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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

European Radiology volume 29, pages 2045–2057 (2019)Cite this article

Abstract

Objectives

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

Methods

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.

Results

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%.

Conclusions

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.

Key Points

• 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.

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Abbreviations

ADCmean :

Apparent diffusion coefficient mean

CR:

Complete response

CRT:

Chemoradiation

DW-MR:

Diffusion-weighted magnetic resonance

FIGO:

International Federation of Gynecology and Obstetrics

FN:

False negative

FP:

False positive

FRFSE:

Fast-recovery fast spin echo

FSE:

Fast spin echo

IVIM:

Intravoxel incoherent motion

LACC:

Locally advanced cervical cancer

maxTD:

Maximum tumor diameters

nCRT:

Neoadjuvant chemoradiotherapy

PACS:

Picture archiving and communication system

pR0:

Absence of any residual tumor

pR1:

Microscopic residual tumor

pR2:

Macroscopic residual tumor

PR:

Partial response

PRICE:

Prospective imaging of cervical cancer and neoadjuvant treatment

RECIST:

Response Evaluation Criteria In Solid Tumors

ROI:

Region of interest

SE:

Spin echo

SPSS:

Statistical Package for the Social Sciences

TN:

True negative

TP:

True positive

TUS:

Transvaginal ultrasound

TV:

Tumor volume

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Funding

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

Author information

Affiliations

  1. Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy

    B. Gui, M. Miccò, A. L. Valentini, F. Cambi & R. Manfredi

  2. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy

    A. L. Valentini, F. Cambi, M. A. Gambacorta & R. Manfredi

  3. STAR Center (Statistics Technology Archiving Research Center), Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy

    T. Pasciuto

  4. Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy

    T. Pasciuto, A. Testa & G. Scambia

  5. Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy

    A. Testa, G. F. Zannoni & G. Scambia

  6. Radioterapia Oncologica, Area Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy

    R. Autorino & M. A. Gambacorta

  7. Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy

    G. F. Zannoni

  8. Medicina Nucleare, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy

    V. Rufini & A. Giordano

  9. Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, 00168, Italy

    V. Rufini & A. Giordano

Authors
  1. B. Gui
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  2. M. Miccò
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  3. A. L. Valentini
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  4. F. Cambi
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  5. T. Pasciuto
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  6. A. Testa
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  7. R. Autorino
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  8. G. F. Zannoni
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  9. V. Rufini
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  10. M. A. Gambacorta
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  11. A. Giordano
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  12. G. Scambia
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  13. R. Manfredi
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Corresponding author

Correspondence to B. Gui.

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Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

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”).

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Gui, B., Miccò, M., Valentini, A.L. et al. 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. Eur Radiol 29, 2045–2057 (2019). https://doi.org/10.1007/s00330-018-5768-5

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  • DOI: https://doi.org/10.1007/s00330-018-5768-5

Keywords

  • Uterine cervical neoplasms
  • Magnetic resonance imaging
  • Chemoradiotherapy
  • Diffusion magnetic resonance imaging
  • Tumor volume