The Diagnostic Accuracy and Postoperative Outcomes of Cervical Cancer Patients for MR-invisible or MR-visible Diagnosis of Combined T2- and Diffusion-weighted 3T MRI Using the External Phased-array Receiver

Abstract

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).

Diagnosis Value of Colposcope Combined with Serum Squamous Cell Carcinoma Antigen, Carbohydrate Antigen 125, and Carcinoembryonic Antigen for Moderate to Advanced Cervical Cancer Patients Treated with Modified Fuzheng Peiyuan Decoction

“…e SCC-Ag content in the serum of patients with advanced cervical cancer is higher than that in patients of the early stage, indicating that it is increasing with the malignant progression of cervical lesions and the advancement of specific stage [20]. CA125 and CEA are two common serum tumor markers, the content of which is significantly elevated in many cancers, such as epithelial ovarian cancer, carcinoma of fallopian tube, and lung cancer, and related reports have indicated [21,22] that high levels of CA125 and CEA have important reference values in the diagnosis and prognosis of cervical cancer. e results of this study showed that patients exhibited significant decreases in all serum markers after treatment with the modified Fuzheng Peiyuan decoction, indicating that As a noninvasive diagnostic modality, colposcopy can observe color, vascular structure, and morphological structure of the abnormal parts of the cervix in patients in many ways, but not the lesions in the cervical canal, resulting in poor diagnostic results.…”

Useful MRI Findings for Minimally Invasive Surgery for Early Cervical Cancer

“…Accordingly, even though cervical cancer is stage IB1 based on physical examination, radical parametrectomy is not necessary if the tumor is not visible on MRI (Figure 1). Roh et al reported that an MRI-invisible diagnosis in early-stage cervical cancer patients was associated with a high probability of a false negative result and was associated with underdiagnosis [41]. Invisible cancer on MRI does not indicate absent cancer but rather a small tumor volume [14].…”

“…Invisible cancer on MRI does not indicate absent cancer but rather a small tumor volume [14]. Among patients with invisible cancers on MRI, approximately 50% have no residual tumor, and the other 50% have small residual tumors ranging in size from 4-5 mm [14,41]. Accordingly, minimally invasive surgery is indicated for cervical cancers that are invisible on MRI.…”

“…Residual cancer indicates invasive cervical cancer with an original tumor size greater than 5 mm. Small residual tumor of 5 mm or less is invisible or hard to detect on MRI [14,41]. Therefore, no residual tumor on post-conization MRI indicates a much lower tumor burden but not histological negativity [14,29].…”

“…Therefore, no residual tumor on post-conization MRI indicates a much lower tumor burden but not histological negativity [14,29]. Even though many early cervical cancers are not seen on post-conization MRI, there are small residual cancers with a mean size of approximately 5 mm on hysterectomy specimens [14,41]. For this reason, small cancers at the exocervix are frequently invisible on post-conization MR images.…”