Identifying a low-risk group for parametrial involvement in microscopic Stage IB1 cervical cancer using criteria from ongoing studies and a new MRI criterion

Abstract

BackgroundThere are currently three ongoing studies on less radical surgery in cervical cancer: ConCerv, GOG-278, and SHAPE. The aim of this study was to evaluate the performance of the criteria used in ongoing studies retrospectively and suggest a new, simplified criterion in microscopic Stage IB1 cervical cancer.MethodsA retrospective analysis was performed in 125 Stage IB1 cervical cancer patients who had no clinically visible lesions and were allotted based on microscopic findings after conization. All patients had magnetic resonance imaging (MRI) after conization and underwent type C2 radical hysterectomy. We suggested an MRI criterion for less radical surgery candidates as patients who had no demonstrable lesions on MRI. The rates of parametrial involvement (PMI) were estimated for patients that satisfied the inclusion criteria for ongoing studies and the MRI criterion.ResultsThe rate of pathologic PMI was 5.6% (7/125) in the study population. ConCerv and GOG-278 identified 11 (8.8%) and 14 (11.2%) patients, respectively, as less radical surgery candidates, and there were no false negative cases. SHAPE and MRI criteria identified 78 (62.4%) and 74 (59.2%) patients, respectively, as less radical surgery candidates; 67 patients were identified as less radical surgery candidates by both sets of criteria. Of these 67 patients, only one had pathologic PMI with tumor emboli.ConclusionsThis study suggests that the criteria used in three ongoing studies and a new, simplified criterion using MRI can identify candidates for less radical surgery with acceptable false negativity in microscopic Stage IB1 disease.

Pretreatment risk factors for parametrial involvement in FIGO stage IB1 cervical cancer

“…Lee et al [ 27 ] focused on patients with microscopic stage IB1 disease, namely, the cancer can be seen only with a microscope. They suggested a unique criterion for less radical surgery, as patients with no demonstrable lesions on postconization MRI in microscopic stage IB1 cervical cancer [ 27 ]. The rate of PI was 1.4% (1/74) for invisible tumors on MRI and 11.8% (6/51) for MRI-visible tumors.…”

Practice guidelines for management of cervical cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

“…For a patient with early staged cervical cancer, nerve-sparing radical hysterectomy is an option (2C). In addition, less radical surgery like type 1 hysterectomy may offer a treatment option for carefully selected patients with lesions less than 2 cm in diameter that have no parametrial and nodal involvement (2D) [ 22 23 ].…”

Diagnostic Performance of MRI for Assessing Parametrial Invasion in Cervical Cancer: A Head-to-Head Comparison between Oblique and True Axial T2-Weighted Images

“…First, tumor size appeared to be a major predictor of PMI, as has been consistently reported in the literature. Several size thresholds, including 2, 2.5, and 4 cm, have been suggested for identifying a low-risk group for PMI (141819). In our study, in the subgroup of 33 patients with a tumor sized ≤ 2.5 cm on MRI, only one patient experienced PMI.…”