Carcinoma of the cervix: staging with MR imaging.

Togashi, Kaori; Nishimura, K; Sagoh, T; Minami, S; Noma, Satoshi; Fujisawa, Ichiro; Nakano, Yoshihisa; Konishi, Junji; Okumura, Hiroshi; Konishi, Ikuo

doi:10.1148/radiology.171.1.2928532

Cited by 197 publications

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“…21,22 Some reports have demonstrated the accuracy of MRI in the evaluation of the stage of cervical cancer ranged from 70% to 85%. [23][24][25] These results indicate higher accuracy rate of imaging modality than those of our study. However, a comparative study has reported the accuracy of CT and MRI to be 51% and 75%, respectively in the evaluation of cervical cancer.…”

Section: Discussioncontrasting

confidence: 41%

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

et al. 2008

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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.

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Section: Discussioncontrasting

confidence: 41%

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

et al. 2008

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“…We agreed with their description, and our draft also demonstrated this limitation. The accuracy of cervical mass measured only by MRI was superior to that measured by CT or MRI in previous study [1][2][3][4] as well as the reference which they described. 5 In the subgroup analysis which we have performed after publication, MRI was more accurate than CT for the evaluation of cervical mass in 25 patients who underwent both CT and MRI, even though small number and even without statistically significance (p=0.06).…”

Section: Modalities For Evaluation Of Tumor Size In Cervical Cancermentioning

confidence: 65%

“…4 However, the authors did not mention another study which included the re-analysis of the result of ACRIN 6651/GOG 183 Intergroup study and directly addressed the same issue with the current study. 4 In the study including 172 patients with cervical cancer, MRI is superior to CT and pelvic examination for measuring tumor size using pathologic results as the standard reference. 4 The authors should have explained the discrepancies between the current study and ACRIN 6651/GOG 183 Intergroup study.…”

Section: Modalities For Evaluation Of Tumor Size In Cervical Cancermentioning

confidence: 91%

“…4 In the study including 172 patients with cervical cancer, MRI is superior to CT and pelvic examination for measuring tumor size using pathologic results as the standard reference. 4 The authors should have explained the discrepancies between the current study and ACRIN 6651/GOG 183 Intergroup study. Finally, we recommend a measurement method of tumor size at the time of colposcopic examination.…”

Section: Modalities For Evaluation Of Tumor Size In Cervical Cancermentioning

confidence: 99%

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Modalities for evaluation of tumor size in cervical cancer

et al. 2008

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Lee et al. regarding the value of pelvic examination and imaging modality for the evaluation of tumor size in cervical cancer.1 Using pathologic results as standard reference, the authors compared the accuracy of pelvic examination with that of imaging modalities (CT or MRI) for tumor size measurement. Because the correlation coefficient between pelvic examination and pathologic results was higher than that between imaging modalities and pathologic results, the authors concluded that pelvic examination is superior to imaging modalities for tumor size measurement. However, we have several concerns with respect to the study. First, as shown in Figure 1(B), tumor was not detected by imaging modalities in 21 patients; even an 8 cm-sized tumor was not detected by imaging modalities. We presumed that the undetected tumors of those patients could partially account for poor correlation between imaging modalities and pathologic results. Considering that CT is inferior to MRI in tumor visualization, 2 we think that most of 21 patients might undergo CT alone. Therefore, the causes of insensitive imaging modalities should be addressed. If the insensitivity were due to CT, the result of subgroup analysis that included only patients who underwent MRI has to be presented. Second, in terms of inclusion criteria, only patients with a clinically visible tumor were included in this study. However, the size of tumor can be measured with inspection, palpation, and colposcopic examination (althoughnot specifically addressed). Examiner would be able to measure the tumor size by palpation; hence, it is inappropriate to exclude the patients with a clinically invisible tumor (for example, a tumor located in endocervical canal). The inappropriate exclusion of patients with a clinically invisible tumor accounted for the fact that there were no tumors that were undetected by pelvic examination. Considering that, as we mentioned previously, tumors were undetected by imaging modalities in 21 patients and they presumably accounted for poor correlation between imaging modalities and pathologic results, the inappropriate inclusion criteria could cause a selection bias. In addition, the inappropriate inclusion criteria made the result of this study difficult to apply to patients with an endocervical tumor.Third, in the discussion section, the authors insisted that the accuracy of CT and MRI is overestimated by quoting the result of ACRIN 6651/GOG 183 Intergroup study. 4 However, the authors did not mention another study which included the re-analysis of the result of ACRIN 6651/GOG 183 Intergroup study and directly addressed the same issue with the current study. 4 In the study including 172 patients with cervical cancer, MRI is superior to CT and pelvic examination for measuring tumor size using pathologic results as the standard reference. 4 The authors should have explained the discrepancies between the current study and ACRIN 6651/GOG 183 Intergroup study. Finally, we recommend a measurement method of tumor size at the time of colposcopic exa...

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“…The utility of MR imaging in evaluating uterine cervical cancer before and after treatment has been established, [2][3][4][5] and the usefulness of contrast-enhanced dynamic MR imaging has been reported. [6][7][8] However, the use of gadolinium contrast agents has been associated with nephrogenic systemicˆbrosis (NSF), and their use in patients with advanced uterine cervical cancer carries the risk of hydronephrosis.…”

Section: Discussionmentioning

confidence: 99%

Can MRI Predict Local Control Rate of Uterine Cervical Cancer Immediately after Radiation Therapy?

Tanaka¹,

Ohara²,

Oki³

et al. 2010

magn reson med sci

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Purpose: To evaluate the utility of measuring the volumes of areas of high signal intensity on T 2 -weighted magnetic resonance (MR) images immediately after irradiation for predicting the local control rate of uterine cervical cancer.Materials and Methods: From our departmental database, we identiˆed 109 patients with cervical cancer who underwent MR imaging before irradiation and just before or just after completion of radiation therapy from 1994 to 2007. We included 46 of the 109 patients in this study, 5 patients with local recurrence and 41 patients who were free of disease for more than 2 years. Fifteen received radiation therapy alone, and 28 patients received concurrent chemoradiation therapy. We measured the volumes of areas of high signal intensity involving the uterine cervix on T 2 -weighted MR images before radiation therapy and just before or just after its completion. We measured the 3 orthogonal diameters to calculate the volume as an ellipsoid and evaluated proportional tumor volume and the rate of reduction. We analyzed statistics with Student's t-test.Results: In patients with local recurrence, the mean volume of the areas of high signal intensity on T 2 -weighted MR images just before completion of irradiation therapy or just after was 19.70 cm 3 , which was signiˆcantly larger than that in patients without recurrence (1.77 cm 3 , Pº0.05). The proportional tumor volume was also signiˆcantly larger (Pº 0.05).Conclusions: Although areas of high signal intensity on T 2 -weighted MR images include acute radiation change, their volume and the proportional tumor volume after irradiation can be useful clues in predicting the local control rate of uterine cervical cancer.

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Carcinoma of the cervix: staging with MR imaging.

Cited by 197 publications

References 0 publications

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

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

Modalities for evaluation of tumor size in cervical cancer

Can MRI Predict Local Control Rate of Uterine Cervical Cancer Immediately after Radiation Therapy?

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