the measurement of tumor size was assessed based on postoperative measurement and pathologic findings. The accuracy of detection of lymph node status and parametrial invasion was also assessed by comparing the MRI and pathologic findings.

Results The mean diameter of the tumor size measured by postoperative measurement, MRI, and pelvic examination was 2.97 ± 1.39 cm, 2.78 ± 1.24 cm, and 1.97 ± 1.70 cm, respectively. There were significant differences in the mean diameter of the tumor size between pelvic examinations and MRI scan or postoperative measurement (P < 0.0001). Based on postoperative measurement findings, accuracy of tumor size measurement between pelvic examination and MRI was determined by the degree of agreement with a difference of less than 0.5 or 1.0 cm. Pelvic examination and MRI had an accuracy of 24.75% and 39.60%, respectively, with a difference of less than 0.5 cm, and had an accuracy of 43.56% and 61.39%, respectively, with a difference of less than 1.0 cm. Correlation with postoperative measurement in tumor size was higher for MRI (r[s] = 0.481) than that for pelvic examination (r[s] = 0.362). The sensitivity, specificity, and accuracy of MRI in detecting lymph node metastasis were 27.78%, 85.98%, 77.60%, respectively. The negative predictive value of MRI in detecting parametrial invasion is 100%.

Conclusions Magnetic resonance imaging is an accurate noninvasive modality for preoperative evaluation of tumor size and also gives important information to parametrial invasion and lymph node status in patients with early-stage cervical cancer.

  • Magnetic resonance imaging
  • Cervical cancer
  • Pelvic examination

https://doi.org/10.1097/IGC.0000000000000169

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    Footnotes

    • Supported by grants from the National Science and Technology Infrastructure Program’s “The National Key Technologies R&D Program of China” (grant 2008BAI57B01), the National High Technology Research Development Program of China (863 program, grant 2012AA02A507), and the National Natural Science Foundation of China (grant 81172482 and grant 81372780).

    • The authors declare no conflicts of interest.