Can radicality of surgery be safely modulated on the basis of MRI and PET/CT imaging in locally advanced cervical cancer patients administered preoperative treatment?

Abstract

BACKGROUND:The goal of this study was to prospectively analyze the diagnostic performances of magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT) in predicting pathologically assessed residual disease in a large, single-institution series of locally advanced cervical cancer (LACC) patients triaged to neoadjuvant treatments followed by radical surgery. METHODS: Between April 2007 and March 2010, 96 patients with histologically documented cervical cancer (any histology) and FIGO stage IB2-IVA were enrolled. MRI and PET/CT were recommended to be performed within 4-6 weeks from the end of treatment, and histology was the reference standard. Sensitivity, specificity, and accuracy were compared using the McNemar test. RESULTS: For residual disease in the cervix, sensitivity was higher for MRI than for PET/CT (86.1% vs 63.1%; P ¼ .002), while specificity was significantly higher for PET/CT compared with MRI (P ¼ .002). There was no difference in accuracy values between the 2 imaging modalities. For MRI analysis of lymph node groups, sensitivity, specificity, and accuracy were 35.7%, 95.9%, and 88.0%, respectively. Conversely, sensitivity, specificity, and accuracy for PET/CT were 28.6%, 97.8%, and 88.7%, respectively. Absence of follicular structures replaced by prevalent sclerosis and/or sinus histiocytosis was the most frequently documented morphological pattern in false-positive cases. CONCLUSION: Neither MRI nor PET/CT accurately detected residual disease in LACC patients triaged to radical surgery after neoadjuvant treatment, disallowing the option of avoiding or modulating completion surgery. Cancer 2012;118:392-403. V C 2011 American Cancer Society.

Optimization of MR Imaging for Pretreatment Evaluation of Patients with Endometrial and Cervical Cancer

“…The use of MR imaging enables a more appropriate triaging of patients to hysterectomy if the tumor is confined to the cervix and < 4 cm in size, or chemo-radiation if tumor size exceeds 4 cm or parametrial invasion is present. Although recent multi-institutional trials have raised concerns about the accuracy of cross-sectional imaging in the staging of early cervical cancer (stage < IIB), MRI still remains the best imaging technique for assessment of tumor size, with a high negative predictive value in excluding parametrial invasion (22-26). …”

Laparoscopic Extrafascial Hysterectomy (Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer: Technical Aspects and Operative Outcomes

“…Therefore, this study confirms previous reported data that MRI cannot accurately predict the presence of RD after primary CRT, disallowing the option of avoiding or modulating completion surgery exclusively based on radiology. 9,19 In this scenario, the exact role of positron emission tomography/CT is also a matter of great discussion. It may be more accurate for the detection of microscopic residual cervical cancer than MRI, but available studies are limited by low numbers of analyzed patients.…”

“…Laparoscopy reduces significant procedure-related morbidity and expedites recovery. 9 Besides, image magnification, proper dissection in critical areas, and lower blood loss are additional advantages. 29 On the other hand, several important oncological concerns have limited the widespread use of laparoscopyVpossible inadequate staging, port-site metastasis, and cancer cell dissemination.…”

“…Unfortunately, different imaging modalities cannot accurately predict RD. 9 The importance of adjuvant hysterectomy aiming to improve local control has been previously investigated with conflicting oncological outcomes. Previous studies are very heterogeneous, including operations of different radicality in association or not with retroperitoneal lymphadenectomy that led to unacceptable rates of complication.…”

Impact of advanced parallel or cloud computing technologies for image guided diagnosis and therapy

“…They proposed an analysis to compare the value of MRI with clinical examination in staging of uterus cervical carcinoma (UCC), which remains the second most commonly diagnosed cancer among female patients and the effective approaches towards UCC rely heavily on the precise pre-surgical staging [5][6][7][8]. The conventional International Federation of Gynecology and Obstetrics (FIGO) system based on clinical examination is being applied worldwide for UCC staging.…”