Transrectal ultrasound in the evaluation of cervical carcinoma and comparison with spiral computed tomography and magnetic resonance imaging

Abstract

38 women with biopsy proven untreated cervical carcinoma were prospectively studied with transrectal ultrasound (TRUS), spiral computed tomography (SCT) and magnetic resonance imaging (MRI). 20 women had radical hysterectomy and pelvic lymphadenectomy with detailed histological evaluation of the parametra. The echographic features of cervical carcinoma on TRUS are a hypoechoic (60%) or isoechoic (40%) (relative to normal uterine muscle/cervical stroma), poorly defined mass lesion with indistinct margins in an enlarged cervix. This relatively high percentage of isoechoic tumours and relative lack of contrast resolution may pose a problem in the identification of some tumours, and to our knowledge has not been previously reported. Further limitations of TRUS are in the evaluation of advanced cervical cancer, due to bulky tumours rendering poor access to the parametrium and pelvic sidewall. The overall accuracy in staging of early cervical cancer (less than stage 2b) was 85% for examination under anaesthesia (EUA), 75% for TRUS, 65% for MRI and 50% for SCT. The positive predictive value in evaluating the parametra in this group of patients was also lower for SCT (14%) and MRI (33%) compared with TRUS (100%). In the evaluation of advanced cervical cancer (stage 2b or higher), there was poor correlation between TRUS and EUA, with MRI showing the best correlation with EUA. We conclude that SCT is inferior to both TRUS and MRI in the staging of early stage cervical cancer.

Transrectal ultrasound and magnetic resonance imaging in the evaluation of tumor size following neoadjuvant chemotherapy for locally advanced cervical cancer

“…Several workers have documented the accuracy of transrectal or transvaginal sonography and MRI in early cervical cancer staging. Yang et al reported on the accuracy of staging in a group of 38 patients, comparing results achieved by examination under anesthesia, TRUS, MRI and spiral computed tomography; however, only 20 patients in this study underwent primary surgery. The overall accuracy in staging of early cervical cancer (less than Stage IIB) was 85% for examination under anesthesia, 75% for TRUS, 65% for MRI and 50% for spiral computed tomography.…”

“…Yang et al reported on the accuracy of staging in a group of 38 patients, comparing results achieved by examination under anesthesia, TRUS, MRI and spiral computed tomography; however, only 20 patients in this study underwent primary surgery. The overall accuracy in staging of early cervical cancer (less than Stage IIB) was 85% for examination under anesthesia, 75% for TRUS, 65% for MRI and 50% for spiral computed tomography. The largest cohort published so far, including 95 women, assessed the accuracy of TRUS and MRI in the measurement of the extent of cervical cancer by comparing it with the final histology.…”

“…Magnetic resonance imaging (MRI) is considered the gold standard for assessing local spread of the disease. Comparable accuracy of MRI and transrectal ultrasound (TRUS) or transvaginal ultrasound has been documented in the detection of cervical tumors and in tumor‐size measurement. However, the accuracy of staging after NACT has been evaluated in only a few studies, with limited numbers of cases for both MRI and ultrasound.…”

MRI-based pre-planning in patients with cervical cancer treated with three-dimensional brachytherapy

“…With the introduction of a CT/MRI-based target concept, it is now possible to move from a 2D (using X-ray with prescription to the point A) to a 3D target definition and dose optimisation. Although CT imaging is sufficient for definition of OAR (rectum, bladder, sigmoid), it does not provide information about the tumour topography or the distinction between the uterine cervix and corpus [24,[26][27][28][29]. Recently, 3D MRI-guided brachytherapy has been introduced into clinical practice.…”

Author's reply: Laparoscopic resection of advanced colorectal cancer (Br J Surg 2011; 98: 427–430)

“…FIGO8 recommends a clinical staging system, even though the accuracy is suboptimal when compared with surgical and pathological data. Although ultrasound examination is not included in the FIGO clinical staging system, ultrasound examination is gaining interest because it has been reported to have a diagnostic accuracy similar to that of magnetic resonance imaging (MRI) on local extension of the disease9–13. Ultrasound examination is less time consuming, requires no preparation of the patient, is cheaper and is more widely available than is MRI.…”