A 38-year-old nulliparous woman was referred to our clinic because of cervical incompetence at 19 weeks of gestation. Trans-abdominal cervicoisthmic cerclage was performed after failure of modified Shirodkar cerclage operation in the patient at 21 weeks of gestation via a laparotomic approach. Another 38-year-old patient, who underwent loop electrosurgical excision procedure conization for treatment of cervical dysplasia 4 years ago, presented for cervical incompetence. At 18 weeks of gestation, we performed trans-abdominal laparotomic cervicoisthmic cerclage without any post-operative complications. During antenatal follow-up, there were no obstetrical co-morbidities and finally she gave birth to a healthy infant at full term by cesarean section. We report two cases of women who underwent trans-abdominal cervicoisthmic cerclage surgery because of cervical incompetence as they were not suitable for transvaginal cervical cerclage. Both patients successfully maintained their pregnancy until full term after undergoing transabdominal cervicoisthmic cerclage at more than 18 weeks of gestation.

Background/Aim: This study aimed to determine the diagnostic accuracy and postoperative outcomes of early-stage cervical cancer patients [2009 FIGO stages IA2-IB1 (<2 cm)] diagnosed with magnetic resonance (MR)invisible disease or MR-visible disease using the external phased-array receiver. Patients and Methods: Between 2007 and 2014, 110 patients with a FIGO clinical stage IA2-IB1 (<2 cm) cervical cancer underwent primary surgical treatment after external array coil T2W and DW MR imaging following the diagnostic biopsy procedure. Results: The median histological size of MR-invisible vs. MR-visible diagnosis was 3±6.4 mm and 16±5.2 mm. Eighty-five of the 110 patients had histologically residual tumor. The sensitivity, specificity, PPV, and NPV of tumor diagnosis were 63.5%, 92.0%, 96.4%, and 42.6%, respectively. Histological estimates of 54 (49.1%) MR-invisible vs. 56 (50.9%) MR-visible diagnoses were identified as 23 truenegative (TN) and 31 false-negative (FN) vs. 54 true-positive (TP) and 2 false-positive (FP). The recurrence-free rate was 98.1% in the MR-invisible group and 91.1% in the MRvisible group. The overall survival rates were 100% and 92.9%, respectively. Conclusion: A preoperative MRinvisible diagnosis in early-stage cervical cancer patients led to a high probability of FN and was associated with underdiagnosis.In several developed countries, as a result of regular screening programs for pre-cancerous lesions, the incidence rate of cervical cancer has declined by as much as 65% over the past 40 years, and early-stage cervical cancer diagnosis with a small-volume disease is gradually increasing (1, 2).Based on the current guidelines, clinicians recommend colposcopy through the "see and treat" approach for patients who have any abnormal cytology or a positive human papillomavirus (HPV) test in the screening process. If the colposcopic examination reveals an abnormal finding, the patients undergo conization or loop electrosurgical excisional procedure (LEEP).Recent studies have reported that there is no residual disease in the surgical specimens of approximately 62-67% of patients undergoing radical trachelectomy (3). Meanwhile, magnetic resonance (MR)-invisible disease accounts for 25-39% of early stage cervical cancer patients, and 58-86% of patients with MR invisible diagnosis had no residual tumor (4, 5).Either diagnostic or therapeutic LEEP/conization can lead to incomplete excision and residual tumor extending to margins of the specimen (6). Accurate diagnosis of the size of the remaining tumor following LEEP/conization plays a significant role in the pre-operative management of stage IA2-Ib1(<2 cm) cervical cancer patients (2009 FIGO staging) who should be considered for fertility-sparing surgery and less radical hysterectomy (7, 8). Therefore, the discriminating ability of residual disease has become a key prequisite for magnetic resonance imaging (MRI).In theory, the SNR (signal-to-noise ratio) value would be double at 3T MRI compared with that at 1.5T MRI (9, 10).