Role of Imaging in Pretreatment Evaluation of Early Invasive Cervical Cancer: Results of the Intergroup Study American College of Radiology Imaging Network 6651–Gynecologic Oncology Group 183

Hricak, Hedvig; Gatsonis, Constantine; Dennis, S.; Amendola, Marco A.; Brandt, Kathy R.; Schwartz, Lawrence H.; Koelliker, Susan; Siegelman, Evan S.; Brown, Jeffrey J.; McGhee, Robert B.; Iyer, Revathy B.; Vitellas, Kenneth M.; Snyder, Bradley S.; Long, Harry J.; Fiorica, James V.; Mitchell, Donald G.

doi:10.1200/jco.2005.02.0354

Cited by 217 publications

(163 citation statements)

References 26 publications

(14 reference statements)

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“…Previous studies have demonstrated that early and advanced stage adenocarcinomas are more aggressive and associated with decreased survival rates (33)(34)(35)(36). However, the present study indicated that the tumor cell type was not significantly associated with prognosis (P=0.5831).…”

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confidence: 91%

Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis

et al. 2015

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Abstract. The aim of the present study was to investigate the prognostic role of a number of clinical factors in advanced cervical cancer patients. Patients (n=157) with stage IIA-IIB cervical cancer treated at four Hallym Medical Centers in South Korea (Hallym University Sacred Heart Hospital; Kangnam Sacred Heart Hospital; Chuncheon Sacred Heart Hospital; and Kangdong Sacred Heart Hospital) between 2006 and 2010 were retrospectively enrolled. Univariate analysis identified significant predictive values in the following eight factors: i) Cancer stage (P<0.0001); ii) tumor size (≤4 vs. 4-6 cm, P=0.0147; and ≤4 vs. >6 cm, P<0.0001); iii) serum squamous cell carcinoma antigen level (≤2 vs. >15 ng/ml; P=0.0291); iv) lower third vaginal involvement (P<0.0001); v) hydronephrosis (P=0.0003); vi) bladder/rectum involvement (P=0.0015); vii) pelvic (P=0.0017) or para-aortic (P=0.0019) lymph node (LN) metastasis detected by imaging vs. no metastasis; and viii) pelvic LN metastasis identified by pathological analysis (P=0.0289). Furthermore, multivariate analysis determined that tumor size (≤4 vs. 4-6 cm, P= 0.0371; and ≤4 vs. >6 cm, P=0.0024) and pelvic LN metastasis determined by imaging vs. no metastasis (P=0.0499) were independent predictive variables. Therefore, tumor size and pelvic LN metastasis measured by imaging were independent predictive factors for the prognosis of advanced cervical cancer. These factors may provide more clinically significant prognostic information compared with the currently used International Federation of Gynecology and Obstetrics staging system.

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confidence: 91%

Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis

et al. 2015

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“…24 Above all, a prospective study with a large sample size has demonstrated that the accuracy of CT and MRI is overestimated in the diagnosis of cervical cancer, with the accuracy of CT and MRI being 42% and 53%, respectively. 26 This result was in accord with that of our study.…”

Section: Discussionsupporting

confidence: 80%

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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“…In studies by Hricak et al and Mitchell et al, in locally advanced cervical cancers, imaging modalities were superior for staging purposes (Hricak et al, 2005;Mitchell et al, 2006;Shirazi et al, 2014). In contrast, clinical staging was found to be more effective in a study by Hancke et al (Hancke et al, 2008).…”

Section: Discussionmentioning

confidence: 88%

Effect of Hydronephrosis on Survival in Advanced Stage Cervical Cancer

Goklu

Seçkin²,

Toğrul³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. Materials and Methods: The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. Results: The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (p < 0.05). There was no significant survival difference between patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (p<0.05). Conclusions: Hydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presence or absence of hydronephrosis.

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Role of Imaging in Pretreatment Evaluation of Early Invasive Cervical Cancer: Results of the Intergroup Study American College of Radiology Imaging Network 6651–Gynecologic Oncology Group 183

Abstract: CT and MRI performed similarly; both had lower staging accuracy than in prior single-institution studies. Accuracy of FIGO clinical staging was higher than previously reported. The temporal data suggest that FIGO clinical staging was influenced by CT and MRI findings.

Cited by 217 publications

References 26 publications

Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis

Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis

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

Effect of Hydronephrosis on Survival in Advanced Stage Cervical Cancer

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