Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery—the “PRICE“ study 2: role of conventional and DW-MRI
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To assess the diagnostic performance of conventional and DW-MRI parameters in the detection of residual tumor in locally advanced cervical cancer (LACC) patients treated with neoadjuvant chemoradiotherapy (nCRT) and radical surgery
Between October 2010 and June 2014, 88 patients with histologically documented cervical cancer (FIGO stage IB2–IVA) were prospectively included in the study. Maximum tumor diameters (maxTD), tumor volume (TV), DWI signal intensity (SI), and ADCmean were evaluated at MRI after nCRT. Histology was the reference standard. Treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, χ2, and Fisher’s exact tests. ROC curves were generated for variables to evaluate diagnostic ability to predict PR and to determine the best cutoff value to predict PR. For each diagnostic test, sensitivity, specificity, and accuracy were calculated.
TV and maxTD were significantly smaller in the CR than in the PR group (p < 0.001; p = 0.001) and showed, respectively, sensitivity of 68.8%, specificity of 72.5%, and accuracy of 70.5% and of 47.9, 87.5, and 65.9% in predicting PR. High DWI SI was more frequent in the PR (81.8%) than in the CR group (55.3%) (p < 0.009). ADCmean was higher in the CR (1.3 × 10-3 mm2/s, range 0.8–1.6 × 10-3 mm2/s) than in the PR group (1.1 × 10-3 mm2/s; range 0.7–1.8 × 10-3 mm2/s) (p < 0.018). High DWI SI showed sensitivity, specificity, and accuracy of 81.8, 44.7, and 64.6% in predicting PR. The ADCmean measurement increased sensitivity, specificity, and accuracy to 75.0, 76.2, and 75.4%.
Conventional and DW-MRI is useful for predicting PR after nCRT in LACC. The ADCmean value ≤ 1.1 × 10-3 mm2/s was the best cutoff to predict PR.
• Conventional and DW-MRI is useful for predicting PR after nCRT in LACC.
• The combination of T2 sequences, DW-MRI, and the quantitative measurement of ADC mean showed the best results in predicting pathological PR.
• The best cutoff for predicting pathological PR was ADCmeanvalue ≤ 1.1 × 10-3 mm2/s.
KeywordsUterine cervical neoplasms Magnetic resonance imaging Chemoradiotherapy Diffusion magnetic resonance imaging Tumor volume
Apparent diffusion coefficient mean
Diffusion-weighted magnetic resonance
International Federation of Gynecology and Obstetrics
Fast-recovery fast spin echo
Fast spin echo
Intravoxel incoherent motion
Locally advanced cervical cancer
Maximum tumor diameters
Picture archiving and communication system
Absence of any residual tumor
Microscopic residual tumor
Macroscopic residual tumor
Prospective imaging of cervical cancer and neoadjuvant treatment
Response Evaluation Criteria In Solid Tumors
Region of interest
Statistical Package for the Social Sciences
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Anna Lia Valentini.
Conflict of interest
The authors declare that they have no competing interests.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in three other articles. Two of these studies analyze exclusively US parameters (“Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study: the role of ultrasound” and “Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study 2: the role of ultrasound after chemoradiation to assess residual tumor”). The third study analyzes the role of DW-MRI in the early prediction of tumor response (“The PRICE study: the role of conventional and diffusion-weighted magnetic resonance imaging in assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery”).
• Diagnostic or prognostic study
• Performed at one institution
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