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Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016

European Radiology volume 28, pages 530–541 (2018)Cite this article

Abstract

Objective

To review the diagnostic performance of MRI for detection of parametrial invasion (PMI) in cervical cancer patients.

Methods

MEDLINE and EMBASE databases were searched for studies providing diagnostic performance of MRI for detecting PMI in patients with cervical cancer. Studies published between 2012 and 2016 using surgico-pathological results as reference standard were included. Study quality was evaluated using QUADAS-2. Sensitivity and specificity of all studies were calculated. Results were pooled and plotted in a hierarchical summary receiver operating characteristic plot. Meta-regression and subgroup analyses were performed.

Results

Fourteen studies (1,028 patients) were included. Study quality was generally moderate. Pooled sensitivity was 0.76 (95% CI 0.67–0.84) and specificity was 0.94 (95% CI 0.91–0.95). The possibility of heterogeneity was considered low: Cochran’s Q-test (p = 0.471), Tau2 (0.240), Higgins I2 (0%). With meta-regression analysis, magnet strength, use of DWI, and antispasmodic drugs were significant factors affecting heterogeneity (p < 0.01). Subgroup analysis for studies solely using radical hysterectomy as reference standard yielded pooled sensitivity and specificity of 0.73 (95% CI 0.60–0.83) and 0.93 (95% CI 0.90–0.95), respectively.

Conclusions

MRI shows good performance for detection of PMI in cervical cancer. Using 3-T scanners and DWI may improve diagnostic performance.

Key Points

• MRI shows good performance for detection of parametrial invasion in cervical cancer.

• Subgroup of studies using only radical hysterectomy showed consistent results.

• Using 3-Tesla scanners and diffusion-weighted imaging may improve diagnostic performance.

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Abbreviations

CE:

Contrast-enhanced

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

FIGO:

Federation of Gynecology and Obstetrics

FSE:

Fast spine echo

HSROC:

Hierarchical summary receiver operating characteristic

MRI:

Magnetic resonance imaging

PMI:

Parametrial invasion

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

SE:

Spin echo

TSE:

Turbo spin echo

T2WI:

T2-weighted imaging

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Author information

Author notes

  1. Sungmin Woo and Chong Hyun Suh contributed equally to this paper.

Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Sungmin Woo, Sang Youn Kim, Jeong Yeon Cho & Seung Hyup Kim

  2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea

    Chong Hyun Suh

  3. Department of Radiology, Namwon Medical Center, 365, Chungjeong-ro, Namwon-si, Jeollabuk-do, 590-702, Republic of Korea

    Chong Hyun Suh

  4. Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 110-744, Republic of Korea

    Jeong Yeon Cho & Seung Hyup Kim

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  1. Sungmin Woo
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Correspondence to Sang Youn Kim.

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Guarantor

The scientific guarantor of this publication is Sang Youn Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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The authors state that this work has not received any funding.

Statistics and biometry

One of the authors (Chong Hyun Suh) has significant statistical expertise.

Informed consent

Written informed consent was not required for this study due to the nature of the study, which was a systematic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required for this study due to the nature of the study, which was a systematic review and meta-analysis.

Methodology

• Meta-analysis

• Multicentre study

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Woo, S., Suh, C.H., Kim, S.Y. et al. Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016. Eur Radiol 28, 530–541 (2018). https://doi.org/10.1007/s00330-017-4958-x

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  • DOI: https://doi.org/10.1007/s00330-017-4958-x

Keywords

  • Cervical cancer
  • Magnetic resonance imaging
  • Meta-analysis
  • Parametrial invasion
  • Systemic review