Preoperative imaging in patients undergoing trachelectomy for cervical cancer: validation of a combined T2- and diffusion-weighted endovaginal MRI technique at 3.0 T

Gynecol Oncol. 2014 May;133(2):326-32. doi: 10.1016/j.ygyno.2014.02.026. Epub 2014 Feb 26.

Abstract

Aim: The aim of this study is to validate high-resolution endovaginal T2- and diffusion-weighted MRI measurements (tumour size, volume and length of uninvolved cervical canal) against histology in patients undergoing trachelectomy.

Patients/interventions: 55 consecutive patients 25-44 years with cervical cancer being considered for trachelectomy were prospectively assessed with endovaginal T2-W and diffusion-weighted MRI. Two independent observers blinded to histology recorded maximum tumour dimension, volume and distance from the superior aspect of the tumour to the internal os. Following trachelectomy, pathologist-outlined tumour sections were photographed with a set scale and similar measurements were recorded.

Results: Fifteen of 45 patients subsequently treated with fertility-sparing surgery had residual tumour (median histological volume: 0.28 cm(3), IQR=0.14-1.06 cm(3)). Sensitivity, specificity, positive and negative predictive values for detecting tumour: Observer 1: 86.7%, 80.0%, 68.4%, and 92.3%, respectively; Observer 2: 86.7%, 90.0%, 81.0%, and 93.1%, respectively. Size and volume correlated between observers (r=0.96, 0.84, respectively, p<0.0001). Size correlated between each observer and histology (observer 1 r=0.91, p<0.0001; observer 2 r=0.93, p<0.0001), volume did not (observer 1: r=0.08, p=0.6; observer 2: r=0.21, p=0.16); however, differences between observer measurements and histology were not significant (size p=0.09, volume p=0.15). Differences between MRI and histology estimates of endocervical canal length were not significant (p=0.1 both observers).

Conclusion: In subcentimetre cervical cancers, endovaginal MRI correlates with pathology and is invaluable in assessing patients for fertility-sparing surgery.

Keywords: Cervical cancer; Endovaginal; Fertility-sparing; MRI; Trachelectomy; Volume.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Carcinoma / diagnosis
  • Carcinoma / pathology*
  • Carcinoma / surgery
  • Cervix Uteri / pathology*
  • Cervix Uteri / surgery
  • Cohort Studies
  • Diffusion Magnetic Resonance Imaging / methods
  • Female
  • Fertility Preservation / methods
  • Humans
  • Hysterectomy / methods*
  • Magnetic Resonance Imaging / methods*
  • Organ Sparing Treatments / methods
  • Preoperative Care
  • Sensitivity and Specificity
  • Tumor Burden
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery