Value of pelvic examination and imaging modality for the evaluation of tumor size in cervical cancer

Abstract

Objective: The purpose of this study was to compare the accuracy of pelvic examination versus imaging modality such as computed tomography (CT) or magnetic resonance imaging (MRI) in the measurement of the tumor size of invasive cervical carcinoma based on pathologic findings. Methods: Patients with stage Ib-II cervical cancer who underwent primary surgical treatment between January 2003 and December 2005 were evaluated retrospectively. One hundred three consecutive patients aged 24 to 81 years (mean age, 50.6 years), who had not received any treatment previously were included in this study. Accuracy of preoperative CT or MRI versus pelvic examination in the measurement of tumor size was compared based on pathologic findings. All patients were examined and staged clinically by the gynecologic oncologist. Surgery was performed within 2 weeks after imaging studies. The data were analyzed using descriptive statistics. Results: The largest diameter of the tumor measured by pathologic findings was 2.76±1.76 cm. Based on pathologic findings, accuracy was estimated by the degree of agreement with a difference of ＜0.5 or 1.0 cm between the measurements of tumor size obtained by pelvic examination and imaging modality. Pelvic examination and imaging modality had an accuracy of 46.6% and 39.8%, respectively, with a difference of ＜0.5 cm, and an accuracy of 72.8% and 55.3%, respectively, with a difference of ＜1.0 cm. Correlation with pathologic findings was higher for pelvic examination (rs=0.680) than for imaging modality (rs=0.410). In determining the size of tumor mass differentiating ＞4.0 cm from ≤4.0 cm, imaging modality showed higher accuracy than pelvic examination. Conclusion: For the patients with stage Ib to II cervical cancer, pelvic examination is superior to imaging modality with regard to evaluation of the tumor size. However, imaging modality may be accurate for evaluating bulky tumors of cervical cancer.

The potential for less radical surgery in women with stage IA2–IB1 cervical cancer

“…In the present study, tumor size was evaluated during pelvic examination with a low accuracy of 70.5% (with a difference of less than 1.0 cm), similar to a previous report [22]. A smaller tumor size (≤2 cm; postoperative gross measurement) was the only independent favorable factor for both PI and VI for women with stage IA2-IB1 cervical cancer.…”

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

“…It has been demonstrated that the accuracy of pelvic examination in the measurement of primary tumor size of cervical cancer is approximately around 50% with a difference of 0.5 cm 16 and 50% to 72% with a difference of less than 1.0 cm. 16,17 The accuracy of MRI in the measurement of primary tumor size ranged from 39.8% 16 to 70% 18 with a difference of 0.5 cm and 55.3% with a difference of 1.0 cm. 16 In comparison with other studies, we also used the difference of 0.5 or 1.0 cm as an error range to evaluate the measurement accuracy.…”

“…16,17 The accuracy of MRI in the measurement of primary tumor size ranged from 39.8% 16 to 70% 18 with a difference of 0.5 cm and 55.3% with a difference of 1.0 cm. 16 In comparison with other studies, we also used the difference of 0.5 or 1.0 cm as an error range to evaluate the measurement accuracy. The accuracy of MRI in preoperative measurement of the primary tumor size is 39.60% (with error range T0.5 cm) and 61.39% (with error range T1.0 cm), whereas the accuracy of pelvic examination is 24.75% (T0.5 cm) and 43.56% (T1.0 cm), respectively.…”

Parametrial Involvement in FIGO Stage IB1 Cervical Carcinoma: Diagnostic Impact of Tumor Diameter in Preoperative Magnetic Resonance Imaging

“…The reported accuracy of manual examination in determining the cervical tumor diameter is approximately 50%. 12,13 Magnetic resonance imaging (MRI) has been shown to be useful in the assessment of tumor diameter in patients with cervical carcinoma, with an accuracy of 83% to 93%, and recently, its use in preoperative evaluation has become more and more common in the practice of gynecologic oncology. 14Y18 Although several previous studies addressed the correlation between tumor diameter and other pathological prognostic factors, and other studies utilized MRI as an adjunct to the preoperative staging by manual examination, there have been no previous studies directly addressing the association between the tumor diameters measured preoperatively using MRI and other prognostic factors evaluated with postsurgical pathological examination.…”