Utility of 3T MRI in Women with IB1 Cervical Cancer in Determining the Necessity of Less Invasive Surgery

Abstract

Purpose: Cervical cancer that is invisible on magnetic resonance imaging (MRI) may suggest lower tumor burden than physical examination. Recently, 3 tesla (3T) MRI has been widely used prior to surgery because of its higher resolution than 1.5T MRI. The aim was to retrospectively evaluate the utility of 3T MRI in women with early cervical cancer in determining the necessity of less invasive surgery. Materials and methods: Between January 2010 and December 2015, a total of 342 women with FIGO stage IB1 cervical cancer underwent 3T MRI prior to radical hysterectomy, vaginectomy, and lymph node dissection. These patients were classified into cancer-invisible (n = 105) and cancer-visible (n = 237) groups based on the 3T MRI findings. These groups were compared regarding pathologic parameters and long-term survival rates. Results: The cancer sizes of the cancer-invisible versus cancer-visible groups were 11.5 ± 12.2 mm versus 30.1 ± 16.2 mm, respectively (p < 0.001). The depths of stromal invasion in these groups were 20.5 ± 23.6% versus 63.5 ± 31.2%, respectively (p < 0.001). Parametrial invasion was 0% (0/105) in the cancer-invisible group and 21.5% (51/237) in the cancer-visible group (odds ratio = 58.3, p < 0.001). Lymph node metastasis and lymphovascular space invasion were 5.9% (6/105) versus 26.6% (63/237) (5.8, p < 0.001) and 11.7% (12/105) versus 40.1% (95/237) (5.1, p < 0.001), respectively. Recurrence-free and overall 5-year survival rates were 99.0% (104/105) versus 76.8% (182/237) (p < 0.001) and 98.1% (103/105) versus 87.8% (208/237) (p = 0.003), respectively. Conclusions: 3T MRI can play a great role in determining the necessity of parametrectomy in women with IB1 cervical cancer. Therefore, invisible cervical cancer on 3T MRI will be a good indicator for less invasive surgery.

Invisible cervical cancers on MRI: Can the type of histology (SCC versus non-SCC) influence surgical planning?

“…Cervical cancer that is not visible on MRI strongly suggests a lower tumor volume compared to those that are visible on MRI (1)(2)(3). Therefore, tumor invasion of the parametrium or vagina is extremely rare in invisible cervical cancer.…”

“…Previously reported studies showed that postoperative outcomes were good when Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer was not visible on preoperative magnetic resonance imaging (MRI) (1)(2)(3). This cancer has a much lower tumor burden than those visible on MRI.…”

Special Issue: “Management of Early Stage Cervical Cancer”

“…They showed that patients with a non-visible tumor had more favorable characteristics in terms of histological features and oncological outcomes compared with patients with visible tumors, suggesting how preoperative imaging may guide surgical radicality. Interestingly, they reported a significant difference in the number of squamous cell carcinomas (SCCs) versus non-SCCs between the two groups that, on the one hand, may have affected the oncological outcomes, but on the other hand, may suggest different MRI characteristics according to the histological type [ 3 ].…”