Uro-Genital Radiology/Radiologia Uro-Genitale

La radiologia medica

, Volume 114, Issue 6, pp 960-975

First online:

Localized cervical cancer (stage <IIB): accuracy of MR imaging in planning less extensive surgery

  • R. ManfrediAffiliated withDepartment of Radiology, University of Verona Email author 
  • , B. GuiAffiliated withDepartment of Bioimages and Radiological Sciences, “A. Gemelli” University Hospital
  • , A. GiovanzanaAffiliated withDepartment of Radiology, University of Verona
  • , S. MariniAffiliated withDepartment of Radiology, University of Verona
  • , M. Di StefanoAffiliated withDepartment of Obstetrics and Gynecology, “A. Gemelli” University Hospital
  • , G. ZannoniAffiliated withDepartment of Pathology, “A. Gemelli” University Hospital
  • , G. ScambiaAffiliated withDepartment of Obstetrics and Gynecology, “A. Gemelli” University Hospital
  • , L. BonomoAffiliated withDepartment of Radiology, University of Verona

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Abstract

Purpose

This study was undertaken to determine the accuracy of magnetic resonance (MR) imaging in the preoperative staging of patients with clinically localised cervical cancer eligible for less extensive surgery.

Materials and methods

Fifty-three patients with biopsy-proven carcinoma of the uterine cervix and eligible for conservative surgery prospectively underwent MR imaging. Images were assessed for tumour site and size, infiltration of the cervical stroma, infiltration of vaginal fornices and relationship between the tumour and the internal os of the endocervical canal and the presence and dimensions of pelvic and lumboaortic lymph nodes (cutoff values 1 cm and 0.5 cm minimum axial diameter). MR imaging data were compared with the histopathological findings.

Results

The endocervix was the site of origin of 25% (13/53) of the cervical tumours and the exocervix the site of origin of 75% (40/53). In the assessment of cervical stroma infiltration, there was agreement between MR imaging and histopathology in 75% of cases. MR imaging had 67% sensitivity, 92% specificity and 91% diagnostic accuracy in assessing infiltration of the vaginal fornices. In the evaluation of the infiltration of the internal os, MR imaging had 86% sensitivity, 93% specificity and 92% accuracy. In the assessment of the lymph nodes, when using a cutoff value of 1 cm, MR imaging had a sensitivity, specificity and diagnostic accuracy of 28%, 100% and 89%, respectively. With a cutoff value of 0.5 cm, MR imaging had a sensitivity, specificity and diagnostic accuracy of 33%, 92% and 83%, respectively.

Conclusions

MR imaging had a high level of accuracy in the preoperative assessment of the extent of cervical tumour in patients eligible for conservative surgery. Accuracy is lower in the evaluation of the pelvic and lumboaortic lymph nodes.

Keywords

Uterine neoplasms Cervical cancer Magnetic resonance imaging Staging

Carcinoma della cervice uterina localizzato (stadio<IIB): accuratezza della RM nella pianificazione di una chirurgia meno estesa

Riassunto

Obiettivo

Valutare l’accuratezza della RM nella stadiazione pre-operatoria delle neoplasie localizzate della cervice uterina, candidate ad una chirurgia meno aggressiva.

Materiali e metodi

Sono state sottoposte ad esame RM 53 pazienti con carcinoma della cervice uterina confermato istologicamente, candidate a chirurgia conservativa. L’analisi delle immagini ha compreso: localizzazione e dimensioni del tumore, infiltrazione dell’anello stromale, infiltrazione dei fornici vaginali ed estensione oltre l’orifizio uterino interno, presenza e dimensioni di linfonodi pelvici o lombo-aortici (valore soglia 1 cm e 0,5 cm di diametro assiale minimo). I risultati sono stati confrontati con quelli istopatologici.

Risultati

Nella valutazione dell’infiltrazione dello stroma cervicale vi è stata una concordanza RM/istopatologia in 40/53 (75%) casi. Nella valutazione dell’infiltrazione dei fornici vaginali la RM ha riportato una sensibilità del 67%,una specificità del 92% ed un’accuratezza diagnostica del 91%; nella valutazione dell’estensione oltre l’orifizio uterino interno dell’ 86%, 93% e 92%, rispettivamente. Nella valutazione dei linfonodi la RM ha riportato una sensibilità, specificità ed accuratezza diagnostica del 28%, 100% e 89%, usando come valore soglia 1 cm; e del 33%, 92% e 83%, con un valore soglia di 0,5 cm.

Conclusioni

La RM ha dimostrato un’elevata accuratezza nella valutazione pre-operatoria dell’estensione (T) tumorale in pazienti candidate ad intervento chirurgico conservativo. L’accuratezza è minore nella valutazione dei linfonodi pelvici e lombo-aortici.

Parole chiave

Neoplasie dell’utero Carcinoma della cervice Risonanza magnetica Stadiazione