Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report.

Abstract

Aims: The aim of this study was to evaluate the use of pre and post-therapy transrectal and transvaginal ultrasonography (TRUS, TVUS) with contrast enhancement and strain elastography compared with clinical examination and magnetic resonance imaging (MRI) in the assessment of advanced stage cervical cancer. Material and methods: This was a prospective study, carried out over a period of nine months on subjects with advanced-stage cervical cancer (stage ≥IIB). All included patients were examined clinically and underwent abdomino-pelvic contrast enhanced MRI and multimodal US examinations (TRUS with strain elastography and contrast enhanced TVUS) at the time of diagnosis and after radiochemotherapy. Tumor size and staging at TRUS and TVUS was compared with the same data obtained by clinical examination and MRI. Pathology was the golden standard. Results: Eight patients accomplished the inclusion criteria. In five cases the tumor stage was identical on clinical and MRI examinations. In all cases parametrial infiltration was diagnosed by all pre-treatment examinations. No significant differences were observed in tumor size between clinical, US and MRI exams either at baseline or post-therapy, in native or post-contrast examinations. The size of the tumor evaluated pre-treatment proved to be significantly smaller post-contrast in both US and MRI examinations compared with the native images. Post-therapy, no significant differences were observed on US measured tumor dimensions when comparing native with post-contrast images. Oppositely, significant smaller dimensions were observed on post-contrast MRI compared with native scans. Conclusions: TRUS is accurate in the estimation of pre-therapy cervical cancer dimension. The post therapy tumor evaluation is better performed with MRI. The use of intravenous contrast agents on both examinations did not improved the accuracy of tumor evaluation pre-or post-therapy.

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery

“…These results seem to confirm that contrast evaluation of the irradiated cervix is non‐specific, as contrast uptake may occur both in residual tumor and in post‐treatment normal tissue. This was also confirmed in a small series by Csutak et al ,. in which ultrasound assessment with contrast agents after treatment did not appear to be useful in predicting pathological response.…”

“…These results seem to confirm that contrast evaluation of the irradiated cervix is non-specific, as contrast uptake may occur both in residual tumor and in post-treatment normal tissue. This was also confirmed in a small series by Csutak et al 25 , in which ultrasound assessment with contrast agents after treatment did not appear to be useful in predicting pathological response. The only parameter that differed significantly between our two groups at both baseline and early examinations was VI, which was higher in patients who went on to have a complete response compared with those who had a partial response.…”

“…There are few data in the literature assessing the role of ultrasound examination in the evaluation of tumor behavior during neoadjuvant treatment. The use of two‐dimensional (2D) ultrasound and three‐dimensional (3D) power Doppler, as well as contrast enhancement using SonoVue (sulphur hexafluoride microbubbles), has been investigated in cervical cancer, but their ability to predict pathological response in locally advanced cervical cancer has not yet been investigated.…”

Application of transrectal ultrasound in guiding interstitial brachytherapy for advanced cervical cancer

“…MRI can also determine this plane, and the distances of the needles can be measured to obtain M1-M4. Compression of the rectal probe during ultrasound scan and changes in body position during MRI can affect the consistency of the two sets of data; however, the effects are small, with the results of this study showing high levels of consistency between D1-D4 and M1-M4 [25,26,27].…”

The assessment of spectral Doppler parameters in uterine arteries of patients with locally advanced squamous cell cervical cancer

“…Transvaginal ultrasound (TVUS) and transrectal ultrasound (TRUS) are cost-efficient diagnostic tools, characterized with high specificity and moderate sensitivity in evaluating parametrial involvement in cervical cancer patients [15][16][17][18][19]. Fischerova et al claimed that ultrasounds are superior to MRIs, as it enables to accurately predict parametrial infiltration in cervical cancer patients.…”