Uterine Cervical Malignancy: Diagnostic Accuracy of MRI with Histopathologic Correlation

Abstract

Objective:Cervical cancer is the third most common malignancy in women worldwide. Accurate staging of the disease is crucial in planning the optimal treatment strategy. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in the assessment of extension and staging of cervical malignancy in correlation with histopathologic examination.Materials and Methods:Thirty females with untreated pathologically proven uterine cervical carcinoma were included in this prospective study. The patients were 40 - 65 years of age and their average age was 45 years. All patients were subjected to routine clinical staging workup and underwent MRI for preoperative staging. Preoperative MRI findings were reviewed and compared with the final pathological staging that is the Gold Standard of reference.Results:Histopathologic examination established that of the 30 tumors, 22 (73.3%) were squamous cell carcinoma. According to the International Federation of Gynecology and Obstetrics (FIGO) staging criteria, 2/30 patients (6.6%) were stage IB, 12/30 (40.3%) were IIA, 8/30 were IIB (26.6%), and 8/30 (26.6%) were IVA. MRI had a sensitivity of 100% and specificity 85.7% in the detection of parametrial infiltration, and a sensitivity of 100% and specificity of 90% in the detection of vaginal infiltration. It was sensitive (100%) and specific (100%) in detecting tumor extension to the stroma, urinary bladder, and rectum. Pathological examination demonstrated stage IB cervical carcinoma in 2/30 patients (6.6%), stage IIA disease in 10/30 patients (33.3%), stage IIB in 6/30 patients (20%), and stage IV disease in 8/30 patients (26.6%). MRI features demonstrated stage IB in 2/30 patients (6.6%), stage IIA disease in 12/30 patients (40%), stage IIB in 8/30 patients (26.6%), and stage IV disease in 8/30 patients (26.6%). MRI staging of cervical carcinoma was in concordance with histopathologic staging in stages IB and IVA and over-staging in IIA and IIB stages.Conclusion:MRI is an optimal non-invasive modality for preoperative staging of uterine cervical malignancy, and crucial in subsequent more accurate treatment planning.

Monitoring treatment response in patients undergoing chemoradiotherapy for locally advanced uterine cervical cancer by additional diffusion‐weighted imaging: A systematic review

“…A systematic review of 57 single‐institution studies showed a sensitivity of 74% for detecting parametrial invasion and 75% for both detecting bladder and rectal invasion . Several recent studies even showed sensitivity values up to 100% for the detection of parametrial infiltration, vaginal infiltration, tumor extension to the stroma, urinary bladder invasion, and rectum invasion . Therefore, MRI is widely used for initial local staging of uterine cervical cancer .…”

“…3 Several recent studies even showed sensitivity values up to 100% for the detection of parametrial infiltration, vaginal infiltration, tumor extension to the stroma, urinary bladder invasion, and rectum invasion. 4,5 Therefore, MRI is widely used for initial local staging of uterine cervical cancer. 6,7 MRI is also increasingly used for monitoring treatment response in patients with advanced cervical cancer undergoing chemoradiotherapy.…”

The Role of Magnetic Resonance Imaging in Pretreatment Evaluation of Early-Stage Cervical Cancer

“…9,10 More and more studies are focusing on management of low-risk early-stage cervical cancer in which tumor size is an important criterion. 11,12 Therefore, accurate preoperative evaluation of tumor size is very important. Although many studies have compared the staging of MRI to clinical examination, few of them evaluated their accuracy of tumor size measurement.…”

Effect of Chemotherapy Bleomycin, Vincristin, Mitomycin and Carboplatin by Tumor Mass and Infiltration Parametrial for Cervical Cancer Patients: Case Study in Sanglah General Hospital, Denpasar

“…16 Adanya perbedaan infiltrasi tumor/ kanker ke parametrium sebelum dan sesudah kemoterapi merupakan faktor penting dalam evaluasi pra-operasi pada kanker serviks yang secara signifikan dapat memengaruhi stadium penyakit dan pengobatan. 17 Peningkatan maupun penurunan %CFS digunakan oleh klinisi di RSUP Sanglah untuk mengevaluasi suatu keberhasilan atau ketidakberhasilan dari sebuah kemoterapi. Peningkatan %CFS setelah adanya pemberian kemoterapi menunjukkan suatu keberhasilan terapi dan sebaliknya, kegagalan kemoterapi diindikatorkan oleh terdapatnya penurunan atau tidak adanya perubahan %CFS setelah kemoterapi diberikan.…”